Effects of Caudal Bupivacaine, Bupivacaine/Morphine, and Intravenous Ketorolac for Postoperative Analgesia in Pediatric Day Surgery Patients / 대한마취과학회지

BACKGROUND: For outpatient pediatric anesthesia, pain has perhaps been the main cause of hospitalization. Caudal blocks have been used to treat postoperative pain after low abdominal surgery. The purpose of this study was to evaluate and compare the analgesic effect and the incidence of side effect of caudal bupivacaine alone, a bupivacaine-morphine mixture, and intravenous ketorolac in pediatric day surgery patients. METHODS: Forty three patients, aged 1 to 7 years, were divided into three groups after the induction of general anesthesia. Caudal blocks were performed with 0.2% bupivacaine 0.7 ml/kg alone (group B), 0.2% bupivacaine 0.7 ml/kg and morphine 0.03 mg/kg (group M), and normal saline 0.7 ml/kg (group K). Ketorolac 0.8 mg/kg (group K) or normal saline 2 ml (group B and M) was injected intravenously before incision. Postoperative pain/discomfort scales and 4-point patient sedation scores were assessed, and the incidences of side effects were observed after recovery. RESULTS: Pain/discomfort scores in the group B and K were significantly greater than in group M. There was no difference among the groups in the 4 point patient sedation score. The incidences of nausea/vomiting and urinary retention were more frequent in group M but discharge was not delayed by the side effect. CONCLUSIONS: The addition of morphine to bupivacaine for caudal block provides more effective postoperative analgesia than caudal block with bupivacaine alone and intravenous ketorolac administration in day surgery. Side effects such as nausea/vomiting and urinary retention must be considered after use of morphine during caudal block.

Effects of Caudal Bupivacaine, Bupivacaine/Morphine, and Intravenous Ketorolac for Postoperative Analgesia in Pediatric Day Surgery Patients / 대한마취과학회지

BACKGROUND: For outpatient pediatric anesthesia, pain has perhaps been the main cause of hospitalization. Caudal blocks have been used to treat postoperative pain after low abdominal surgery. The purpose of this study was to evaluate and compare the analgesic effect and the incidence of side effect of caudal bupivacaine alone, a bupivacaine-morphine mixture, and intravenous ketorolac in pediatric day surgery patients. METHODS: Forty three patients, aged 1 to 7 years, were divided into three groups after the induction of general anesthesia. Caudal blocks were performed with 0.2% bupivacaine 0.7 ml/kg alone (group B), 0.2% bupivacaine 0.7 ml/kg and morphine 0.03 mg/kg (group M), and normal saline 0.7 ml/kg (group K). Ketorolac 0.8 mg/kg (group K) or normal saline 2 ml (group B and M) was injected intravenously before incision. Postoperative pain/discomfort scales and 4-point patient sedation scores were assessed, and the incidences of side effects were observed after recovery. RESULTS: Pain/discomfort scores in the group B and K were significantly greater than in group M. There was no difference among the groups in the 4 point patient sedation score. The incidences of nausea/vomiting and urinary retention were more frequent in group M but discharge was not delayed by the side effect. CONCLUSIONS: The addition of morphine to bupivacaine for caudal block provides more effective postoperative analgesia than caudal block with bupivacaine alone and intravenous ketorolac administration in day surgery. Side effects such as nausea/vomiting and urinary retention must be considered after use of morphine during caudal block.

Caudal Epidural Morphine for Postoperative Analgesia in Children / 대한마취과학회지

BACKGROUND: The use of caudal morphine for postoperative analgesia has been increased in popularity since 1981. The purpose of this study was to compare the effect of analgesia and incidence of side effects of a mepivacaine-morphine mixture with mepivacaine alone. METHODS: Forty patients were randomly divided into two groups. In group 1, caudal block was performed with 1% mepivacaine 1 ml/kg alone. In group 2, caudal block was performed with 1% mepivacaine 1ml/kg-morphine 0.03 mg/kg mixture. Postoperative five-point pain scores and side effects were measured. RESULTS: There were no significant differences in sedation dose, incidence of side effects and supplemental analgesics. Pain scores were significantly lower at postoperative 2 and 3 hours in mepivacaine-morphine mixture group. CONCLUSIONS: Caudal epidural mepivacaine-morphine (0.03 mg/kg) mixture is effective in children for control of postoperative pain without significant side effects.

The Effects of Clonidine in Pediatric Caudal Anesthesia / 대한마취과학회지

BACKGROUND: Caudal anesthesia is considered a safe and reliable anesthetic technique for many pediatric surgical procedures. It is well known that extradural clonidine produces analgesia in adult. The purpose of this study is to assess its efficacy in children. METHODS: We randomized 45 pediatric patients aged under 10 years, weighted under 25 kg presented for lower abdominal surgery with duration of operation would be shorter than 2 hours, into three groups of 15 each. After sedation with the use of intravenous thiopental sodium, caudal anesthesia was performed with the use of 1 mL/kg of 0.25% bupivacaine. We allocated randomly the patients who received no additional medication in 0.25% bupivacaine (group I), with epinephrine 1/200,000 (group II), and with 1 mcg/kg of clonidine (group III). The degree of postoperative analgesia was evaluated using the Broadman ""Objective Pain/discomfort Scale"" (OPS) at hourly intervals for 24 hours. RESULTS: Duration of sleep in the recovery room was significantly longer in group III than in group I and group II, and statistical significant difference was found between the group I and group II. Duration of analgesia was significantly longer in group III than in group I and group II. Overall hourly OPS scores were lower in group III than in group I and group II. CONCLUSION: Duration of postoperative analgesia with caudal bupivacaine was increased by addition of 1 mcg/kg of clonidine.