Effects of adding dexmedetomidine to local infiltration of bupivacaine on postoperative pain in pediatric herniorrhaphy: a randomized clinical trial (original) (raw)
Related papers
Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
Objective: To compare the efficacy of intravenous paracetamol and rectal diclofenac combination with caudal block using 1ml/kg of 0.25% bupivacaine in the management of post-operative pain following paediatric inguinal herniotomy. Methodology: This quasi-experimental study was conducted at the Department of Anesthesia, Holy Family Hospital, Rawalpindi, from February 2020 to August 2020. A total of 342 children aged 2-12 years requiring inguinal herniotomy were enrolled after satisfying the inclusion and exclusion criteria. Computer-generated random numbers were used to split the patients into two groups. Group A received intravenous paracetamol (30 mg/kg) and rectal diclofenac (1mg/kg). Group B received a caudal block using 1ml/kg of 0.25% Bupivacaine. Pain was assessed postoperatively in the PACU by modified Objective Pain Scale (OPS) every 15 minutes for the 1st hour and hourly up till 8 hours. Effective analgesia was defined as a modified OPS score of ≤ 3 for upto 8 hours after...
2016
Introduction: Neostigmine and midazolam are each added to bupivacaine for the purpose of caudal anesthesia. In this study, we compared neostigmine and midazolam, each coadministered with bupivacaine, in terms of analgesia and side effects during pediatric inguinal hernia operations. Material and Methods: We included 60 children 1–6 years-old, candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group received bupivacaine 25% 1 ml/kg with neostigmine 2 µg/kg through the caudal route. Heart rate, mean arterial pressure, and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at two, four, six, 12, and 24 hours after the operation, along with rescue ana...
Pakistan Armed Forces Medical Journal
Objective: To compare the effectiveness of Bupivacaine local wound infiltration with Bupivacaine caudal block on postoperative pain in children undergoing open inguinal hernia repair. Study Design: Quasi-experimental study. Place and Duration: Department of Paediatric Surgery, Pak Emirates Military Hospital Rawalpindi, from Jan to Sep 2019. Methodology: 60 patients (30 each in two groups) fulfilling the inclusion criteria who underwent open inguinal herniotomy were included in this study. Patients in group-A received caudal block with 0.25% Bupivacaine 1 ml/kg body weight, while Group-B received local wound infiltration of 0.5% Bupivacaine 2 mg/kg body weight after the completion of surgery. The post-operative pain score was calculated using Hannallah's objective pain scale at 30 minutes, one, two, four, six and eight hours following the procedure. A total pain score of 3 requiring the rescue analgesia in the form of oral Paracetamol (10 mg/kg body weight) was considered the end...
Local anaesthesia in postoperative analgesia for herniorrhaphy
Ambulatory Surgery, 1996
Objective: 'To test the hypothesis that local infiltration with buptvacaine at the time of herniorrhaph>i would decrease postoperative pain. Design: Sixty-five patients in whom a polypropylene mesh was implanted to treat an inguinal hernia were included in a random double-blind study. Operative anaesthesia was intrddural with prilocaine 5%. 1.25 mgikg. After the procedure. an ilioinguinal and iliohypogastric block was performed by infiltration of soft tissues with 0.1'; n&kg of either bupivacaine 0.5% or NaCl 9 g/l. Postoperative pain was assessed with an analog pain scale, (range 0 5) in the recovery room. 8 h later and 24 h later. The patient assessed the pain 24 h after surgery (range O-5) and the relationship with the pain hr expected (range O-2). The time when the first dose of analgesia (diclofenac 75 mg i.v.) was given was also noted (range O-6). A score (range O-28) was calculated to quantify postoperative pain. Results: Thirty-three patients were infiltrated with bupivacaine and B2 patients received placebo. Both groups were similar in sex, age, weight and operating time (44 (20 min)). No pain vvas reported for bupivacaine (score 1.4 (0.9)) and minor pain for placebo (score 2.1 (1.0)) in the recovery room (P < 0.05). Further pain assessment was similar in both groups (scores range: 1 .I-1.5). The first dose of analgesia was administered 2-3 h postoperatively (score 4.4 (2.0)) in the placebo group and 4 to 5 h postoperatively (score 2.9 (2.4)) in the bupivacaine group (P < 0.05). The final postoperative pain score was 11.3 (3.9) in the placebo group and 9.2 (4.4) in the bupivacdine group (P < 0.05). Conclusions: Local infiltration of the abdominal wall with bupivacaine reduces immediate postoperative pain and delays the ;tdmmrstration oi postoperative analgesia.
