Local anaesthetic wound infiltration following paediatric appendicectomy: a randomised controlled trial: Time to stop using local anaesthetic wound infiltration following paediatric appendicectomy?

OBJECTIVE: This study sought to determine the efficacy of post-operative wound infiltration with local anaesthetic following paediatric appendicectomy.

METHOD: In a randomised, controlled, prospective, clinical trial children aged between five and sixteen years were assigned to one of three treatment arms; infiltration of the surgical wound with bupivicaine, saline, or no infiltration. Anaesthetic and analgesic protocols were employed. Patients and observers were blinded to the treatment group. The primary end-points were post-operative pain, scored at intervals during the first twenty post-operative hours, and additional post-operative analgesic requirements beyond that which was provided by a standard protocol. In addition, adverse wound outcomes were recorded.

RESULTS: Eighty-eight children were recruited. There were no differences in age, sex or other confounding variables between groups. There was no significant difference in mean pain scores or analgesic requirements between groups through-out the post-operative period.

CONCLUSION: Wound infiltration with local anaesthetic following appendicectomy in children provides no additional benefit over regular simple analgesia. Its routine use represents dogmatic practise which ought to be challenged for this patient group.