Postoperative analgesia for the surgical correction of congenital clubfoot: comparison between peripheral nerve block and caudal epidural block.
OBJECTIVE
Correction of congenital clubfoot (CCF) is associated with severe postoperative pain. Caudal epidural block associated with general anesthesia is the anesthetic technique used more often in children, but it is limited by the short duration of the postoperative analgesia. Peripheral nerve blocks are associated with a low incidence of complications and prolonged analgesia. The objective of this study was to compare the duration of analgesia in peripheral nerve blocks and caudal block, as well as morphine consumption in the first 24 hours after correction of CCF in children.


METHODS
This is a randomized, double-blind study with children undergoing surgeries for posteromedial release of CCF, who were divided in four groups according to the anesthetic technique: caudal (ACa), sciatic and femoral block (IF), sciatic and saphenous block (IS), and sciatic block and local anesthesia (IL), associated with general anesthesia. In the first 24 hours, patients received oral dypirone and acetaminophen, and they were evaluated by anesthesiologists who were unaware of the technique used. Oral morphine (0.19 mg x kg(1) per day) was administered according to the scores of the CHIPPS (Children's and infants' postoperative pain scale) scale.


RESULTS
One hundred and eighteen children separated into four groups: ACa (30), IF (32), IS (28), and IL (28) participated in this study. The mean time between the blockade and the first dose of morphine was 6.16 hours in group ACa, 7.05 hours in group IF, 7.58 in IS, and 8.18 hours in IL. Morphine consumption was 0.3 mg.kg-1 per day in all four groups. Significant differences were not observed among the groups.


CONCLUSIONS
peripheral nerve blocks did not promote longer lasting analgesia or a decrease in morphine consumption in the first 24 hours in children undergoing CCF correction when compared to caudal epidural block.
Rodrigues
Monica Rossi
MR
Hospital SARAH, Brasília, DF. frank.monica@hotmail.com
Paes
Franklin Cêspedes
FC
Duarte
Leonardo Teixeira Domingues
LT
Nunes
Luiz Guilherme Nadal
LG
Costa
Verônica Vieira da
VV
Saraiva
Renato Angelo
RA
D000698:Analgesia; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003025:Clubfoot / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block; D010149:Postoperative Pain / Q000517:prevention & control*
D000701:Analgesics, Opioid; D009020:Morphine