JMS SKIMS, 2011
BACKGROUND: Recent clinical studies have demonstrated that children experience a similar severity of post operative pain as adults and that even preterm infants demonstrate alterations in heart rate, blood pressure and oxygen saturation in response to pain. OBJECTIVE: To study the advantage of tramadol wound infiltration over bupivacaine on post operative pain relief in children following inguinal herniotomy and orchiodopexy METHODS: In this prospective single blinded randomized controlled study, 705 children aged between 1–7 years undergoing elective repair of unilateral inguinal hernia and orchiodopexy were randomly divided into 3 groups of 25 each. Group A (Tramadol) à wound infiltration with 2mg/Kg Tramadol in 0.2ml/Kg saline, Group B (Bupivacaine) à wound infiltration with 0.2ml/Kg of 0.25% of Bupivacaine and Group C (Tramadol i/m) à 2mg/Kg tramadol intra muscularly 20 minutes before the end of surgery. Children were assessed post-anesthesia for pain score and discharged from P...
Pediatric Anesthesia, 2006
Background: It has been demonstrated that tramadol is an effective analgesic. We aimed to compare postoperative analgesic effects of wound infiltration with tramadol (T) or bupivacaine (B) and intramuscular tramadol (I) after herniotomy in children. Methods: In this study, 75 children were randomly assigned to group T, group B and group I. Wound infiltration was performed to the patients in group T (2 mgAEkg)1 tramadol in 0.2 mlAEkg)1 saline) and group B (0.2 mlAEkg)1 0.25% bupivacaine) into the surgical incision. Twenty minutes before the end of the surgery 2 mgAEkg)1 tramadol was injected i.m. in group I. Faces pain scale was used for assessing pain severity. Patients with pain score >2 were treated with paracetamol. The frequency of side effects and analgesic use were recorded. Patients were discharged on the next day. Results: No side effects were recorded in any group. The pain scores of the patients at the first, fourth and eighth hours were significantly higher in group B and group I than group T (P < 0.05). The pain scores of the patients at the first hour were significantly higher in group I compared with group B (P < 0.05). Average time to first analgesic requirement was significantly longer in group T (6.72 ± 4.09 h after herniotomy than both group I (4.49 ± 3.9 h) and group B (6.04 ± 3.7 h) (P < 0.05). Conclusions: Wound infiltration with tramadol may be a good choice for postoperative analgesia in children having inguinal herniotomy.
British Journal of Anaesthesia, 2006
Background. This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children. Methods. Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg À1 (Group B; n=20), bupivacaine 0.25% 0.75 ml kg À1 with tramadol 1 mg kg À1 (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg À1 with tramadol 1.5 mg kg À1 (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg À1 with tramadol 2 mg kg À1 (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was >4. Duration of analgesia and requirement for additional analgesics was noted. Results. Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed. Conclusions. Caudal tramadol 2 mg kg À1 , combined with bupivacaine 0.25% 0.75 ml kg À1 , provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg À1 or 1.5 mg kg À1 in children undergoing inguinal herniotomy.
Dhaka Shishu, Children, Hospital journal, 2020
Background: Dexamethasone has a powerful anti-inflammatory action and has demonstrated reduced morbidity after surgery. 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. 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. Results: Significantly, fewer patients in the dexamethasone group required fentanyl for rescue analgesia (7.9% vs38.5%, p<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. 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.
Saudi Journal of Anaesthesia, 2017
Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6 th till 48 th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.