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COMPARISON OF CAUDIAL ANALGSIA AND INTERAVENOUS DICLOFENAC FOR POSTOPERATIVE PAIN RELIEF IN PAEDIATRIC PATIENTS
Abstract
The treatment of postoperative pain in children has attracted special attention for many decades. Out-patients undergoing day care procedure require perioperative analgesic technique that is effective, has minimal side effects and safe. Adequacy of post operative management is one of the important factors determining when a patient can be safely discharged from the out-patient facility7.
This is a randomised comparative study on postoperative analgesic efficacy and adverse events associated with caudal block and intravenous diclofenac given before surgical incision in 60 ASAI & II children aged 1-7years scheduled for day
case herniotomy.
No premedication was given to any of the patients. Anaesthesia was achieved with 3.5% halothane in 100% oxygen or intravenous propofol 3mg/kg. An LMA was then inserted and secured with adhesive tape. Caudal block with 0.125% bupivacaine
(1ml/kg) was given in GroupI (n=30) and intravenous diclofenac (1ml/kg) in Group II (n=30).
Pain was assessed by two different methods- mCHEOPS and verbal rating scale, during the first 4 hours in the recovery room and up to the 24th hour at home by the parents. Parents were to rate the pain as none, mild, moderate, severe and very severe. Total analgesic consumption at home among the two groups was compared.
The mean duration to first analgesia in the caudal group was 239±24.6 minutes compared to 167.6±43.2 (SEM) minutes in the diclofenac group (p <0.0001). This study showed immediate postoperative pain control was significantly better in the caudal group than the diclofenac group.
The mean pain score in the first 2 hours in the caudal group was 0.0±0.0 while it was 2.8± 2.9 in the diclofenac group (p<0.001). Details of Paracetamol consumption at home in the latter part of the study showed that diclofenac group had better pain control than the caudal group.
No complication was attributed or seen in any of the techniques in the immediate and in the late postoperative.
