Postoperative Analgesia In Children Research Articles

Ultrasound-guided Quadratus Lumborum Block versus caudal block for postoperative analgesia in children undergoing acute appendicitis: a comparative study

Background: ultrasound (US)-guided Quadratus Lumborum Block (QLB) is an effective technique in providing analgesia for abdominal surgery. This study was designed to evaluate the efficacy of a US-guided Quadratus Lumborum Block (QLB) compare it with a caudal block in children after acute appendicitis.
 Patients and methods. Forty eight (48) ASA 1–2, 1–5-year-old children scheduled for elective acute appendicites were studied. All patients received general anesthesia; sevoflurane was used for induction and maintenance of anesthesia and laryngeal mask airway (LMA) was used to secure the airway. After securing an intravenous cannula, patients were randomized to a US-guided Quadratus Lumborum Block (QLB) (n = 24) (group Q) using 0.5 ml/kg of 0.25 % bupivacaine, injected on the same side of surgery, and group C received a caudal block using 1 ml/kg of 0.2 % bupivacaine (n = 24). Surgery was allowed 15 min after administration of the block. Block failure was considered in case of gross movement or more than 20 % change in heart rate and/or ABP persisting more than 1 min after skin incision. Any adverse events were recorded. After surgery, patients remained for 4 h in the recovery room. Postoperative analgesia was evaluated using Children and Infants Postoperative Pain Scale (CHIPPS). An anesthesiologist, who was not part of the study team, evaluated the need for rescue analgesia in the intraoperative and postoperative period and a recovery nurse collected the data. If the CHIPPS score was greater than 4, a rescue analgesia of 20 mg/kg acetaminophen was administered.
 Results. No difference was found in hemodynamics in both groups. Also, intraoperative fentanyl consumption was not different and no rescue analgesia was required in the postanesthesia care unit.
 Conclusion. US-guided Quadratus Lumborum Block (QLB) is as effective as caudal block in providing immediate postoperative analgesia in acute appendicitis.

Postoperative breakthrough pain in paediatric cardiac surgery not reduced by increased morphine concentrations.

Morphine is commonly used for postoperative analgesia in children. Here we studied the pharmacodynamics of morphine in children after cardiac surgery receiving protocolized morphine. Data on morphine rescue requirements guided by validated pain scores in children (n = 35, 3-36 months) after cardiac surgery receiving morphine as loading dose (100 μg kg-1) with continuous infusion (40 μg kg-1 h-1) from a previous study on morphine pharmacokinetics were analysed using repeated time-to-event (RTTE) modelling. During the postoperative period (38 h (IQR 23-46)), 130 morphine rescue events (4 (IQR 1-5) per patient) mainly occurred in the first 24 h (107/130) at a median morphine concentration of 29.5 ng ml-1 (range 7-180 ng ml-1). In the RTTE model, the hazard of rescue morphine decreased over time (half-life 18 h; P < 0.001), while the hazard for rescue morphine (21.9% at 29.5 ng ml-1) increased at higher morphine concentrations (P < 0.001). In this study on protocolized morphine analgesia in children, rescue morphine was required at a wide range of morphine concentrations and further increase of the morphine concentration did not lead to a decrease in hazard. Future studies should focus on a multimodal approach using other opioids or other analgesics to treat breakthrough pain in children. In children receiving continuous morphine infusion, administration of rescue morphine is an indicator for insufficient effect or an event. Morphine rescue events were identified at a wide range of morphine concentrations upon a standardized pain protocol consisting of continuous morphine infusion and morphine as rescue boluses. The expected number of rescue morphine events was found to increase at higher morphine concentrations. Instead of exploring more aggressive morphine dosing, future research should focus on a multimodal approach to treat breakthrough pain in children.

