[Control of postoperative pain in children undergoing hypospadias surgery: quasi-experimental controlled trial].
BACKGROUND
Hypospadias is one of the most common congenital anomalies occurring in approximately (1/300) male births. If it is not surgically corrected the consequences may negatively impact on quality of life in adolescents. The surgery is very invasive and the post-operative phase very painful. To improve the control of post-operative pain, continuous analgesia via epidural catheter was implemented.


OBJECTIVE
To compare the effectiveness in controlling pain of two different regimens: continuous epidural catheter infusion vs oral and rectal non-steroidal pain-killers.


METHODS
Comparative study on children undergoing hypospadias surgery. Group A (catheter) was treated with continuous postoperative analgesia via epidural catheter and Group B (scheduled times) with rectal and oral analgesics at scheduled times and on demand, after caudal block. In both groups nurses measured pain with VAS and FLACC scales (score from 0 to 10) for 72 hours after surgery.


RESULTS
41 children were studied (average age 64.1 months, SD 47.3), with 332 post-operative pain recordings (Group A n = 161, Group B n = 171). Mean pain score of Group A was 0.13 (SD 0.3) and 0.45 (SD 0.8) in group B, p = 0.006. The median duration of the epidural catheter was 65 hours, mean 51.8 hours (SD 24.3). During the 1st post-operative medication, the mean pain score in Group A was 1.2 (SD 1.4), and 3.2 (SD 1.8) in group B, p = 0.003. In group A the number of pain scores indicating pain (> 0) where 3.1% while in group B were 10.5%, p = 0.0007.


CONCLUSIONS
In children undergoing hypospadias surgery, post-operative analgesia with continuous epidural catheter infusion seems to offer a better analgesic coverage than the traditional oral/rectal analgesic treatment at scheduled times and on demand.
Festini
Filippo
F
Dipartimento di pediatria, Sezione di Scienze infermieristiche e Professioni sanitarie, Università di Firenze.
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D
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Cinzia
C
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D000082:Acetaminophen / Q000008:administration & dosage*; D000284:Administration, Oral; D000285:Administration, Rectal; D015360:Analgesia, Epidural / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D016009:Chi-Square Distribution; D002648:Child; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D000077554:Levobupivacaine; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing* / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D000077554:Levobupivacaine; D005283:Fentanyl; D003061:Codeine; D002045:Bupivacaine