Analgesic efficacy of caudal block versus diclofenac suppository and local anesthetic infiltration following pediatric laparoscopy.
OBJECTIVE
To compare the analgesic efficacy of caudal block with diclofenac suppository and local anesthetic infiltration in children undergoing laparoscopy.


METHODS
We studied 50 children undergoing laparoscopy for diagnostic and therapeutic purposes. Their ages ranged from 3 to 13 years, and all belonged to American Society of Anesthesiologists (ASA) class I or II. Anesthesia was carried out using the standard procedure. Patients were randomly assigned to one of two groups. Group 1 received caudal block with bupivacaine 1 mL/kg after anesthetic induction. Group 2 received diclofenac suppository 3 mg/kg postinduction and local anesthetic infiltration at the port sites at the end of the procedure. Pain was assessed using the Hannallah objective pain scale at 15, 30, 60, 120, and 360 minutes postextubation.


RESULTS
The pain scores were comparable in both groups at all times. Twelve percent of caudal block patients and 20% of diclofenac patients needed rescue analgesic, a statistically insignificant difference. In 2 patients, caudal block was technically difficult and they were excluded from the study. The incidence of side effects was low in our study.


CONCLUSIONS
We find the analgesic efficacy of diclofenac suppository combined with local anesthetic infiltration at port sites comparable to caudal block. Given the necessarily invasive nature of caudal block, we suggest the combined use of diclofenac suppository with local anesthetic infiltration at port sites as a useful and more economical alternative for analgesia following pediatric laparoscopy.
Borkar
Jyoti
J
Department of Anesthesiology, B.Y.L. Nair Hospital and T.N. Medical College, Mumbai, India. borkar2000@yahoo.com
Dave
Nandini
N
D000293:Adolescent; D000763:Anesthesia, Caudal / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004008:Diclofenac / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D013488:Suppositories / Q000008:administration & dosage*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D013488:Suppositories; D004008:Diclofenac; D002045:Bupivacaine