Effect of Intravenous Dexamethasone in Combination with Caudal Analgesia on Post Operative Pain Control after Herniotomy in Children

Background: Dexamethasone has a powerful anti-inflammatory action and has demonstrated reduced morbidity after surgery.&#x0D; Objectives: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudalblock on postoperative analgesia in children.&#x0D; Methods: This study was a randomized, double blind clinical trial, in which 77 children of ASA I and II, aged 3-10 years, undergoing elective unilateral herniotomy operation, was allocated in a double blind manner. Control Group I consist of 39 patients and Dexamethasone Group II consists of 38 patients. Group II received i.v. Dexamethasone 0.5 mg/Kg (Maximum 20 mg) and Group I received the same volume of i.v. saline after induction of anaesthesia. After inhalation induction of general anaesthesia, children received either dexamethasone 0.5-1 mg/Kg (maximum 20 mg) (n=39) or the same volume of saline (n=38) i.v. A caudal anaesthetic block was then performed using 1.5 ml/kg of Bupivacaine 0.25% in all patients. After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h.&#x0D; Results: Significantly, fewer patients in the dexamethasone group required fentanyl for rescue analgesia (7.9% vs38.5%, p&lt;0.05) in the post-anaesthetic care unit or acetaminophen (23.7% vs 64.1%) after discharge compared with the control group. The time to first administration of oral acetaminophen was significantly longer in the dexamethasone group (646 vs 430 min). Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups.&#x0D; Conclusion: Intravenous dexamethasone 0.5-1 mg/Kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia with out adverse effects in children undergoing herniotomy.&#x0D; DS (Child) H J 2019; 35(2) : 145-149

Ultrasound-guided ilioinguinal-iliohypogastric block (ILIHB) or perifocal wound infiltration (PWI) in children: a prospective randomized comparison of analgesia quality, a pilot study

BackgroundIlioinguinal-iliohypogastric block (ILIHB) is a well-established procedure for postoperative analgesia after open inguinal surgery in children. This procedure is effective and safe, especially when ultrasound is used. Data availability for comparing ultrasound-guided blocks versus wound infiltration is still weak. The study was designed to determine the efficacy of ultrasound-guided ILIHB (US-ILIHB) on postoperative pain control in pediatric patients following a inguinal daycase surgery, compared with perifocal wound infiltration (PWI) by the surgeon.MethodsThis randomized, double-blinded trail was conducted in pediatric patients aged from 6 months to 4 years. The total number of children included in the study was 103. Patients were allocated at random in two groups by sealed envelopes. The ILIHB group recieved 0,2% ropivacain for US-ILIHB after anesthesia induction. The PWI group recieved 0,2% ropivacain for PWI performed by a surgeon before wound closure. Parameters recorded included the postoperative pain score, pain frequency, time to first analgesics and consumption of analgesics.Results: US-ILIHB significantly reduced the occurrence of pain within the first 24 h after surgery (7.7%, p = 0.01). Moreover, the pain-free interval until administration of the first dose of opioids was 21 min longer, on average (p = 0.003), following US-ILIHB compared to perifocal wound infiltration. 72% of children who received US-ILIHB did not require additional opioids, as compared to 56% of those who received PWI.ConclusionThus our study demonstrates that US-ILIHB ensures better postoperative analgesia in children and should be prioritized over postoperative PWI.Trail registrationUIHBOPWIIC, DRKS00020987. Registered 20 March 2020 – Retrospectivley registered.

Caudal block versus Penile block for postoperative ‎analgesia in children undergoing hypospadias repair

