Optimising post operative pain reduction in Hypospadias by Levobupivacaine

Abstract

PURPOSE In a collaborative study of paediatric urologists, nurse practioners (NP) and anaesthesiologists a paediatric pain study was performed concerning postoperative pain reduction by Levobupivacaine (LB) in Hypospadias patients. Aim was to protract the average duration and dispersion of anaesthesia, and to perform a power-analysis for a dose-effect trial in the future. MATERIAL AND METHODS Two different concentrations of LB (0,125% and 0,375%) were compared. LB was used for a caudal block before the operation, no other analgesics before, during or after the operation were permitted. Each group included 10 children. The NP coordinated the study. Measurement of pain intensity and legs movement were taken on a fixed time schedule and registration list, with the Children and Infants Postoperative Pain Scale (CHIPPS) and Bromage scale. Measurement started at the recovery and continued at the department. The child received analgesics when CHIPPS ≥ 4. RESULTS Hypospadias: glandular (3), coronal (10), penoscrotal (3), distal shaft (1), mid shaft (2), Hypospadia sine hypospady (1). Averages: age of the child 18 months (10-54); weight 10 kg (4-21); duration of the operation and anaesthesia: 2:32 hour (1:00-3:13) and 2:37 (1:03-3:14); recovery time: 1:03 (40-90) and total observation time: 16:57 hour (3:01-26:15); moving legs after 2:43 hour (1:52-3:42) and standing up after 3:3 hour (2:05-6:15). 50% of the children with a low dose LB had a CHIPPS ≥ 4 and 11% of the children with a higher dose of LB had a CHIPPS ≥ 4. CONCLUSIONS Significant differences; treatment with a higher dose LB seems to have a longer effect but a remarkably long pain free period in some patients was seen with the low dose.