Comparison of Caudal Analgesia and Intravenous Diclofenac for Postoperative Pain Relief in Paediatric Patients Undergoing Daycase Herniotomy
AbstractBackground: Effective postoperative pain management is a vital determinant to when a child can be safely discharged from the hospital after day case surgery. This study compared the effect of caudal bupivacaine block with intravenous diclofenac for postoperative pain relief in children aged 1-7years undergoing herniotomy.
Patient and method: Sixty(60) ASA physical status I & II children randomly received caudal block with 0.125% bupivacaine 1ml/kg (Group A) or intravenous infusion of diclofenac 1mg/kg in 4.3% dextrose in 0.18% saline 4ml/kg (Group B) after induction of general anaesthesia. Postoperative pain was assessed in the recovery room with mCHEOPS on arrival, 1, 2, 3, and 4hr intervals. The parents assessed pain for 24 hours postoperatively. Oral paracetamol 20mg/kg was administered if pain was moderate or severe. Total analgesic consumption was compared in both groups at 24hr after surgery.
Results: The time to first rescue analgesia was 239.3± 24.6min in group A versus 167.6±43.2min in group B, (p=0.024). Pain scores at 0, 1, 2 and 3hours were significantly different with patients in group A having lower scores at 0-2 hours. The time to micturition was 156.5±28.3min in group A and 182.9±39.5min in group B (p=0.004) while time to ambulation was 186.5± 44.2min in group A, but 218.0± 32.4min in group B (p=0.003). The times to discharge from the recovery room were not different between the groups. Twenty five patients (83.33%) in group A were given oral paracetamol compared with16 patients (53.3%) in group B. No complication was noted in any of the two groups.
Conclusion: Caudal bupivacaine provided better post-operativepain relief than i/v diclofenac in the first 3hours after administration but i/v diclofenac decreased pain and analgesic requirement in the latter part of the postoperative period due to its long duration of action.
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