ABSTRACT Background: Caudal block is recommended for analgesia during and after hypospadias repair operation of the penis in children. Aim of the Study: Compare the effectiveness of caudal block vs. dorsal penile block in children undergoing hypospadias repair surgery with respect to postoperative analgesia and appeal for rescue analgesics during the first 24hours. ‎ Patients and Methods: ‎ The study was conducted on 40 male children, ASA I-II, 4-8 years of age undergoing hypospadias repair surgery under general anesthesia. Children were randomly classified into two groups: (Group P) (penile group=20 patients) received a penile block of 2mL bupivacaine 0.25 per cent on each side, (Group C) (caudal block group=20 patients) with a caudal block of 0.25 per cent (1mg / kg) bupivacaine on each side. Postoperative pain assessment will be conducted by mCHEOPS) Children's Hospital of Eastern Ontario Pain Scale (request for rescue analgesic and complete analgesic dosage (mg.). Results: The PACU mCHEOPS pain score was lower in Group C at 2 hrs, 4 hrs and 6 hrs postoperative. Also, the time for the first need for rescue analgesia was statistically significantly lower in group C. The overall analgesic rescue requirement in Group C was also significantly lower. Conclusions: Caudal block tended to be more effective in lowering postoperative pain scores and decreasing the need for rescue analgesia. Key Words: Caudal block, Penile block, Bupivacaine, Hypospadias repair.

Intravenous Dexamethasone Prolongs the Analgesic Effect of Caudal Bupivacaine after Hypospadias Repair Surgery

Background: Dexamethasone has a powerful anti-inflammatory action and has been demonstrated to reduce morbidity after surgery. Objective: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children. Patients and methods: Sixty pediatric patients (aged 2-10 years) undergoing hypospadias repair surgery were included in this prospective, randomized, double-blinded study at Sohag University Hospital. After induction of general anaesthesia, children received either dexamethasone 0.5 mg ∕ kg (maximum 10 mg) (n=30) or the same volume of saline (n=30) i.v. A caudal anaesthetic block was then performed using 1 ml ∕kg of bupivacaine 0.25% in all patients. Results: After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. The time to first administration of acetaminophen (rescue analgesia) was significantly longer in the dexamethasone group (11.35 ± 2.36 hr vs 8.75 ± 1.33 hr) with a significant value of 0.01. Total amount of the analgesia required (paracetamol) was significantly lower in dexamethasone plus caudal block group than the caudal block alone (430 mg vs 680 mg) respectively. Conclusion: Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Intravenous dexamethasone 0.5 mg ∕ kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing hypospadias repair surgery.

Intravenous Dexamethasone Prolongs the Analgesic Effect of Caudal Bupivacaine after Hypospadias Repair Surgery

Background: Dexamethasone has a powerful anti-inflammatory action and has been demonstrated to reduce morbidity after surgery. Objective: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children. Patients and methods: Sixty pediatric patients (aged 2-10 years) undergoing hypospadias repair surgery were included in this prospective, randomized, double-blinded study at Sohag University Hospital. After induction of general anaesthesia, children received either dexamethasone 0.5 mg ∕ kg (maximum 10 mg) (n=30) or the same volume of saline (n=30) i.v. A caudal anaesthetic block was then performed using 1 ml ∕kg of bupivacaine 0.25% in all patients. Results: After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. The time to first administration of acetaminophen (rescue analgesia) was significantly longer in the dexamethasone group (11.35 ± 2.36 hr vs 8.75 ± 1.33 hr) with a significant value of 0.01. Total amount of the analgesia required (paracetamol) was significantly lower in dexamethasone plus caudal block group than the caudal block alone (430 mg vs 680 mg) respectively. Conclusion: Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Intravenous dexamethasone 0.5 mg ∕ kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing hypospadias repair surgery.

Порівняння різних методів післяопераційного знеболення у дітей з перитонітом, ускладненим інтраабдомінальною гіпертензією

Порівняння різних методів післяопераційного знеболення у дітей з перитонітом, ускладненим інтраабдомінальною гіпертензією

Postoperative Analgesia in Children Using Peripheral Nerve Blocks

Postoperative Analgesia in Children Using Peripheral Nerve Blocks

A Comparative Study between Effects of Ultrasound Guided Ilioinguinal /Iliohypogastric Nerve Block versus Caudal Block on Postoperative Analgesia in Children Undergoing Inguinal Surgery

