Continuous local anesthetic wound infusion: Impact on pain score and opioid use in patients undergoing elective mastectomy.

Introduction: Opioids are commonly used to control acute postoperative pain but their usage is associated with significant complications and the potential of addiction. This study was designed to assess the effect of a Continuous Local Anesthetic Wound Infusion Catheter (CLAWIC) on pain score and as an opioid-sparing agent in patients undergoing elective mastectomy. Method: The search was done using all patients' record from February 2013 to February 2018. The data were collected through the acute pain service database, operation room lists, surgical site infection database, acute pain service sheet, and anesthesia sheet. The patients inclusion criteria were adults who underwent elective mastectomy surgery at King Fahad Specialist Hospital. Patient age, sex, weight, and height were also recorded. Result: The opioid use intraoperatively and postoperatively was significantly lower in the CLAWIC than in the control group. Also, accumulative opioid use was significantly lower in the CLAWIC group. From transfer to the PACU until 48 hours postoperatively, the percentage of patients requiring opioids was significantly lower in the CLAWIC group. After 48 hours, there was no difference in opioid use between the two groups. Visual Analog Scale (VAS) pain scores were significantly lower in the CLAWIC than in the control group. Conclusion: CLWIC showed opioid-sparing effects following mastectomy, as shown by a significantly lower mean opioid dose and a lower percentage of subjects needing opioid analgesia. The procedure is easy to perform and relatively safe. CLWIC could reduce opioid consumption while maintaining good postoperative pain control.

Management of postdural puncture headache in pediatric using an epidural catheter for an epidural blood patch.

We report the case of an 8-year-old child suspected to have postdural puncture headache after multiple lumbar punctures for collection of cerebrospinal fluid for analysis. His symptoms included headache, nonprojectile vomiting, and lethargy. When conservative management failed, an epidural blood patch was applied and the depth of the epidural space was determined using MRI. Epidural blood patch treatment was successful, and an epidural catheter was left in situ, in case a second patch was required.