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Nursing guidelines

Wound catheter management

  • Introduction

    Continuous infusion of local anaesthetic has been shown to reduce post-operative pain and opioid requirements and is commonly used as part of a multimodal analgesia strategy. During surgery, a catheter is placed adjacent to a peripheral nerve or beneath the surgical incision to deliver local anaesthetic directly to the targeted site. This catheter is typically connected to a disposable elastomeric pump.

    The elastomeric pump contains a reservoir of local anaesthetic and infuses the medication at a constant, preset rate through a fenestrated catheter. Catheter lengths vary depending on the specific product used, allowing for tailored delivery across the wound or nerve distribution.

    Alternatively, local anaesthetic may be administered via a wound catheter using a yellow colour-coded Alaris® PCAM™ syringe driver pump designed for regional analgesia. This device allows for titration of the infusion rate and requires programming and regular refilling by ward nursing staff.

    Compared to syringe drivers, elastomeric pumps offer a more practical and patient-friendly solution. Their compact, lightweight design supports greater mobility and facilitates participation in physiotherapy, promoting active recovery without the encumbrance of pole-mounted equipment.

    Aim

    • To provide nursing staff with a standardised guideline for the safe and appropriate care of neonatal and paediatric patients receiving post-operative pain relief via wound catheter.
    • To provide an overview of the function of the wound catheter in delivering local anaesthetic directly into the surgical site for optimal post-operative pain management.
    • To outline the perioperative steps for wound catheter placement and infusion commencement, ensuring effective function prior to ward transfer.

    Definition of Terms

    • AutoFuser®: a type of elastomeric pump that continuously delivers local anaesthetic which is connected to a compatible wound catheter.
    • CPMS: Children’s Pain Management Service.
    • Elastomeric pump: a small disposable, non-electronic device that delivers medication at a controlled rate using pressure from a deflating balloon reservoir.
    • Local anaesthesia: an agent which blocks the conduction of impulses in nerve tissues through sodium channel deactivation.
    • Wound catheter: a tube similar in size to an epidural catheter with fenestrations along a variable length (product dependent), typically with product specific markings indicating the distance from the most proximal fenestration.

    Indications for wound catheter infusion

    • Continuous local anaesthetic delivery for the management of moderate to severe post-operative pain in patients who are likely to experience pain at the surgical site e.g. bone/cartilage donor sites, lower limb procedures and laparotomy.
    • Perineural infusion of local anaesthetic following upper or lower limb surgery, where targeted blockade of peripheral nerve conduction can likely reduce postoperative pain.
    • As an adjunct to opioid infusions when opioids alone do not provide adequate analgesia.
      • Reduce opioid requirements and minimise associated side effects such as respiratory depression, nausea, vomiting, constipation and tolerance — particularly when prolonged opioid use is anticipated.
      • Primary analgesic modality, used in combination with simple analgesics when clinically appropriate.

      Insertion and prescription

      • The wound catheter is inserted intra-operatively by the surgeon and added as Lines Drains and Airways (LDA).
      • The wound catheter must not be cut / shortened.
      • The regional analgesia infusion order (e.g. AutoFuser®) must be prescribed by the anaesthetist in the medication administration record (MAR) as outlined by the RCH Pain Management Guideline for Regional Anaesthetic Infusion Blocks. This includes information regarding recommended regional anaesthetic infusion solutions and guidance on special patient groups including neonates, infants less than 8 months and children with significantly impaired liver synthetic-metabolic function.The regional analgesia infusion is then delivered via an elastomeric pump or via a syringe driver pump (see either option below).

      AutoFuser® elastomeric pump

      (Photo credit: J.Robson, RCH CPMS)