Abstract Background The most commonly performed inguinal surgeries in children include inguinal hernia repair with or without orchidopexy and hydrocele repair. For postoperative pain with these surgeries, a regional analgesic modality such as caudal analgesia (CA), ilioinguinal and iliohypogastric nerve block (IL/IH), or even local infiltration is combined with a general anaesthetic (GA). Regional analgesia techniques are commonly used to facilitate pain control during pediatric surgical practice, decrease parenteral opioids requirements and improve the quality of post-operative pain control and patient-parent satisfaction. When compared to intravenous (IV) opioids, regional techniques reduce the risk of side effects such as somnolence, respiratory depression, emesis, and ileus. Patients and Methods: After approval of anesthesia, intensive care and pain management department, scientific and ethical committees, and after informed parental written consents, this prospective randomized clinical trial study was conducted in Ain Shams University Hospitals. This study is considered to be a pilot exploratory study. Forty five children patients were included in the study scheduled for elective inguinal surgeries (e.g.; unilateral inguinal hernia repair, hydrocele repair, or orchidopexy). Patients will be randomized using a random number table and the use of a closed envelopes technique to receive either combined general anesthesia with ultrasound guided caudal block (Group A), combined general anesthesia and ultrasound guided ilioinguinal /iliohypogastric block (Group B), or general anesthesia with intravenous morphine (group C). Results Among 45 children of (27 boys and 18 girls), aged from one to six years old, ASA physical status I–II who were scheduled for elective unilateral inguinal surgeries, fifteen patients received general anesthesia with ultrasound guided caudal epidural anesthesia (1ml/kg bupivacaine 0.25%), fifteen patients received general anesthesia with ultrasound-guided ilioinguinal/ iliohypogastric nerve block (0.5ml/kg bupivacaine 0.25%) and fifteen patient received general anesthesia with intravenous morphine (0.1 mg/kg). Conclusion The current study demonstrated that ultrasound-guided ilioinguinal /iliohypogastric nerve block was more effective than ultrasound guided caudal epidural block or intravenous morphine usage in children aged 1-6 years old undergoing unilateral inguinal surgeries as it carried the advantages of faster onset of action, longer duration of postoperative analgesia, the need of lower volumes of local anesthetic agents with no recorded complications.

Caudal block versus penile block for postoperative analgesia in children undergoing hypospadias repair

Abstract Background Hypospadias repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work The aim of this work is to evaluate the success rate and the effectiveness of penile block for hypospadias repair in pediatric patients in comparison with caudal block. Patients and Methods This prospective randomized study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 80 ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Group P penile block (n = 40) received dorsal penile nerve block by using the subpubic approach technique. Group C: Group C caudal block (n = 40) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was no statistically significant difference between two groups regarding haemodynamics including MBP (P &amp;lt; 0.05) and HR (P &amp;lt; 0.05). FLACC pain scores were significantly lower in group C compared with group P (P&amp;lt; 0.01). Also, the time to first need for analgesia was significantly lower in group C compared with group P (P&amp;lt; 0.001) .The total rescue analgesic requirement was also significantly lower (P&amp;lt; 0.001) in group C compared with group P.Postoperative time of ambulation was also significantly lower (P&amp;lt; 0.05) in group P compared with group C. Conclusion the current study revealed that caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with penile block in pediatric patients undergoing hypospadias repair.

Ultrasound-guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing inguinal hernia surgery: A comparative study.

