Pediatric burns affect approximately 15-20 patients per 100 000 hospital admissions, but unfortunately there is a lack of evidence to guide optimal strategies for acute pain control. The aim of this study was to evaluate whether caudal analgesia with single injection of local anesthetics reduced pain medication consumption in pediatric patients who required surgical intervention for burn injuries. Retrospective data from patients <7 years old who had burn surgery in the operating rooms at a single regional burn center from 2013 to 2021 was obtained and analyzed. A 1:1 propensity-score matching method using nearest neighbor matching without replacement was utilized to create matched cohorts. Primary outcome was opioid consumption, which is presented as opioid equivalents divided by patient weight in kilograms, at 24 h after surgery. Comparing propensity-score matched groups, there were no statistically significant differences in adjusted morphine equivalents received by the caudal group (0.122 [0.0646;0.186]) and the no caudal group (0.0783 [0.0384;0.153]) at 24 h after surgery (p = 0.06). This is the first study to the best of our knowledge of the association of caudal analgesia in pediatric burn patients with postoperative pain control. The data showed an increase in pain medication consumption postoperative at 24 h and intraoperative for patients who received single injection caudal blocks, but when adjusted using propensity-score matching, the difference was no longer statistically significant.

Error-free mitosis depends on accurate chromosome attachment to spindle microtubules, powered congression of those chromosomes, their segregation in anaphase, and assembly of a spindle midzone at mitotic exit. The centromere-associated kinesin motor CENP-E, whose binding partner is BubR1, has been implicated in congression of misaligned chromosomes and the transition from lateral kinetochore-microtubule association to end-on capture. Although previously proposed to be a pseudokinase, here we report the structure of the kinase domain of Drosophila melanogaster BubR1, revealing its folding into a conformation predicted to be catalytically active. BubR1 is shown to be a bona fide kinase whose phosphorylation of CENP-E switches it from a laterally attached microtubule motor to a plus-end microtubule tip tracker. Computational modeling is used to identify bubristatin as a selective BubR1 kinase antagonist that targets the αN1 helix of N-terminal extension and αC helix of the BubR1 kinase domain. Inhibition of CENP-E phosphorylation is shown to prevent proper microtubule capture at kinetochores and, surprisingly, proper assembly of the central spindle at mitotic exit. Thus, BubR1-mediated CENP-E phosphorylation produces a temporal switch that enables transition from lateral to end-on microtubule capture and organization of microtubules into stable midzone arrays.