      Delivery via AutoFuser® elastomeric pump

      • The AutoFuser® device is prepared and then documented on the MAR by the perioperative nursing staff according to RCH Perioperative Suite Local Procedure: Pain buster - Pain Relief System Perioperative Management
      • The tubing attached to the wound catheter has a clamp. The clamp must be released to commence the infusion and documented on the MAR. The clamp is usually released in the Post Acute Care Unit (PACU) unless otherwise ordered.
      • The pump should be secured to the patient with the clip at or near the level of the catheter insertion site to ensure accurate flow.
      • The filter vent should not be taped or covered.
      • Medication labels must be printed, affixed to the pump and infusion lines, and verified by two nurses against the MAR and patient details.
      • The nurse must document when the infusion starts.
      • At the time of filling, the AutoFuser® medication reservoir will appear fully inflated within the protective housing. It should always be filled to its specified fixed volume as delivery becomes inaccurate if it is under- or over-filled.
      • The AutoFuser® used at RCH is pressurised to deliver local anaesthetic at a specified rate that cannot be adjusted. The rate may be 2mL/hr or 5 mL/hr depending on the pump specification.
      • The duration until the pump empties will depend on the volume of the AutoFuser® connected to the wound catheter and its delivery rate. For instance, a 100 mL AutoFuser® infusing at 2 mL/hour will be depleted 50 hours after the clamp is released. Similarly, a 275 mL AutoFuser® delivering at 5 mL/hour will be empty after 55 hours.

      See Medication Management Procedure for more information.

      Delivery via Alaris® PCAM™ syringe driver pump

      • Only REM-EPISETTM is to be used for delivery of local anaesthetic infusions via Alaris® PCAM™ pump.
      • The REM-EPISETTM tubing has a T-configuration. The clear tubing with the bag spike connects to the flask of anaesthetic solution. The short yellow tubing is connected to the syringe, allowing the syringe to be refilled. The long yellow tubing with the yellow luer lock connects to the filter or the catheter hub. There are two one-way valves in the REM-EPISET TM  tubing to prevent the risk of gravity free-flow.
      • A yellow colour coded syringe driver must be used for all regional anaesthetic infusions. A handset is used for bolus delivery if prescribed. Only Anaesthetic, PACU or CPMS staff can program the PCAM™ pump.
      • The two authorised nurses who put up each flask of infusion solution must sign the record of infusion on the regional analgesia infusion prescription on the MAR. Yellow medication labels must be printed and affixed to the pump and infusion lines. See User Applied Labelling of Injectable Medicines, Fluids and Lines excluding Perioperative Environments.
      • The regional anaesthetic infusion lines are to be maintained as a closed system.
      • Changing flasks of infusion solution must be done using aseptic technique.
      • To refill the syringe from the flask the infusion should be paused and the syringe removed from the pump before being refilled from the flask.
      • Ensure the spiked end of the flask is pointing downwards to avoid air being drawn into the tubing.

      Wound catheter infusion management

      Assessment

      • Patients require routine post-operative clinical observations
      • Complete hourly pain assessment. Wound infusion is used as part of a multimodal analgesia regimen and other additional analgesia will often still be necessary. Inadequate analgesia should be reported to CPMS for review on pager 5773 / Spectralink 52702.
      • Assess for local anaesthetic toxicity (Signs include: dizziness, blurred vision, decreased hearing, restlessness, tremor, hypotension, bradycardia, arrythmias, numbness of tongue, metallic taste, seizures, sudden loss of consciousness). If suspected, cease the infusion, contact CPMS and proceed with management of local anaesthetic poisoning.
      • Assess the insertion site for signs of inflammation, infection, dislodgement of the catheter or dressing integrity. These should be reported to CPMS.

      Wound catheter care

      • Ensure the tubing is secured to the skin with adhesive dressing.
      • Do not tape over the filter.
      • Check catheter is connected to the pump.
      • Check catheter is unclamped.
      • Ensure the catheter and tubing are not kinked.
      • Check all system connections are secure.
      • Inspect the wound catheter exit site and operative dressing every four hours for signs of excessive leakage. Leakage may occur if the catheter’s fenestrated segment lies too close to the skin exit site. An absorbent dressing (such as Combine) should be applied over the original dressing should excessive leak occur, and CPMS contacted.
      • Do not immerse the pump in water. When the patient is showering, the pump should be placed in a waterproof bag/covering.

      Local anaesthetic administration

      • If delivery is via AutoFuser® pump, ensure the pump is not under the bedcovers (to avoid heating as the pump is calibrated to room temperature).
      • To monitor medication delivery of the AutoFuser® pump, regularly check the position of the fluid against the graduation scale on the clear protective housing. The reservoir empties slowly, so the reservoir fluid may need to be re-checked in a few hours.
      • Continue infusion until the date and time specified by the anaesthetist prescriber, after which the wound catheter can be removed. The elastomeric pump is a single-use item and can be disposed of in waste.