Background and Aims:Ultrasound-guided (USG) transversus abdominis plane (TAP) block has emerged as a safe and effective regional anesthesia technique as it provides adequate postoperative pain relief for lower abdominal surgeries. Caudal block is a gold standard technique in pediatric surgeries. Our aim was to compare the duration of postoperative analgesia between TAP block and caudal block in children undergoing inguinal hernia surgeries.Material and Methods:In a prospective, randomized, controlled study, 112 children of age 2-8 years and ASA grade I and II, undergoing elective inguinal hernia surgery were randomly allocated into two groups: Group T (n = 56) received USG-guided TAP block with 0.5mL/kg of 0.2% ropivacaine and Group C (n = 56) received caudal block with 1mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of postoperative analgesia and the secondary outcome variables included variation in hemodynamic parameters and adverse effects, if any.Results:There was no significant difference in median of CHEOPS score till 5 postoperative hours, thereafter till 24 postoperative hours, significantly lower CHEOPS score were found in Group T. Mean duration of analgesia was 523.44 ± 61.30 min in Group T, whereas in Group C, it was 352.59 ± 32.54 min. No significant difference was observed in hemodynamic variations and adverse effects.Conclusion:TAP block and caudal block both are effective in providing postoperative analgesia in children undergoing inguinal herniotomy. USG-guided TAP block was found to be superior as it provided longer duration of analgesia and reduced rescue analgesic dose without any significant adverse effects as compared with caudal block after inguinal herniotomy.

The performanceof a postinduction fentanyl test in identifying severe obstructive sleep apnea syndrome.

Children with severe obstructive sleep apnea syndrome (OSAS) are more sensitive to opioids. Identifying such children and reducing or even eliminating opioids are necessary but difficult. We have previously shown that patients sensitive to intraoperative fentanyl require less opioids postoperatively. The objective of this study was to evaluate the performance of a postinduction fentanyl test in identifying severe obstructive sleep apnea syndrome. A prospective, observational, assessor-blinded study was carried out with 104 sleep study assessed children undergoing elective adenotonsillectomy. Intravenous fentanyl (1µg/kg) was administered as a test in nonpremedicated, spontaneously breathing, sevoflurane-induced patients before endotracheal intubation. The respiratory rates before and after fentanyl administration were studied. The primary outcome was the sensitivity and specificity of the postinduction fentanyl test in identifying severe OSAS compared with polysomnography. A postinduction fentanyl test had a likelihood ratio of 7.2 (95% CI: 3.6-14.6) and an area under the curve value of 0.896 (95% CI: 0.821-0.947) to identify severe obstructive sleep apnea syndrome. The pragmatic cut-off value for the postinduction fentanyl test was found to be 50%. Using a reduction in respiratory rate of >50%, the postinduction fentanyl test detected severe OSAS with a sensitivity of 87%, a specificity of 88%, a positive predictive value of 85%, and a negative predictive value of 89%. Our study showed that a postinduction fentanyl test had good predictive value in identifying severe obstructive sleep apnea syndrome and early postoperative adverse respiratory events and could provide a reference for postoperative analgesia in children undergoing adenotonsillectomy.

Systemic Lidocaine Infusion for Post-Operative Analgesia in Children Undergoing Laparoscopic Inguinal Hernia Repair: A Randomized Double-Blind Controlled Trial.

Systemic lidocaine can provide satisfactory post-operative analgesia in adults. In this study, we assessed whether intravenous lidocaine is effective for post-operative analgesia and recovery in children undergoing laparoscopic inguinal hernia repair. A total of 66 children aged from six months to less than six years were classified in either the lidocaine (L) or control (C) groups. Children in Group L received a lidocaine infusion (a bolus dose of 1 mL kg−1, followed by a 1.5 mg kg−1 h−1 infusion), whereas Group C received the same volume of 0.9% saline. The primary outcome was the number of patients who presented face, legs, activity, crying and consolability (FLACC) scores of four or more, and therefore received rescue analgesia in the post-anesthesia recovery care unit (PACU). Secondary outcomes included the highest FLACC score in the PACU, FLACC, and the parents’ postoperative pain measure (PPPM) score at 48 h post-operation, as well as side effects. The number of children who received rescue analgesia in the PACU was 15 (50%) in Group L and 22 (73%) in Group C (p = 0.063). However, the highest FLACC score in PACU was lower in Group L (3.8 ± 2.4) than in Group C (5.3 ± 2.7) (p = 0.029). In conclusion, systemic lidocaine did not reduce the number of children who received rescue analgesia in PACU.

