Abstract
Background: Relief of post-operative pain is provided traditionally by single drug regimens but combinations of different regimens have been suggested to be more rational and effective. Rectal administration of NSAIDs in children is a safe and convenient route of drug absorption. The present study was designed to compare the efficacy and safety of caudal bupivacaine (0.125%) either with buprenorphine (4µg/ml) or with rectal diclofenac suppository (2.5 mg/kg).
Material & Methods: The present study was carried out on 50 children in the Department of Anaesthesiology and critical care at the attached group of hospitals, Dr. S.N. Medical college, Jodhpur. The randomly selected children belonging to either sex were allocated to two groups, each group consisted of 25 children. Routine monitoring of every child included precordial stethoscope, ECG, NIBP, SpO2 through pulse oxymeter and temperature. After surgery the children were transferred to recovery ward and were observed up to 1 hour and then in post-operative ward at 1, 4, 6, 12, 24 hours.
Results: Our study showed that the mean age of patients in group A was 4.78±2.446 yrs and group B was 5.240±2.521 yrs, it was not statistically significant (P>0.05) and mean values of weight and duration of surgery were also not statistically significant (P>0.05 respectively). At 6 hours of observation one patient in group A and 2 patients in group B demanded for rescue analgesia. At 12 hours of observation 4 patients from both groups demanded for rescue analgesia.
Conclusion: We concluded that caudal bupivacaine 0.125% in a dose of 1 ml/kg with rectal diclofenac Na suppository in a dose of 2.5 mg/kg just after induction of anaesthesia provides equivalent analgesia up to 24 hour in postoperative period with minimum side effects and lesser incidences of nausea and vomiting, sedation, time taken to void urine, in comparison to caudal bupivacaine in the same dose along with buprenorphine.
Keywords: Post-operative pain, Caudal anaesthesia, Buprenorphine, Bupivacaine, Rectal diclofenac Na.
References
- Campbell MF. Caudal Anaesthesia in children. Am J Urol.1933; 30:245-249.
- Fell D, Errington MC, Taylor E and Wanless JG. Paediatric postoperative analgesia. Anaesthesia 1988; 43:107-110.
- Kehlet H. Surgical stress: The role of pain and analgesia. British Journal of Anaesthesia. 1989; 63: 189-95.
- Dahl JB, Rosenberg J, Dirkes WE, Mogensent, Kehlet H. Prevention of post-operative pain by balanced analgesia. British Journal of Anaesthesia. 1990; 64: 518-20.
- Stoelting RK. Opioid agonist and antagonist. In pharmacology and physiology in anaesthetic practice, 2nd edition Philedelphia. J.B. Lippincott Company.1991; 95-101.
- Lanz E, Simko G, Theiss D, Glocke MH. Epidural buprenorphine: a double blind study of post-operative analgesia and side effects. Anesth Analg. 1984; 63:593-98.
- Girotra S, Kumar S. Post-operative analgesia in children who have genitor-urinary surgery: a comparison between caudal buprenorphine and bupivacaine. Anaesthesia 1990; 45: 406-408.
- Wolff J,Carl P and Crawford ME. Epidural buprenorphine for postoperative analgesia. A controlled comparison with epidural morphine. Anaesthesia 1986;41:76-79.
- Gundersen RY, Andersen R, Narverid G. Postoperative pain relief with high dose epidural buprenorphine: a double blind study. Acta Anaesthesiologica Scandinavica 1986; 30:664-67.
- Mc Gown RG. Caudal analgesia in children-five hundred cases for procedures below the diaphragm. Anaesthesia 1982;37:806-18.
- Brandao, L de F, Marlete M.Anestesia caudal em pediatria. Revisa Brasil de Anestasia 1969; 19: 549.
- Wolf AR, Valley RD, Fear DW, Roy WL, Lerman J. Bupivacaine for caudal analgesia in infants and children: The optimal effective concentration. Anaesthesiology 1988; 69: 102-6.
- Anil Kumar TK, Karpurkar SA, Shinde VS; Postoperative pain relief in children following caudal bupivacaine and buprenorphine- a comparative study. J Postgrad Med. 1994;40 (2):61-64.
- De Boer AG, Moolenaar F, De Leede LGJ, Breimer D: Rectal drug administration: Clinical pharmacokinetic considerations Clinical Pharmacokinetics 1982; 7: 285-311.
- Moores MA, Wandless JG, Fell D. Paediatric post-operative analgesia. A comparison of rectal diclofenac with caudal bupivacaine after inguinal herniotomy. Anaesthesia 1990;45: 156-8.
- Gadiyar V, Gallagher TM, Crean PM, Taylor RH. The effect of a combination of rectal diclofenac and caudal bupivacaine on post-operative analgesia in children. Anaesthesia 1995; 50:820-22.
Corresponding Author
Dr Anita Harsh
Associate Professor, Department of Pathology, S.M.S. Medical College, Jaipur
Address: 241/3, Parwati Marg, Raja Park, Jaipur-302004 India
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