Mehmet Kenan EROL, Firdevs KAYA, Mehmet ÇAKMAK, Abdulhakim SENGEL

Comparison of intravenous paracetamol and caudal block in terms of analgesic effects in patients at pediatric surgery

Aim: In our study, we aimed to evaluate retrospectively the efficacy of postoperative analgesia in patients with caudal block versusparacetamol in 67 cases, between the ages of 2-8 years who had undergone elective inguinal hernia and circumcision surgery afterinduction of general anesthesia.Material and Methods: In this study, we evaluated retrospectively the files of 67 cases between 2-8 years old patients who had caudalblock or I.V. paracetamol who undergone inguinal hernia and circumcision operation between September 2017 and September2018. The files of the cases, anesthesia follow-up forms and nurse observation forms were examined; demographic data, vital signs,duration of surgery, postoperative analgesic requirement and recorded complications were evaluated.Results: The mean age was 3.2±2.35 years in the caudal group and 4.3±2.15 years in the paracetamol group, the mean body weightwas 15.1±4.51 kg in the caudal group and 19.4±6.4 in the paracetamol group. The surgical period of patients in the caudal groupwas 51±12.2 minutes and it was 37.8±15.8 in the paracetamol group. The mean duration of postoperative analgesia was 8.1±1.42hours in the caudal group and 1.05±1.0 hours in the paracetamol group. There were no complications in any of the patients inthe postoperative period. No significant results were found in the vital signs of both groups. While VAS values were statisticallysignificant at 6th and 12th hours, VAS value at 24th hour was not statistically significant.Conclusion: Caudal epidural anesthesia may be a simple and safe method of anesthesia effective in postoperative pain control.May it ensure serious patient comfort with reduced analgesic requirements after surgery. It may be recommended to use pediatricsurgery under umbilicus for high success rates and low complication rates.

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1. Sharpe P, Klein JR, Thompson JP, et. al. Analgesia for circumcision in a pediatric population: Comparision of caudal bupivacaine alone with bupivacaine plus two doses of clonidine. Pediatr Anaesth 2001;11:695-700.
2. Silvani P, Camporesi A, Agostino MR, et al. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol 2006;72:453-9.
3. Zadra N, Giusti F. Caudal block in pediatrics. Minerva Anestesiol 2006;67:126-31.
4. Desborough JP. The stress response to trauma and surgery. Br J Anasth 2000;85:109-17.
5. Kayhan Z. Clinical Anesthesia 3rd. edition. Logos Corporation. 2004. p. 694-95.
6. Johnston P, Findlow D, Aldridge LM, et al. The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children. Pediatr Anesth 1999;9:31–4.
7. Gunter JB, Dunn CM, Bennie JB, et al. Optimum concentration of bupivacaine for combined caudal-general anesthesia in children. Anesth 1991;75:57-61.
8. Delbos A, Boccard E. The morphine-sparing effect of propacetamol in orthopedic postoperative pain. J Pain Sympt Manage 1995;10:279-86.
9. Hernandez-Palazon J, Tortosa JA, Martinez-Lage JF, et al. Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery. Anesth Analg 2001;92:1473-6.
10. Peduto VA, Ballabio M, Stefanini S. Efficacy of propacetamol in the treatment of postoperative pain. Morphine-sparing effect in orthopedic surgery. Acta Anaesthesiol Scand 1998;42:293-8.
11. Van Aken H, Thys L, Veekman L, et al. Assessing analgesia in single and repeated administrations of propacetamol for postoperative pain: Comparison with morphine after dental surgery. Anesth Analg 2004;98:159-65.
12. Haas DA. An update on analgesics for the management of acute postoperative dental pain. J Can Dent Assoc 2002;68:476-82.
13. Dalens B. Regional anesthesia in children. Anesth Analg 1989;68:654-72.
14. Summer E, Hatch DJ. Regional anesthesia. In: Armytage EN, edition. Textbook of pediatric anesthetic 1st edition. London: Bailliere Tindall; 1989:213-33.
15. Lee JJ, Rubin P. Comparison of a bupivacaine clonidine mixture with plain bupivacaine for caudal analgesia in children. Br J Anaesth 1994;72:258-62.
16. Dressen AJ, Zekpo AL, Ehounoud H, et al. Caudal anesthesia: Experience of the university hospital center of Treichville. 50 cases. Med Trop (Mars) 1993;53:321-4.
17. Ecoffey E, Despartment J, Maury M. Bupivacaine in children: Pharmacokinetics following caudal analgesia. Anesthesiology 1985;63:447-8.
18. Tuğcu V, Yetkin M, Karadağ S, et al. Caudal blocking in hypospadias surgery. Turkish Urology Journal: 2005,31:220- 4.
19. Bissonnette B, Dalens B. Regional Anesthetic Tecniques. Wonsiewicz M, Noujaim S, Kurtz S.Pediatric Anesthesia: Principles-practice. New York: Mc Graw Hill; 2002. p. 541- 44.