      AutoFuser® reservoir

      (Photo credit: J. Robson, RCH CPMS)

      Removing the wound catheter

      • The wound catheter can be removed upon completion of an AutoFuser® pump infusion or cessation of the wound infusion as recommended by CPMS.
      • Explain the removal technique to the patient if age/cognition appropriate and to the carer.
      • Use Comfort Kids guidelines for procedural pain management.
      • Use standard aseptic technique as per RCH Procedure Aseptic Technique.
      • Lift the dressing securing the wound catheter in place and loosen adhesive at the catheter site if present.
      • Gently pull the wound catheter out in one smooth movement parallel to wound, holding the catheter close to the exit site at the skin.
      • There may be some initial resistance if Dermabond glue has been used to prevent catheter migration. To facilitate removal, apply continuous firm pressure while withdrawing the catheter. This technique should help overcome the initial resistance caused by the adhesive. The catheter should be easy to remove and typically not painful.
      • If there is any resistance during removal, stop and contact the surgical team.
      • Check the distal end marker to ensure the tip is intact, if any concerns contact the surgical team and CPMS.
      • Cover exit site with a clear dressing.
      • Document removal.

      Discharge planning and community-based management

      • Patients can be discharged with an AutoFuser® wound infusion continuing at home.
      • Some families are happy to remove the catheter at home when the AutoFuser® is empty with instructions from CPMS. An information sheet outlining removal will be discussed with the family member who will remove the catheter. The CPMS contact phone number is included on the information sheet.
      • If a patient is discharged with the catheter in situ and the family do not feel confident to remove the catheter, then options for removal include:
        • the family can arrange removal by their GP
        • Walllaby  team can remove the catheter if the patient is receiving hospital in the home care
        • RCH Post Acute Care (PAC) nursing may be able to assist
        • Please flag/discuss with Wallaby and/or Post Acute Care teams directly.

      Companion Documents

      Links

      RCH Comfort Kids

      Please remember to read the disclaimer.


      The revision of this nursing guideline was coordinated by Jo Robson, Clinical Nurse Consultant, Children's Pain management Service, and approved by the Nursing Clinical Effectiveness Committee. Updated November 2025. 

       

