title: The efficacy of pre- versus postsurgical axillary block on postoperative pain in paediatric patients.
abstract: We compared the effects of pre- and postsurgical axillary block on pain after hand and forearm surgery in 55 children in a double-blind randomized study. The successful blocks are reported here (n=49). Children aged 1-11 years and ASA I or II were allocated randomly to receive axillary block with 2 mg.kg-1 of 0.25% bupivacaine, either after induction but before the surgery (presurgical group, n=25) or immediately after surgery, before the end of anaesthesia (postsurgical, n=24). In all patients, a standard general anaesthesia technique was used. The Faces Pain Scale (FPS) and analgesic requirements were recorded for 24 h at various times after operation. Eight patients (32%) in the presurgical group and 20 patients (83.33%) in the postsurgical group did not require additional analgesic within the first 24 h after operation (P< 0.05). In patients who had pain during the observation period, the pain started 13.66+/-2.61 h in the presurgical group and 13.14+/-2.34 h in the postsurgical group after performing block (P> 0.05). The FPS scores were similar in both groups during the first 8 h in the postoperative period (P> 0.05). There was a significant difference at 10 h after surgery (P< 0.05). Cumulative FPS score was higher in the presurgical group (10.50+/-1.06) than in the postsurgical group (9.45+/-1.28) (P< 0.05), but both groups had effective analgesia overall, the mean FPS score being less than 2. Additional analgesic consumption was similar in these patients in both groups. A lower isoflurane concentration was used in the presurgical group (0.68% vs 1.72%, P< 0.001). We did not demonstrate the superiority of preemptive analgesia, but our results indicate that presurgical axillary block with 0.25% bupivacaine allows the use of inhalational anaesthetics at lower concentrations while providing a reasonably painless postoperative period.
authors.affiliation: Department of Anaesthesiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Altintas
authors.forename: P
authors.initials: P
authors.lastname: Bozkurt
authors.forename: N
authors.initials: N
authors.lastname: Ipek
authors.forename: A
authors.initials: A
authors.lastname: Yücel
authors.forename: G
authors.initials: G
authors.lastname: Kaya
mesh_terms: D000698:Analgesia; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine