Efficacy of combined local anesthetic wound infiltration and paracetamol suppositories in relieving postoperative pain in children

ABSTRACT

To evaluate the efficacy of combined incisional infiltration with Bupivacine and Paracetamol suppositories with Paracetamol suppositories alone in relieving the postoperative pain associated with surgery of inguinal pathologies. Prospectively, on hundred and ten children whom underwent groin surgery at Prince Rashed Ben Al-Hassan hospital form April 1, 2008 to December 1, 2008 were included in the study. Their ages ranged from six months to 13 years. Surgery was performed under general anesthesia. Patients were randomized into two groups; group A [55 patients] received Paracetamol rectally 30 mg/kg immediately preoperatively, while group B [55 patients] had Paracetamol rectally 30mg/kg and incisional wound infiltration with Bupivacaine 1 mg/kg. Post operative pain was managed by giving Paracetamol. The duration of the postoperative analgesia was estimated based on the time when rescue analgesia was first given. Assessment of the quality of postoperative analgesia was based on the children's behavior. In our study, both parents and older children were willing to cooperate. None of the children in the study groups suffered from local anesthetic toxicity such as arrhythmias, seizures, allergy and hematoma or tissue edema. In group A, 15 children suffered pain in the recovery room and received further analgesia in the form of Paracetamol suppositories, 18 had pain and received analgesia at home within four to six hours after discharge. The remaining 22 suffered pain during the next five days after surgery. In group B, two patients had pain in the recovery room, eight had pain with early mobilization at home and had their first analgesic dose after five to eight hours. The other 45 children had no significant post-operative pain. Group B showed an increased duration of postoperative analgesia with early mobilization. Rescue mean time at which children had their first post-operative dose of analgesia was two to four hours in group A and it was five to eight hours in group B. No patient in group B needed analgesia after day three post-operatively. Wound infiltration with Bupivacaine 1mg.kg combined with rectal Paracetamol 20 mg/kg has a better and valuable efficacy compared to the rectal Paracetamol 30mg/kg alone with respect to providing pain relief following inguinal herniotomy, hydrocelectomy and orchidopexy in children, with a longer duration of pain relief and earlier mobilization