      Evidence Table

      Reference

      Source of Evidence

      		Key findings and considerations
      Bulut, T., Yilmazlar, A., Yavascaoglu, B., & Sarisozen, B. (2011). The effect of local anaesthetic on post-operative pain with wound instillation via a catheter for paediatric orthopaedic extremity surgery. Journal of Children's Orthopaedics, 5(3), 179–185. https://doi.org/10.1007/s11832-011-0337-3 Randomised, double-blind, placebo-controlled trial
      • RCT involving 40 children (aged 1–12 years) undergoing upper or lower extremity orthopaedic surgery found wound catheter delivery of bupivacaine boluses provide effective and sustained post-operative analgesia in paediatric orthopaedic patients.
      • There were few complications.
      • Pain scores were clinically and significantly lower in the study group up to 48 hours, indicating prolonged analgesic effect.
      Bykowski, M. R., Sivak, W., Garland, C., Cladis, F. P., Goldstein, J. A., & Losee, J. E. (2019). A multimodal preemptive analgesic protocol for alveolar bone graft surgery: Decreased pain, hospital stay, and health care costs. The Cleft Palate Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association, 56(4), 479–486. https://doi.org/10.1177/1055665618791943 Retrospective comparative cohort study
      • Multiple perioperative analgesic strategies following alveolar bone grafting in a paediatric tertiary hospital were evaluated for postoperative pain, hospital length of stay (LOS), and associated costs.
      • Following iliac crest bone graft harvest, patients receiving trephine harvest with a ropivacaine pain pump reported significantly lower pain scores (1.8/10) than those with open harvest (7.3/10), indicating superior pain control. 
      • Hospital stay was shorter for the “Trephine + Pain Pump” group (median 0.5 days), with nearly half discharged the same day.
      • The optimised protocol with trephine harvest and pain pump use saved an estimated US$7,265 per bilateral alveolar bone graft compared to traditional open harvest methods. 
      • Trephine harvest with ropivacaine wound catheter infusion is a safe, effective, minimally invasive alternative to traditional grafting, with low morbidity, short operative times, and no significant increase in complications.
      Hermansson, O., George, M., Wester, T., & Christofferson, R. (2013). Local delivery of bupivacaine in the wound reduces opioid requirements after intraabdominal surgery in children. Pediatric Surgery International, 29(5), 451–454. https://doi.org/10.1007/s00383-013-3296-6
      		 Randomised, double-blind, placebo-controlled trial
      • RCT involving 33 children aged 6 months to 13 years undergoing elective abdominal or bladder surgery (enterostomy closure, open gastrostomy, ureteral reimplantation) found continuous wound infusion of bupivacaine is a safe and effective method for reducing postoperative opioid use in children. 
      • Children receiving bupivacaine wound infusions required significantly fewer morphine doses on postoperative day 1 compared to the saline group. No significant difference was observed on days 2 or 3. 
      • Bupivacaine serum levels remained below toxic thresholds. No increase in wound infection rates was observed. The technique was well tolerated and considered safe for paediatric use. 
      • No significant differences were found between groups in time to full oral intake or length of hospital stay, suggesting analgesic benefit without accelerating recovery.
      • Continuous wound infusion may offer advantages over epidural analgesia, which is more invasive and associated with systemic side effects and increased nursing demands.
      Machoki, M. S., Millar, A. J., Albetyn, H., Cox, S. G., Thomas, J., & Numanoglu, A. (2015). Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control. Pediatric Surgery International, 31(11), 1087–1097. https://doi.org/10.1007/s00383-015-3796-7 Randomised, single-blind, controlled trial
      • Continuous wound infusion resulted in lower average pain scores (2.5) compared to epidural (3.0) and standard analgesia (3.5), with consistent low pain trends across paediatric abdominal surgeries.
      • Continuous wound infusion groups required markedly less morphine than both control groups. 
      • Continuous wound infusion patients resumed full enteral feeds and mobilised approximately 2 days earlier than controls. They also had reduced need for urinary catheterisation and earlier catheter removal. 
      • No wound infections or bupivacaine-related complications were reported even in high-risk wound categories. 
      • Continuous wound infusion is simple to administer, requires minimal expertise, and does not necessitate intensive monitoring—making it a practical alternative to epidural analgesia.
      Mattila, I., Pätilä, T., Rautiainen, P., Korpela, R., Nikander, S., Puntila, J., Salminen, J., Suominen, P. K., Tynkkynen, P., & Hiller, A. (2016). The effect of continuous wound infusion of ropivacaine on postoperative pain after median sternotomy and mediastinal drain in children. Paediatric Anaesthesia, 26(7), 727–733. https://doi.org/10.1111/pan.12919 Randomised, double-blind, placebo-controlled trial
      • Trial of 49 children aged 1-9 years following median sternotomy found continuous ropivacaine wound infusion did not significantly reduce opioid use, improve pain scores, or affect recovery outcomes in children post-ASD closure compared with placebo.
      • Local anaesthesia may have been only partly effective and the mediastinal drain which was not infiltrated may have caused major discomfort.
      • No signs of local anaesthetic toxicity were found.  

        Mitchell, D. T., Obinero, C., Ekeoduru, R. A., Nye, J., Green, J. C., Talanker, M., Nguyen, P. D., & Greives, M. R. (2023). It's hip to go home: An evaluation of outpatient alveolar bone grafting in patients with cleft palate. The Journal of Craniofacial Surgery, 34(7), 2191–2194. https://doi.org/10.1097/SCS.0000000000009693 Retrospective single-institution review
        • Continuous wound infusion via pain pumps provided effective pain control in paediatric patients who underwent iliac crest bone harvest. The median pain score at discharge was 0, indicating excellent postoperative pain management with continuous infusion pain pumps. 
        • 96.3% of patients were discharged on the same day of surgery, with a median post-anaesthesia care unit (PACU) stay of 1.75 hours, demonstrating the feasibility of outpatient alveolar bone grafting.
        • There was a low complication rate, with only 1 readmission due to donor site infection, and no re-operations were needed within 30 days.
        • Use of minimally invasive trephine drill harvest combined with pain pumps reduced donor site morbidity and facilitated early discharge.
        • Outpatient alveolar bone graft with pain pumps reduces inpatient costs, especially important for cleft patients who undergo multiple surgeries. 
        • While effective, 10% of pain pumps malfunctioned, leading to some emergency department visits—highlighting the need for preoperative education and close follow-up to mitigate device-related concerns.  

