Abstract
Backgrounds: In childhood, the most performed emergency abdominal operation is appendectomy. In this study, we aimed to evaluate a combination of levobupivacaine and morphine via caudal route in the management of postoperative pain after open appendectomy in children. Methods: A total of 120 children with ASA I-II physical status, aged 3-7 years and undergoing open appendectomy, were randomly allocated to two groups; only 0.5% levobupivacaine 1.5 mL/kg (Group L) and 0.5% levobupivacaine 1.5 mL/kg plus morphine 50μg/kg (Group LM). After the surgery, pain management was quantified with Modified Eastern Ontario Children’s Hospital pain scale (mCHEOPS) up to 24 hours postoperatively Side effects of the procedure and test drugs were also recorded. Results: A total of 102 patients aged between 3-7 years, belonging to ASA I-IIE category were included in the study. The two groups were comparable for demographic data. On comparison of postoperative pain scores, Group L had significantly higher pain scores at 1, 2 and 3 hours postoperatively compared to Group LM (p<0.05). Conclusion: In children undergoing open appendectomy, single-dose levobupivacaine + morphine mixture via caudal route is a simple, safe and efficient method for post-operative analgesia.
Highlights
Acute appendicitis is a common condition affecting all age groups with a life-time incidence between 7 and 9% [1,2] and appendectomy is one of the most commonly performed surgical procedure
Six patients in group L, eight patients in group LM for prolonged of postoperative length of hospital stay, and four patients in group LM due to wound infection were excluded from the study
Patients were divided into group L (n=54) and group LM (n=48)
Summary
Acute appendicitis is a common condition affecting all age groups with a life-time incidence between 7 and 9% [1,2] and appendectomy is one of the most commonly performed surgical procedure. Open appendectomy performed through the right lower quadrant incision was first described in 1894 [3]. It has become the standard treatment of choice for acute appendicitis, remaining mainly unchanged for 100 years due to its favorable efficacy and safety [2]. Caudal administration of morphine is a frequently used epidural technique for postoperative analgesia in children. Epidural administration of morphine provides long term potent analgesia with dose dependent sedation and respiratory depression. Minimal effective dose of morphine via caudal route for postoperative pain relief after lower-abdominal surgery is still not determined [5,6,7,8]
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