Effectiveness of postoperative pain therapy in children assessed by their parents – is inadequate analgesia potentially dangerous?

Inadequate pain therapy can lead to negative physical and psychological consequences, increase complications and even mortality. We aimed to assess effectiveness of postoperative analgesia in children from their parents’ point of view. We also wanted to evaluate their degree of satisfaction of postoperative analgesia and to identify areas for improvement. Patients’ parents (n = 85) from Paediatric University Hospital in Warsaw, Poland, took part in our survey. They evaluated pain intensity on five-point Likert Scale and on numerical rating scale (NRS). Mean value of pain on NRS was 4.22 (SD±2,53). On Likert scale the majority of parents described pain intensity as moderate. High percentage (38.82%) of children were in pain while their parents took the survey and only 19% of children did not feel pain at all. In 36 children (42.36%) pain caused sleep disturbances. In same cases non-pharmacological methods of analgesia were effective. Due to inadequate pain relief one of the parents arbitrarily administered a formulation containing paracetamol and codeine. The study revealed low efficacy of analgesia among children of surveyed parents. Their level of satisfaction was inadequately high (91% of them were „very satisfied” or “rather satisfied”). The survey confirmed the need for systematic pain assessment tools. Parental education seems necessary to make them aware that postoperative pain can be treated effectively. Administration of drugs without consulting medical staff is dangerous. It may result in the use of contraindicated agents (as in the case described), drug overdose or unexpected interactions.

Comparison between Post-Operative Analgesic Efficacy of Low-Concentration High-Volume and High-Concentration Low-Volume Combinations of Ropivacaine for Transverse Abdominis Plane Block in Pediatric Open Inguinal Hernia Repair.

Transverse abdominis plane (TAP) block can provide post-operative analgesia in children undergoing open inguinal hernia repair. However, the optimal anesthetic dose, and concentration for TAP block in the pediatric population, is not well defined. This study compared the post-operative analgesic effect of TAP block between low-concentration, with high-volume (LCHV) and high-concentration, with low-volume (HCLV) combinations of local anesthetic. Forty-four patients who underwent open inguinal hernia repair were randomly assigned to two groups. The patients in the LCHV group received 0.67 mL/kg of 0.15% ropivacaine. Whereas, those in the HCLV group received 0.4 mL/kg of 0.25% ropivacaine. Both groups received the same amount of ropivacaine (1 mg/kg). The primary outcome measure was the face, leg, activity, cry, consolability (FLACC) scale score at post-anesthetic care unit (PACU; T1). FLACC scale score at T1 was significantly lower in the HCLV group (2.91 versus 1.43; mean difference, −1.49; 95% confidence interval, −0.0245 to −2.936; p = 0.0464). FLACC scale scores one hour and six hours after the surgery were not different between the two groups. This study reports better post-operative analgesic effects after unilateral open inguinal hernia repair with 1 mg/kg of 0.25% ropivacaine than 1 mg/kg of 0.15% ropivacaine at PACU.

Comparison of Caudal Tramadol with different doses of Midazolam addon for Postoperative analgesia in Children Undergoing Inguinoscrotal Operations