          Muthusamy, K., Recktenwall, S. M., Friesen, R. M., Zuk, J., Gralla, J., Miller, N. H., Galinkin, J. L., & Chang, F. M. (2010). Effectiveness of an anesthetic continuous-infusion device in children with cerebral palsy undergoing orthopaedic surgery. Journal of Pediatric Orthopaedics, 30(8), 840–845. https://doi.org/10.1097/BPO.0b013e3181f59f53 Randomised controlled trial
          • Study of 37 children with cerebral palsy (CP) compared pain outcomes between two groups—those receiving a pain pump plus oral analgesics vs. oral analgesics alone. The pain pump group experienced significantly lower pain intensity on the day of surgery and for two days postoperatively.
          • Analgesic use was significantly lower in the pain pump group during the first two postoperative days, though not significantly different overall.
          • Parents removed the catheter after 48h.
          • High satisfaction with pain management was reported in both groups, showing acceptability of the pain pump approach among caregivers.
          • The study supports multimodal analgesia, highlighting wound catheter infusion as an effective strategy to improve pain control in children with CP.  

            Niiyama, Y., Yotsuyanagi, T., & Yamakage, M. (2016). Continuous wound infiltration with 0.2% ropivacaine versus a single intercostal nerve block with 0.75% ropivacaine for postoperative pain management after reconstructive surgery for microtia. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 69(10), 1445–1449. https://doi.org/10.1016/j.bjps.2016.05.009 Randomized controlled trial
            • Continuous wound infiltration with 0.2% ropivacaine significantly reduced pain intensity at rest compared to a single intercostal nerve block in children undergoing costal cartilage graft harvest for microtia reconstruction.
            • Patients receiving continuous wound infiltration required significantly less supplemental analgesia.
            • Plasma concentrations of ropivacaine remained within safe limits throughout the 48–72 hour postoperative period, indicating a favourable safety profile.
            • Postoperative opioid use was successfully avoided, reducing the risk of opioid-related side effects such as nausea, sedation, and respiratory depression.
            • Continuous wound infiltration is a simple and feasible technique that can be integrated into multimodal analgesia strategies for paediatric surgical patients.
            • While continuous wound infiltration reduced pain at rest, it did not improve pain during coughing or time to mobilisation, suggesting that combining it with other techniques (e.g., intercostal nerve block) may enhance analgesic efficacy.
            Palmer, G. M., & Alcock, M. M. (2020). Chapter 10.6.2.5 The paediatric patient: Continuous local anaesthetic wound catheter infusions. In S. A. Schug, G. M. Palmer, D. A. Scott, R. Halliwell, J. Trinca; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (Eds.), Acute Pain Management: Scientific Evidence (5th edition) (pp. 997-998). ANZCA & FPM, Melbourne. https://hdl.handle.net/11055/1071 Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine publication: Systematic reviews of the most recent and best available evidence for acute pain management
            • The evidence for use of wound catheter infusions in children is limited. 
            • Continuous wound catheter infusions of local anaesthetic are effective (Level II evidence) and safe analgesic techniques (Level IV evidence).
            • Lipid emulsion (20%) has been used in successful resuscitation of paediatric patients (neonates to 18 years) with local anaesthetic systemic toxicity; dosing recommendations are the same as for adults and higher doses have led to adverse effects.  

