Evaluation of Local Anesthetic at Incision Site
Evaluation of Local Anesthetic at Incision Site
Patient will have usual appendectomy surgery with an injection of local or saline at incision
 site either before or after the incision at random.

 The clinical hypothesis of this trial is that pediatric patients who undergo a local
 anesthetic pre-incisional and/or post-incisional will reduce the amount of postoperative pain
 and therefore reduce the amount of analgesics required to keep the patient satisfied.

 Primary: To determine if local anesthetic reduces postoperative pain. Secondary: To assess
 the timing of local anesthetic injection affects postoperative pain.
This is a prospective randomized-controlled pilot study of 100 pediatric subjects, recruited
 through Phoenix Children's Hospital and Pediatric Surgeons of Phoenix, who will undergo a
 laparoscopic appendectomy (LA) for acute non-perforated appendicitis. The reviewer and
 subject will be blind to the treatment to help prevent bias. The subjects will be randomized
 by envelope using a random number generator, and the infiltrated solution will be given to
 the surgeon by the pharmacy.

 The subjects will be approached preoperatively and will be divided into three groups:
 pre-incisional injection of local anesthetic, post-incisional injection of local anesthetic,
 and (pre or post) injection of saline as the control.

 All patients will have a standard 3 port laparoscopic appendectomy, port placement, port and
 instrument type, and operative technique will be determined by the surgeon's usual practice.

 On induction, the following protocol will be utilized: a 2 mg/kg bolus of propofol, 1.5 mg/kg
 of lidocaine, 0.1 mg/kg of morphine, and 0.6 mg/kg of rocuronium. A standardized anesthetic,
 using a mixture of sevoflurane in oxygen and air, will be utilized. Once the appendectomy is
 complete, a single dose of 0.5 mg/kg of ketorolac will be given prior to extubation. A total
 of 0.5 mL/kg of 0.25% Bupivicaine or saline, up to a maximum of 30 cc, will be injected using
 a 22g needle. Pre-incision: local will be to be given intradermally and onto the peritoneum
 under direct vision; post-closure local will be injected intradermally after closure.

 The subjects will be assessed for postoperative pain immediately upon wakening, and then 1,
 2, 4, 8, 12, and 24 hours after the LA procedure by the bedside nurse by using the VAS and by
 measuring the total amount of opioid use.
Inclusion Criteria:

 -  Patients undergoing Appendectomy for acute non-perforated appendicitis Must be between
 9-17 years old

 Exclusion Criteria:

 -  n/a