Bristol-led study of pain relief in children undergoing surgery awarded £3.3m

The National Institute for Health and Care Research (NIHR) has awarded £3.3m to a study exploring the best way to manage pain for children who have had abdominal surgery. The Caterpillar Study is a randomised controlled trial to see whether using wound infusion catheters in children and young people undergoing abdominal surgery is better than normal pain treatment alone.

The team, led by Dr Caroline Wilson Consultant Paediatric Anaesthetist at the Bristol Royal Hospital for Children and Jane Blazeby Professor of Surgery at the University of Exeter, will investigate whether wound infusion catheters should be used alongside standard pain treatment to provide children with pain relief after surgery. Researchers are planning to include 520 children aged between 6 months and 16 years, from up to 16 children’s hospitals across the UK.

Dr Caroline Wilson, said:

“For children and families, the period after major surgery can be challenging, and effective pain relief is essential to recovery.

“Wound infusion catheters offer a promising way of targeting pain directly at the site of surgery, but robust evidence is needed to understand exactly how much they help.

“The Caterpillar Study brings together experts from across the UK to answer this important question and, we hope, improve the experience of children and young people undergoing major abdominal surgery in the future.”

Wound infusion catheters are small plastic tubes placed into or next to a surgical wound by doctors. These tubes are connected to a pump that slowly delivers local anaesthetic directly into the wound. This keeps the affected area numb and can continue for up to 3 days after surgery.

The study will invite children and young people who are having a major abdominal operation (called a laparotomy) to take part. Participants will be placed into one of two groups. Both groups will receive standard pain medicines, including morphine through a button-controlled pump. One of the groups will also have the catheters delivering local anaesthetic. At the end of the study, the team will compare which group does best while ensuring that pain is treated properly in all children.

Professor Jane Blazeby, said:

“Clinical trials are one way of improving NHS care, but few have been conducted in children’s surgery.

“The Caterpillar Study is an opportunity for children’s surgeons, anaesthetists and nurses to work together on a national research project.

“Caterpillar will create evidence of relevance to future care and transform how research in this field is conducted – exciting stuff”.

The Caterpillar Study will be a collaboration between researchers working at the following Bristol and UK-based organisations:

Professor Anthony Gordon, Director for the NIHR Health Technology Assessment (HTA) Programme, which is funding the trial, said:

“Identifying the most effective method of pain relief for children undergoing abdominal surgery is absolutely vital. Not only will it benefit the children as they begin their recovery, it will also help reassure their parents that any pain or discomfort they may be experiencing is being managed in the best way possible.

“The Caterpillar study demonstrates the crucial importance of funding trials like this, which the NIHR has been doing for the past two decades. They provide vital evidence which builds on our knowledge and expertise, allowing the NHS to continually improve the care it provides.”