727 THE USE OF INTRAPERITONEAL NEBULIZATION OF BUPIVACAINE REDUCES THE NEED FOR POSTOPERATIVE OPIOIDS IN YOUNG CHILDREN UNDERGOING ROBOTIC-ASSISTED LAPAROSCOPIC RECONSTRUCTIVE SURGERY

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You have accessJournal of UrologyPediatrics: Basic Research1 Apr 2012727 THE USE OF INTRAPERITONEAL NEBULIZATION OF BUPIVACAINE REDUCES THE NEED FOR POSTOPERATIVE OPIOIDS IN YOUNG CHILDREN UNDERGOING ROBOTIC-ASSISTED LAPAROSCOPIC RECONSTRUCTIVE SURGERY Vitor C. Zanetta, Petra Meier-Haran, Constance S. Houck, Luis M. Pereira, Hiep T. Nguyen, and Bartley G. Cilento Vitor C. ZanettaVitor C. Zanetta Boston, MA , Petra Meier-HaranPetra Meier-Haran Boston, MA , Constance S. HouckConstance S. Houck Boston, MA , Luis M. PereiraLuis M. Pereira Boston, MA , Hiep T. NguyenHiep T. Nguyen Boston, MA , and Bartley G. CilentoBartley G. Cilento Boston, MA View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.812AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraperitoneal bupivicaine is thought to reduce postoperative pain in adults, but there is lack of information about its safety and efficiency in the pediatric population. In a preliminary evaluation of its pharmacokinetics (PK), we observed that some children receiving nebulized intraperitoneal bupivacaine had peak plasma levels that were greater than 2.0 mcg/mL. We sought to compare those previous results with a newer administration technique utilizing a micropump nebulizer (MN) to demonstrate improved safety and continued efficiency in reducing post-operative analgesic needs. METHODS Children ages 6 months to 6 years, undergoing robot-assisted laparoscopic urologic surgery received bupivacaine 1.25 mg/kg intraperitoneally by 1 of 2 methods. Group 1 received 1.25 mg/kg bupivacaine diluted in 30 mL saline via a mucosal atomization device (average particle size 30 microns) as a single bolus over ∼1min after creation of the pressurized pneumoperitoneum. Patients in group 2 received 1.25 mg/kg of undiluted bupivacaine 0.5% via MN (average particle size 3.0 microns) into the insuflation tubing over 15-30 minutes. Blood samples were drawn in a timely fashion. A standardized 1.25 mg/kg of 0.25% bupivacaine (max.10 mL) was injected subcutaneously into the trocar incisions. Postoperative analgesia was achieved with ketorolac IV, PRN morphine IV or an oral opioid. Pain report was recorded with Faces scales or FLACC score. Plasma bupivacaine levels were measured by HPLC. Demographic data and opioid requirements were analyzed using Student's t-test. PK analysis was done with WinNonlin, Monolix. RESULTS 54 children were evaluated. The bupivacaine plasma concentrations ranged between 0 - 2.44 mcg/mL in Group 1 and between 0 - 0.83 mcg/mL in Group 2, which also had lower peaks. There were no arrhythmias or clinical signs of neurotoxicity noted. The morphine requirements for both groups were low (at most 0.2 mg/kg). Their total opioid requirement was one half of that administered to historical controls (0.2 mg/kg vs. 0.4mg/kg). CONCLUSIONS The peak plasma levels were lower in children who had MN intraperitoneal bupivacaine, indicating a reduced extent of systemic absorption and improved safety. The addition of this local anesthetic reduced post-operative needs for IV opioids and consequently, allows for same day discharges in children undergoing robotic-assisted laparoscopic reconstructive surgery. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e298 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vitor C. Zanetta Boston, MA More articles by this author Petra Meier-Haran Boston, MA More articles by this author Constance S. Houck Boston, MA More articles by this author Luis M. Pereira Boston, MA More articles by this author Hiep T. Nguyen Boston, MA More articles by this author Bartley G. Cilento Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...