Continuous Incisional Infusion of Local Anaesthetic (CIILA) Reduces Postoperative Opioid Usage in Children.

Abstract

Aim: Adequate post-operative pain relief is associated with shorter recovery time and higher patient satisfaction. Universally, opioids have been the mainstay but are associated with many adverse effects. We aimed to assess the safety and effectiveness of Continuous Incisional Infusion of Local Anaesthetic (CIILA) for postoperative pain relief in the paediatric population.

Methods: After Trust approval for the use of CIILA was obtained, data were collected prospectively from 2019 to 2022. Patients who had previously undergone laparotomy were used as historical controls. Morphine usage, pain scores and complications were documented. Median (IQR) were quoted throughout and comparison between groups performed using a Mann-Whitney U test. p < 0.05 was accepted as significant.

Results: 76 cases with CIILA were included (laparotomies n = 43, renal transplants n = 33), 58 children who underwent laparotomy served as control group. Age at surgery was 9.0 years (IQR: 2.3-13.1) and 6.1 years (IQR: 2.9-10.6), respectively; p = 0.23). Total morphine usage and number of bolus doses (<48 h) were significantly less in the CIILA group [23 (IQR: 2.6-261.6) vs. 460 (IQR: 265.0-566.0) mcg/kg total, and 0.4 (IQR: 0.4-10.0) vs. 10 (IQR: 10.0-10.0) mcg/kg bolus dose respectively, both p < 0001)]. Reported pain scores were similar in both groups [1.0 (IQR: 1.0-7.0) vs 0.0 (IQR: 0.0-0.5); p = 0.13)]. Length of stay was significantly shorter in the CIILA group [(4.5 days (IQR: 3.5-6.0) vs 6.0 days (IQR: 4.0-8.0); p = 0.02)]. There were no toxicity issues nor any local infection complications reported in the CIILA group.

Conclusion: The use of CIILA is safe, and was associated with lower morphine consumption postoperatively. We suggest that CIILA should be more widely used in the paediatric population.