Control of Post-Operative Pain in Children Undergoing Hypospadias and Penile Curvature Surgery: Quasi-Experimental Study

Abstract

PURPOSE Hypospadias and penile curvature (HPC) are common congenital anomalies. If not surgically corrected they may negatively affect the quality of life of adolescents. Surgery is invasive and the post-operative phase is very painful. To obtain a good control of post-operative pain, the use of an epidural catheter to administer analgesia continuously was introduced. No studies are available about the efficacy of this method compared to the use of rectal and oral analgesia in children undergoing HPC surgery. Aim: To verify if in children undergoing HPC surgery, post-operative continuous analgesia with epidural catheter is more effective in controlling pain than traditional treatment. MATERIAL AND METHODS Quasi-experimental controlled study. Convenience sample of children undergoing HPC surgery, admitted to the Surgical Department of Meyer Children Hospital (Florence, Italy) from January to April 2007.Children were divided into two groups: Group A was treated with tunneled epidural catheter and Group B treated with rectal analgesia at fixed time plus oral analgesia on demand. Nurses measured pain using VAS and FLACC scales (scores 0 to 10) for 72h after surgery. RESULTS 41 children observed (mean age 64.1 months, SD 47.3), 332 post-operative pain recordings (Group A n=161, Group B n=171). Mean pain score of Group A was 0.13 (SD 0.8) and 0.42 (SD 1.4) in Group B, T-test p = 0.02. Median duration of the epidural catheter was 65h, the mean 51.8 h (SD 24.3). 93 pain recordings during medication. During the first medication mean pain score in Group A was 1.5 (SD 1.8), 3.2 (SD 1.8) in Group B T-test p=0.01. CONCLUSIONS In children undergoing HPC surgery the use of continuous analgesia in epidural catheter seems to reduce pain compared to the use of traditional analgesic treatment.