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A Prospective Randomized Controlled Trial Assessing the Use of Aerosolized Intraperitoneal Bupivacaine in Reducing Postoperative Pain in Children Undergoing Laparoscopic Surgery: Preliminary Results
Brian J. Minnillo, MD, Frank J. Penna, MD, Constance S. Houck, MD, Petra M. Meier, MD, Andres D. Silva, MD, Drew A. Freilich, MD, Hiep T. Nguyen, MD
Children's Hospital Boston, Boston, MA, USA.

BACKGROUND: Laparoscopic surgery has decreased the severity of postoperative pain in children. However, children often experience abdominal and shoulder pain requiring significant amounts of opioids, potentially prolonging their hospitalization. The goal of this study was to assess in a randomized fashion the effectiveness of aerosolized intraperitoneal bupivacaine in reducing postoperative pain in children.
METHODS:
Twenty-five patients undergoing robot-assisted laparoscopic surgery at our institution were randomized to either receive aerosolized intraperitoneal bupivacaine (1.25 mg/kg) or an equivalent volume of saline after establishment of pneumoperitoneum. Postoperative pain scores and opioid utilization were compared between the two groups. All patients received a standardized anesthetic and opioid analgesic regimen. Blood samples were obtained after aerosolization at 5, 15, 30, 60 min[1] . Review was undertaken at midpoint of study per IRB standards.
RESULTS:

Bupivacaine arm (12)Saline arm (13)
Weight (kg)49.7 ± 24.345.0 ± 11.9
Age (yr)12.1 ± 4.811.9 ± 5.0
LOS (days)1.2 ± 0.61.4 ± 0.8
Operative time (min)173 ± 40169 ± 66
Insufflation time (min)156 ± 39151 ± 62
Postop opioid (mg/kg)0.23 ± 0.140.34 ± 0.23
Peak VAS[2] Pain Score (0-10, 0 = no pain)
PACU710
Floor- At arrival710
4 hrs. postop47
8 hrs. postop69
12 hrs. postop49
16 hrs. postop36
20 hrs. postop45

CONCLUSIONS: Preliminary data suggest that the use of aerosolized intraperitoneal bupivacaine lowers mean and peak postoperative pain scores and opioid utilization after laparoscopic surgery. Patient enrollment is expected to be completed in 6 mos.
[1] Visual Analogue Scale
[2] Results of bupicavaine plasma levels will be available at the time of presentation.
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