Analgesia for hypospadius repair in children: a comparison of caudal bupivacaine and intravenous morphine

The present study is a prospective randomized double-blinded study that was designed to evaluate and compare the effectiveness of postoperative pain control and the incidence of complications between caudal block and intravenous morphine in paediatric patients undergoing hypospadius repair. Sixty patients aged 1-7 years were randomly allocated to two groups of thirty. One group received intravenous morphine 100 microgram/kg before the skin incision and the other had a caudal block with 0.5ml/kg bupivacaine 0.25% before the skin incision. All patients received standardized anaesthesia. Pain was assessed using a 0 - 10 scale at 0, 1, 2, 3, 4, 6, 8 and 24 postoperative hours. The time to the first analgesia, the number of paracetamol doses, the incidence of respiratory depression, vomiting, itching, motor weakness and urine retention were assessed during the first 24 hours. Pain scores were significantly higher in group M compared to group C on admission to the post-anaesthesia care unit and during the following 3 postoperative hours. There was no significant difference in pain scores between the two groups at 4, 6, 8 and 24 hours after surgery. The time to the first analgesia was significantly lower in Group M compared to Group C. The total number of intraoperative fentanyl doses was significantly higher in Group M compared to group C, and there was no significant difference in the number of total paracetamol doses over the 24 postoperative hours between the two groups. None of the sixty patients experienced postoperative respiratory depression, urine retention or motor weakness, but significantly more patients in Group M experienced vomiting and itching compared to Group C. The degree of parent's satisfaction about the quality of postoperative analgesia and the side effects was better in the caudal group compared to the morphine group. We conclude that caudal analgesia is more effective than intravenous morphine [100 microgram/kg] for postoperative pain control during the immediate postoperative period in children undergoing hypospadius surgical repair with a higher incidence of vomiting and itching in the morphine treated patients

Preemptive ilioinguinal-iliohypogastric nerve block versus intravenous morphine for postoperative pain control after unilateral inguinal herniotomy in children: a comparative study

Inguinal hernia repair in children is one of the commonest surgical procedures. As a day-case procedure, it requires adequate post-operative pain control. A prospective randomized double-blinded study was designed to compare the effectiveness of postoperative pain control and incidence of complications between combined ilioinguinal/iliohypogastric nerve block and intravenous morphine. Sixty patients aged 2-12 years were randomly allocated to two groups of thirty. One group received intravenous morphine 100 microgram/kg before skin incision and the other had an ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine [0.25 ml/kg] also before skin incision. All patients have received standardized anaesthesia. Pain was assessed using 0-10 scale at 0.30 minutes and 1, 2, 3 and 4 hours postoperative. Time to first analgesia, number of paracetamol doses and the incidence of respiratory depression, vomiting and itching were assessed during the first 24 hours. During the first four postoperative hours, the two groups had identical pain scores. Time to first analgesia and number of doses of the rescue drug for residual pain during the first 24 postoperative hours was equal for the two groups. None of the 60 patients had respiratory depression but the morphine group patients were found to have more episodes of vomiting [P<0.05], no significant differences in itching [p=NS]. We concluded that both intravenous morphine [100 microgram/kg] and ilioinguinal-iliohypogastric nerve block have the same analgesic effect for postherniorrhaphy pain in children with higher incidence of vomiting in morphine treated patients

impact of long-lasting preemptive epidural analgesia before total hip replacement on the hormonal stress response. a prospective, randomized, double-blind study

Recent studies suggest that preemptive analgesia may be effective in reducing postoperative pain. One physiologic explanation may be interference with the endogenous opioid response. We investigated whether long-lasting preoperative preemptive analgesia may have an effect on the hormonal stress response after total hip replacement. 42 patients scheduled for elective hip replacement for coxarthrosis were randomized to receive, on the day before the operation, either 5 ml*h[-1] ropivacaine 0.2% [study group, n=21] or 5 ml*h[-1] saline [control group, n=21]. Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia [PCEA] with ropivacaine 0.2%. The main outcome measure was the concentration of authentic beta-endorphin [1-31] in plasma up to 4 days after surgery. Additional parameters included concentrations of adrenocorticotrope hormone and cortisol. Both groups were comparable concerning preoperative parameters and pain scores. Epidural blocks were sufficient in all patients for operative analgesia. Preemptive analgesia was performed for 11-20 hours in both groups and led to significantly decreased pain scores before surgery. Preemptive analgesia with epidural ropivacaine did not lead to decreased concentrations of beta-endorphin [1-31] before the start of surgery or in the postoperative period. Furthermore, no differences could be detected in the time course of beta-endorphin and adrenocorticotrope hormone after surgery. However, cortisol concentrations differed significantly between groups before the operation, but showed a comparable rise after surgery. Differences in postoperative pain after preemptive analgesia do not seem to be due to an altered endogenous opioid response

balanced anesthesia with dexmedetomidine decreases postoperative nausea and vomiting after laparoscopic surgery

To evaluate the effect of adding dexmedetomidine to a balanced anesthetic technique on postoperative nausea and vomiting after laparoscopic gynecological surgeries. A prospective double-blind randomized study was designed at Jordan University Hospital, Amman, Jordan between December 2008 and February 2009. Eighty-one female patients in their child-bearing age [17-48 years]; American Society of Anesthesiologists [ASA] clinical status I, who were scheduled for elective diagnostic laparoscopic surgeries under general anesthesia were divided into 2 groups. Group D [n=42] received dexmedetomidine infusion, while group P [n=39] received 0.9% sodium chloride infusion along with the balanced anesthesia. The incidence of early [up to 24 hours] postoperative nausea, vomiting, nausea and vomiting, and the need for postoperative rescue anti-emetic medications were recorded. The total incidence of postoperative nausea and vomiting decreased significantly in group D; 13 out of 42 patients [31%], compared to group P; 23 out of 39 patients [59%], vomiting alone did not significantly change, the incidence of postoperative nausea, and the use of rescue anti-emetic medications were significantly different. A significant drop in overall consumption of fentanyl and sevoflurane was also noted in group D. Combining dexmedetomidine to other anesthetic agents, results in more balanced anesthesia and a significant drop in the incidence of postoperative nausea and vomiting after laparoscopic gynecological surgeries