title: [Extramucosal pylorotomy via the umbilical route under general anesthesia and para-umbilical cord: evaluation of intra- and postoperative analgesia].
abstract: OBJECTIVE
  To assess both intra- and postoperative analgesia in infants undergoing extramucosal pylorotomy via a circumumbilical incision under general anaesthesia with neither opioid nor muscle relaxant, associated with a paraumbilical block.
  
  
  METHODS
  Open prospective study covering a 1-year period.
  
  
  METHODS
  The study included 32 infants (age = 1.1 +/- 0.7 months, body weight = 4,427 +/- 876 g).
  
  
  METHODS
  General anaesthesia was induced with either thiopentone or halothane and, after tracheal intubation, maintained with halothane in a N2O-O2 50 vol% mixture. Para-umbilical block was obtained using 0.5 mL.kg-1 of 1% lidocaine with epinephrine. Pain was assessed using time course of respiratory rate, heart rate and mean arterial pressure. A change of more than 20% in one of these variables was considered as criterion for poor analgesia.
  
  
  RESULTS
  Intraoperative analgesia was adequate in all patients but one, 3 minutes after incision. Surgical conditions were considered as being good or satisfactory in 76% and 24% of cases, respectively. Postoperative analgesia, assessed 1 and 6 hours after completion of surgery, was convenient in 90% of infants, the end of the action of the local anaesthetic resulting in a poor analgesia at the 6th hour in four of them.
  
  
  CONCLUSIONS
  Provided a short bevel needle is used and basic safety rules of local anaesthesia are followed, the para-umbilical block provides adequate intra and postoperative analgesia in infants undergoing extramucosal pylorotomy via circumumbilical route.
authors.affiliation: Clinique chirurgicale pédiatrique, hôpital Saint-Antoine, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Courrèges
authors.forename: F
authors.initials: F
authors.lastname: Poddevin
authors.forename: D
authors.initials: D
authors.lastname: Lecoutre
mesh_terms: D000698:Analgesia / Q000379:methods*; D000768:Anesthesia, General; D005753:Gastric Mucosa; D006221:Halothane; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care; D011182:Postoperative Care; D011708:Pylorus; D013270:Stomach / Q000601:surgery*; D013874:Thiopental; D014472:Umbilicus
chemical_list: D013874:Thiopental; D006221:Halothane