Trial of three methods of intraoperative bupivacaine analgesia for pain after paediatric groin surgery.
OBJECTIVE
To evaluate the relative effectiveness of three techniques of regional anaesthesia in the provision of postoperative analgesia in children.


METHODS
Random assignment was made of 183 children scheduled for groin surgery to one of three groups. Bupivacaine 0.5% plain (2 mg.kg-1) was injected by the surgeon after skin incision. Group A received wound infiltration. Group B had regional nerve blockade. Group C had a combination of both methods. Postoperatively, pain was assessed using the CHEOPS behavioural scale at half hourly intervals until discharge home. Satisfactory pain control was arbitrarily defined as a CHEOPS score of < or = six. Potential differences among the groups were sought using graphical representation of mean pain scores, the frequencies of maximum pain scores, and the incidence of postoperative vomiting and oral analgesic consumption.


RESULTS
Fifteen patients had to be excluded from analysis. This left 61 patients in Group A, 55 in Group B, and 52 in Group C. There were no demographic differences among the groups. No differences were demonstrated among the groups either in CHEOPS pain scores at any observation point (P = > 0.8), or in the incidence of vomiting or need for postoperative analgesia. (P = 0.52 and P = 0.41 respectively). Overall, 80% of the observations made (1,135/1,425) met our definition of satisfactory pain control. A post hoc calculation of the power of the study confirmed sufficient power to detect a 5% difference among groups.


CONCLUSIONS
All three methods achieved analgesia with 80% of the pain scores meeting our definition of satisfactory pain control. None of the techniques enjoyed any apparent advantage.
Anatol
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Unit of Paediatric Surgery, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad, West Indies.
Pitt-Miller
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D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006119:Groin / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D009407:Nerve Block; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
D000779:Anesthetics, Local; D002045:Bupivacaine