              Staals, L. M., Dogger, J., Keyzer-Dekker, C., Boerlage, A. A., Bokhorst, E. F., van Wijk, J. J., Scheepe, J. R., van Dijk, M., van Rosmalen, J., & de Wildt, S. N. (2025). Efficacy and safety of wound catheter infusion with ropivacaine after abdominal surgery in children aged < 1 year: A randomized controlled trial. Paediatric Drugs, 27(5), 593–604. https://doi.org/10.1007/s40272-025-00700-x Randomised, double-blind, placebo-controlled trial
              • In infants undergoing abdominal surgery, wound catheter infusion with ropivacaine did not significantly reduce cumulative morphine use over 48 hours, but significantly fewer infants required morphine postoperatively compared to controls.
              • Despite reduced morphine use, pain scores were not significantly different between the ropivacaine and placebo groups, suggesting wound catheter infusion provided adequate analgesia.
              • Plasma concentrations of ropivacaine remained below toxic thresholds, supporting safety in infants.
              • Wound catheter infusion was successfully implemented in the majority of cases, demonstrating that it is a feasible regional anaesthesia technique in infants undergoing abdominal surgery.
              • There were no reported adverse events related to wound healing or local anaesthetic toxicity. 
              • The study was underpowered due to early termination after enrolling 30 patients, which may have affected the statistical significance of some outcomes.
              Stamenkovic, D. M., Bezmarevic, M., Bojic, S., Unic-Stojanovic, D., Stojkovic, D., Slavkovic, D. Z., Bancevic, V., Maric, N., & Karanikolas, M. (2021). Updates on wound infiltration use for postoperative pain management: A narrative review. Journal of Clinical Medicine, 10(20), 4659. https://doi.org/10.3390/jcm10204659 Narrative review
              • Published adult data from the past 20 years was reviewed. Continuous wound catheter infusion was found to be an effective component of multimodal analgesia and demonstrated improved pain relief, reduced opioid use, fewer side effects, increased patient satisfaction, and shorter hospital stays across a wide range of surgeries.
              • Continuous wound infiltration provided prolonged and more consistent analgesia compared to single-shot or intermittent bolus techniques, especially when delivered via preperitoneal catheters.
              • The risk of local anaesthetic systemic toxicity was noted at 11% following subcutaneous wound infiltration, highlighting the importance of appropriate dosing and monitoring. Ropivacaine and bupivacaine were preferred for their long-acting effects and lower toxicity.
              • Wound infection rates with continuous infiltration were low (0.7–1.2%) and were minimised through aseptic, non-touch techniques and proper wound management.
              • Continuous wound infiltration was more cost-effective than epidural or IV PCA, requiring less equipment and training. It avoided motor block and supported early mobilisation, making it suitable for Enhanced Recovery After Surgery (ERAS) protocols.  

                Swenker, D.J., Dirckx, M., & Staals, L.M. (2024). The efficacy of wound catheter infusion with local anesthetics for the treatment of postoperative pain in children: A systematic review. Paediatric & Neonatal Pain, Jun 5;6(4), 99-110. https://doi.org/10.1002/pne2.12126 Systematic review
                • A comprehensive review of literature identified 28 relevant studies, including 10 high-quality randomized controlled trials, supporting wound catheter infusion use in children under 18 years.
                • Wound catheter infusion with local anaesthetics demonstrated effective postoperative pain relief and/or decreased opioid requirements in children undergoing abdominal and extremity surgeries.
                • Wound catheter infusion may reduce the need for intravenous opioids, thereby minimizing opioid-related side effects such as respiratory depression, nausea, vomiting, urinary retention, and sedation — especially beneficial in young infants. 
                • Unlike neuraxial blocks, wound catheter infusion avoids risks like dural puncture, neurological deficits, and epidural abscess. It also has a higher success rate due to placement under direct vision and may be more suitable when epidural placement fails.
                • Across 28 studies (712 patients), no serious adverse events (e.g., local anaesthetic systemic toxicity or wound healing complications) were reported. Plasma concentrations of local anaesthetic remained below toxic levels, indicating safe systemic absorption.  Infection rates were low, supporting wound catheter infusion as a safe technique in children.
                • Wound catheter infusion can be used with elastomeric bulb devices for outpatient care, potentially allowing earlier discharge and better resource allocation, especially in selected procedures.
                Tirotta, C.F., Munro, H.M., Salvaggio, J., Madril, D., Felix, D.E., Rusinowski, L., Tyler, C., Decampli, W., Hannan, R.L., & Burke, R. P. (2009). Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery. Paediatric Anaesthesia, 19(6), 571–576. https://doi.org/10.1111/j.1460-9592.2009.03009.x Randomized, double-blind, placebo-controlled trial
                • Study involving 72 children found continuous incisional infusion of local anaesthetic (LA) is safe and effective for up to 72 hours post-open heart surgery.
                • LA group had significantly lower morphine requirements in the first 24 hours (0.05 mg/kg vs 0.2 mg/kg).
                • More patients required no morphine in the LA group compared to placebo (7/35 vs 1/37). 
                • LA group required less sedation. 
                • Plasma LA levels remained below toxic thresholds, confirming safety.
                • There were no significant differences in secondary outcomes (e.g., oral intake, bowel movement, catheter removal, length of stay).