Background and aims Continuous wound infiltration (CWI) of local anaesthetics has been a promising alternative to other regional techniques for postoperative analgesia in adults. Although lower incidence of adverse effects and avoidance of neurological complications of epidural anaesthesia are benefits of CWI, there are only a few reports on the effectiveness of CWI for paediatric patients.
Methods Laparoscopic right adrenalectomy for pheochromocytoma was scheduled in a 14-year-old girl (height 153.8cm; weight 55.3 kg) with von Hippel-Lindau disease. She was treated with urapidil preoperatively. Anaesthesia was induced and maintained with total intravenous anaesthesia. Before the resection of right adrenal gland, phentolamine was administered. Norepinephrine and dopamine infusions were started after the resection for the maintenance of blood pressure.
One multi-holed catheter for CWI was placed over the sutured peritoneum and 7 ml of 0.375% ropivacaine was injected. After the end of surgery, bilateral rectus sheath blocks and right transversus abdominis plane block were performed with a total of 25 ml of 0.375% ropivacaine, and continuous infusion of 0.2% ropivacaine at 4 ml/h through the catheter was started and continued for 4 days. Infusion of fentanyl at 11 µg/h was used for supplemental analgesia over 24 hours postoperatively.
Results Infusions of norepinephrine and dopamine were continued for three days postoperatively. the numeric rating scales were 1–2 on postoperative days 1–5.
Conclusions CWI provides continuous analgesia while avoiding both neurological complications and hemodynamic instability. This technique might be considered for postoperative pain management after paediatric laparoscopic surgeries.
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