title: Regional analgesia combined with avoidance of narcotics may reduce the incidence of postoperative vomiting in children.
abstract: BACKGROUND
  The anesthesia literature cites a high incidence of postoperative vomiting (POV) after pediatric ochidopexy and hernia repair (34-50%) and after penile procedures (37-49%). We hypothesized that regional analgesia combined with avoidance of narcotics administered to children scheduled for lower abdominal or urologic procedures may be associated with a lower incidence of POV. The aim of this prospective study was to 1) assess the incidence of POV in children in the hospital and during a 24-h post-anesthesia study period, and 2) evaluate the effect of age on POV.
  
  
  METHODS
  After obtaining institutional and parental consent, 110 pediatric outpatients, 1-12 yr old, ASA physical status I or II, scheduled for elective outpatient urologic or lower abdominal procedures, were enrolled. Children were fasting and premedicated with midazolam, 0.5 mg/kg p.o. They received a combined light general anesthesia and a presurgical caudal block. Anesthesia was induced via a mask and consisted of halothane and nitrous oxide in oxygen. For the caudal block 1 ml/kg of 0.25% bupivacaine or 0.2% ropivacaine were used to provide intra- and postoperative pain relief. No prophylactic antiemetics were administered.
  
  
  RESULTS
  All caudal blocks provided adequate intraoperative pain relief. The incidence of POV was low, 12% at the hospital, 13% for the 24-h study period, and was not affected by age.
  
  
  CONCLUSIONS
  We concluded that regional analgesia combined with the avoidance of narcotics administered to children scheduled for elective urologic or lower abdominal procedures, is associated with a lower incidence of POV and that age did not affect the incidence of POV.
authors.affiliation: Department of Anesthesiology, The University of Texas Medical School at Houston, Texas, USA. Samia.N.Khalil@uth.tmc.edu
authors.forename: Samia N
authors.initials: SN
authors.lastname: Khalil
authors.forename: Adel
authors.initials: A
authors.lastname: Farag
authors.forename: Ehab
authors.initials: E
authors.lastname: Hanna
authors.forename: Ranganathan
authors.initials: R
authors.lastname: Govindaraj
authors.forename: Alice Z
authors.initials: AZ
authors.lastname: Chuang
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D008874:Midazolam / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects*; D009407:Nerve Block; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D011229:Preanesthetic Medication; D011446:Prospective Studies
chemical_list: D009294:Narcotics; D008874:Midazolam