Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review
Objective: To determine whether continuous local anaesthetic wound infusion (CLAWI) provides more effective pain relief and decrease the need for systemic opioids compared to other analgesic agents in term or preterm newborn infants undergoing thoracic or abdominal surgery. Methods: Cochrane Central...
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Elsevier
2024-10-01
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| Series: | Journal of Pediatric Surgery Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949711624000625 |
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| author | Jeewan Jyoti Eva Sloukova Kaye Spence Annabel Webb Albert Shun Himanshu Popat |
| author_facet | Jeewan Jyoti Eva Sloukova Kaye Spence Annabel Webb Albert Shun Himanshu Popat |
| author_sort | Jeewan Jyoti |
| collection | DOAJ |
| description | Objective: To determine whether continuous local anaesthetic wound infusion (CLAWI) provides more effective pain relief and decrease the need for systemic opioids compared to other analgesic agents in term or preterm newborn infants undergoing thoracic or abdominal surgery. Methods: Cochrane Central Register of Controlled Trials, Medline, Embase and CINAHL were searched from database inception to August 2022. Publications were screened and their references were hand-searched to identify additional studies. This review included randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. Two reviewers independently extracted data and examined the methodological quality of the eligible studies. A meta-analysis was performed for available outcomes. Results: After screening 1202 articles, two RCTs with 98 patients were included. Meta-analysis for combined data was possible for only two outcomes: pain scores post-surgery and length of hospital stay. The random effects model for the pooled standardised mean difference of pain scores between treatment groups post-surgery was -2.54 (95 % CI:7.53, 2.46, p = 0.3196) and for length of stay in the NICU was -0.19 (95 % CI:0.58, 0.21, p = 0.3574), suggesting that CLAWI was not more effective in either providing pain relief or reducing length of stay. However, the small number of studies included, the considerable heterogeneity between the studies, and the small sample sizes of the individual studies limit the generalizability of the findings. Conclusion: This review highlights the need for further, adequately powered well-designed, multicentre trials to examine the effectiveness of CLAWI in reducing postoperative pain in newborns undergoing abdominal and thoracic surgery. Level of evidence: Level I - Evidence from a systematic review of all relevant randomized controlled trials |
| format | Article |
| id | doaj-art-6ea6441d3c144632bf362c5c05e1117c |
| institution | OA Journals |
| issn | 2949-7116 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Open |
| spelling | doaj-art-6ea6441d3c144632bf362c5c05e1117c2025-08-20T02:12:46ZengElsevierJournal of Pediatric Surgery Open2949-71162024-10-01810017710.1016/j.yjpso.2024.100177Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic reviewJeewan Jyoti0Eva Sloukova1Kaye Spence2Annabel Webb3Albert Shun4Himanshu Popat5Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW, Australia; Corresponding author.Multidisciplinary Neonatal Intensive Care Unit, Paediatric Department, The University Hospital Brno, Jihlavska 20, Brno, 62500, Czech RepublicGrace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW, Australia; School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, AustraliaCerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, 88 Mallett Street, Camperdown, NSW, 2050, AustraliaGrace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW, AustraliaGrace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, 2145, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, NSW, 2145, AustraliaObjective: To determine whether continuous local anaesthetic wound infusion (CLAWI) provides more effective pain relief and decrease the need for systemic opioids compared to other analgesic agents in term or preterm newborn infants undergoing thoracic or abdominal surgery. Methods: Cochrane Central Register of Controlled Trials, Medline, Embase and CINAHL were searched from database inception to August 2022. Publications were screened and their references were hand-searched to identify additional studies. This review included randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. Two reviewers independently extracted data and examined the methodological quality of the eligible studies. A meta-analysis was performed for available outcomes. Results: After screening 1202 articles, two RCTs with 98 patients were included. Meta-analysis for combined data was possible for only two outcomes: pain scores post-surgery and length of hospital stay. The random effects model for the pooled standardised mean difference of pain scores between treatment groups post-surgery was -2.54 (95 % CI:7.53, 2.46, p = 0.3196) and for length of stay in the NICU was -0.19 (95 % CI:0.58, 0.21, p = 0.3574), suggesting that CLAWI was not more effective in either providing pain relief or reducing length of stay. However, the small number of studies included, the considerable heterogeneity between the studies, and the small sample sizes of the individual studies limit the generalizability of the findings. Conclusion: This review highlights the need for further, adequately powered well-designed, multicentre trials to examine the effectiveness of CLAWI in reducing postoperative pain in newborns undergoing abdominal and thoracic surgery. Level of evidence: Level I - Evidence from a systematic review of all relevant randomized controlled trialshttp://www.sciencedirect.com/science/article/pii/S2949711624000625Continuous local anaesthetic wound infusionPostoperative painNeonatesNewbornInfantsCardiac surgery, laparotomy |
| spellingShingle | Jeewan Jyoti Eva Sloukova Kaye Spence Annabel Webb Albert Shun Himanshu Popat Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review Journal of Pediatric Surgery Open Continuous local anaesthetic wound infusion Postoperative pain Neonates Newborn Infants Cardiac surgery, laparotomy |
| title | Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review |
| title_full | Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review |
| title_fullStr | Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review |
| title_full_unstemmed | Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review |
| title_short | Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review |
| title_sort | continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery a systematic review |
| topic | Continuous local anaesthetic wound infusion Postoperative pain Neonates Newborn Infants Cardiac surgery, laparotomy |
| url | http://www.sciencedirect.com/science/article/pii/S2949711624000625 |
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