Background: Safe and effective postoperative analgesic modalities have remained a subject of contemporary clinical research, particularly in children. The present study aimed at comparing the effectiveness of pain relief in children undergoing inguinoscrotal surgery with caudal tramadol alone and in combination with different doses of midazolam.&#x0D; Methods: Ninety children of either sex, aged one year to fifteen years, undergoing inguinoscrotalsurgical procedures under general anesthesia were recruited in a randomized double blinded fashion to receive one of the three study medications through caudal route. Group T (n= 30) received injectiontramadol 2mg/kg in a volume of 0.5ml/kg up to a maximum volume of 20ml, while group TM (n= 30)and TM/2 (n= 30) received additional midazolam 50mcg/kg and 25mcg/kg respectively. The study medications were administered immediately after induction of anesthesia. Postoperative analgesia was measured using a modified Hannallah 10 points Pediatric Objective Pain Scale described by Hannallah and colleagues. Pain score of ≤ 4 was considered effective analgesia. Duration of analgesia was defined as the time between caudal injection to the first need of analgesia.&#x0D; Results: The duration of analgesia in group TM (1145±281.41 min) and TM/2 (1012.67±260.68 min)was significantly longer than that in group T (690.83±215.7 min) (p&lt;0.005). The sedation score was the highest in group TM and the least in group T. Nausea vomiting was the commonest side effect in all the three groups without any significant differences in the incidences between the groups.&#x0D; Conclusion: Addition of midazolam to tramadol for caudal administration in children undergoinginguinoscrotal operations produces significantly longer duration of postoperative analgesia than produced by epidural administration of tramadol alone.

Postoperative analgesia in children undergoing adenotonsillectomy under sevoflurane versus propofol-based anesthesia: a randomized controlled trial

BackgroundThe field of pediatric pain management has changed greatly in the past decades. However, the number of children who experience moderate-to-severe postoperative pain, even with analgesic treatment, remains significant. If an intravenous or inhalational anesthetic would include in itself all components of general anesthesia, such as hypnosis, analgesia, and amnesia, it would represent an ideal anesthetic. There are some pieces of evidence that propofol may reduce postoperative pain. This debate on the early potential analgesic efficacy of propofol compared with sevoflurane during the postoperative period in children was evident. The aim of this study is to compare the postoperative potential analgesic effects of propofol-based versus sevoflurane-based anesthesia in children undergoing adenotonsillectomy.MethodsThis study was a prospective comparative randomized, double-blinded trial conducted on 60 children between 3 and 10 years of age and American Society of Anesthesiologists physical status I and ІІ undergoing adenotonsillectomy under general anesthesia. Patients were randomly assigned to one of the following two equal groups: the sevoflurane group and the propofol group. The primary outcome was pain score assessed using the Faces Pain Scale postoperatively. The secondary outcomes included recovery time and adverse events within the first 4 h.ResultsThe current study showed that the postoperative resting and swallowing face pain score was significantly lower in the propofol group than in the sevoflurane group, and postoperative agitation scores were significantly lower in the propofol group than in the sevoflurane group during the first 30 min of early postoperative period. No significant differences were found from 40 min to the fourth postoperative hour. Paracetamol consumption during the 4-h postoperative period was significantly greater in the sevoflurane group than in the propofol group, and the incidence of postoperative nausea and vomiting was lower in the propofol group than in the sevoflurane group (P = 0.001).ConclusionThe use of propofol is more advantageous compared with sevoflurane for the induction and maintenance of general anesthesia in children undergoing adenotonsillectomy. It decreases early postoperative pain, analgesic consumption, postoperative agitation, and postoperative nausea and vomiting. However, the use of propofol in the induction and maintenance of anesthesia is associated with a prolonged recovery time.

The Effect of Glossopharyngeal Nerve Block on Post-Tonsillectomy Pain of Children; Randomized Controlled Trial.

