Effect of scalp infiltration on postoperative pain relief in elective supratentorial craniotomy with 0.5% bupivacaine with adrenaline 1:400,000.

OBJECTIVE: Determine the effect of scalp infiltration on postoperative craniotomy pain with 0.5% bupivacaine with adrenaline 1:400,000. MATERIAL AND METHOD: A prospective randomized double blind control trial was conducted on 50 patients (18-65 years), who were ASA physical status I to III, and scheduled for elective intracranial surgery at Maharaj Nakorn Chiang Mai Hospital, Thailand between October 2006 and December 2007. The patients received wound infiltration before skin closure by either 0.5% bupivacaine with adrenaline 1.:400,000 (group B), or normal saline with adrenaline 1:400,000 (group S). RESULTS: The median pain score in the first 12 hours trended to be lower in the bupivacaine group than in the control, but the differences were not statistically significant apart from the score in the first hour (median pain score = 2, IQR = 3; p = 0.031). There were more pain-free patients in the bupivacaine group than in the control group at all time intervals during the first 12 hours. However, the difference was significant in the first hour (7 vs. 1; p = 0.034). Although the median (range) time interval between the end of surgery and first administration of tramadol was longer in the bupivacaine group, when compared to the control group, it was not statistically significant. CONCLUSION: Surgical wound infiltration, before skin closure, with 0.5% bupivacaine with adrenaline decreased the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy, but only for the first hour after surgery.

Incidence and risk factors of emergence agitation in pediatric patients after general anesthesia.

OBJECTIVE: To study the incidence and evaluate factors associated with emergence agitation (EA) in pediatrics after general anesthesia. MATERIAL AND METHOD: A prospective observational study was conducted in 250 pediatric patients aged 2-9 years, who received general anesthesia for various operative procedures in Maharaj Nakorn Chiang Mai Hospital between October 2006 and September 2007. The incidence of EA was assessed Difficult parental-separation behavior, pharmacologic and non-pharmacologic interventions, and adverse events were also recorded Univariate and multivariate analysis were used to determine the factors associated with EA. A p-value of less than 0.05 was considered significant. RESULTS: One hundred and eight children (43.2%) had EA, with an average duration of 9.6 +/- 6.8 minutes. EA associated with adverse events occurred in 32 agitated children (29.6%). From univariate analysis, factors associated with EA were difficult parental-separation behavior, preschool age (2-5 years), and general anesthesia with sevoflurane. However; difficult parental-separation behavior; and preschool age were the only factors significantly associated with EA in the multiple logistic regression analysis with OR = 3.021 (95% CI = 1.680, 5.431, p < 0.001) and OR = 1.857 (95% CI = 1.075, 3.206, p = 0.026), respectively. CONCLUSION: The present study indicated that the incidence of EA was high in PACU. Preschool children and difficult parental-separation behavior were the predictive factors of agitation on emergence. Therefore, anesthesia personnel responsible for pediatric anesthesia should have essential skills and knowledge to effectively care for children before, during, and after an operation, including implementing the methods that minimize incidence of EA.