BackgroundSensory fibers of the glossopharyngeal nerve supply the tonsillar and peritonsillar areas. Thus, bilateral glossopharyngeal nerve block may alleviate post-tonsillectomy pain and improve postoperative analgesia.ObjectivesThe purpose of this clinical trial was to evaluate the effect of glossopharyngeal nerve block on postoperative analgesia in children undergoing adeno-tonsillectomyMethodsNinety ASA I-II pediatric patients presented for adeno-tonsillectomy were included in this trial. They were equally divided and randomly assigned to one of two groups: A control group, in which children did not receive a nerve block, and a glossopharyngeal nerve block group, in which children received bilateral glossopharyngeal nerve block after surgery. The postoperative pain score (FLACC score) during rest and swallowing, the time for the first request for rescue analgesia, the total dose consumption of pethidine rescue analgesia, and the incidence of postoperative complications were all assessed. Moreover, response to gag reflex, degree of difficulty in swallowing, and parents’ satisfaction were recorded.ResultsBilateral glossopharyngeal nerve block in children presented for adeno-tonsillectomy significantly prolonged the time for the first request of rescue analgesia, compared to the control group, reaching 5.833 ± 2.667 hours (P < 0.0001). It also decreased postoperative pethidine consumption to 0.878 ± 0.387 mg/kg (P = 0.0009). Moreover, it significantly decreased the postoperative FLACC score assessed two, four, six, and twelve hours after surgery, during rest and swallowing (P < 0.05). The response to gag reflex and difficulty in swallowing were also significantly decreased (P ≤ 0.0001 and 0.006, respectively). In addition, glossopharyngeal nerve block significantly increased parents’ satisfaction (P = 0.0002), with no significant increase in the incidence of postoperative complications (P > 0.05).ConclusionsBilateral glossopharyngeal nerve block in children undergoing adeno-tonsillectomy improved the duration and the quality of postoperative analgesia, decreased swallowing difficulties, and improved parents’ satisfaction.

A comparative study of caudal epidural bupivacaine with bupivacaine plus fentanyl and bupivacaine plus neostigmine for anaesthesia and postoperative analgesia in children undergoing sub-umbilical surgeries

Background: Single-shot caudal anaesthesia with local anaesthetic has a limited duration of action.Therefore, many children undergoing sub-umbilical surgery with caudal analgesia require furtheranalgesia during the postoperative period. This study compared the effect of single-dose caudal epiduralbupivacaine, bupivacaine plus fentanyl and bupivacaine plus neostigmine for anaesthesia andpostoperative analgesia in children. Objective: To evaluate effectiveness of bupivacaine with the addition of fentanyl or neostigmine forcaudal anaesthesia and analgesia in children undergoing sub-umbilical surgeries. Methods: Total ninety (90) paediatric patients, aged 2-8 years with ASA(American society ofanesthesiologist) grades I &amp; II who were scheduled for surgery in Sher-E-Bangla Medical college Hospital,Barisal were included in this study. Data were collected by using a pre-designed questionnaire. Thepatients were randomly allocated to one of the three groups. Group A was received caudal 1 ml/kg ofbupivacaine 0.25%, Group B 1 ml/kg of bupivacaine 0.25% with fentanyl 1 μg/kg and Group C 1 ml/kgof bupivacaine 0.25% with neostigmine 2 μg/kg. Heart rate (HR), Blood pressure (BP), oxygen saturation(SpO2), Respiratory rate (RR) were recorded during operation and every five minutes thereafter. Theduration of analgesia was defined as the time from caudal injection to first dose of rescue analgesia.Rescue analgesia was given for an objective pain scale (greater than or equal to) 4 in the form of oralparacetamol (15mg/kg). Results: Assessment of anaesthesia was significantly longer in the two groups of children who receivedadditives compared with local anaesthetics group alone (p&lt;0.01). Mean time to first postoperativeanalgesic administration was 167.37±17.30 min, 280.57±14.40min, and 357.77±19.08 min in groupA, Group B, and group C respectively. The difference was statistically significant (p&lt;0.01) between thethree groups. In these cases duration of analgesia was considered from the placement of caudal to firstanalgesia. Conclusion: Addition of fentanyl or neostigmine to bupivacaine prolonged the duration of surgicalanaesthesia and postoperative analgesia after a single shot caudal injection with minimal incidence ofside effects in children undergoing sub-umbilical surgeries. This could be a safe and cheap alternative toextradural catheter placement for surgical procedures of intermediate duration. JBSA 2019; 32(1): 3-9