COMPARISON OF CAUDIAL ANALGSIA AND INTERAVENOUS DICLOFENAC FOR POSTOPERATIVE PAIN RELIEF IN PAEDIATRIC PATIENTS

Abstract

The treatment of postoperative pain in children has attracted special attention for
many decades. Out-patients undergoing day care procedure require perioperative
analgesic technique that is effective, has minimal side effects and safe. Adequacy
of post operative management is one of the important factors determining when a
patient can be safely discharged from the out-patient facility7.

This is a randomised comparative study on postoperative analgesic efficacy and
adverse events associated with caudal block and intravenous diclofenac given
before surgical incision in 60 ASAI & II children aged 1-7years scheduled for day
case herniotomy.

No premedication was given to any of the patients. Anaesthesia was achieved with
3.5% halothane in 100% oxygen or intravenous propofol 3mg/kg. An LMA was then
inserted and secured with adhesive tape. Caudal block with 0.125% bupivacaine
(1ml/kg) was given in GroupI (n=30) and intravenous diclofenac (1ml/kg) in Group
II (n=30).

Pain was assessed by two different methods- mCHEOPS and verbal rating scale,
during the first 4 hours in the recovery room and up to the 24th hour at home by
the parents. Parents were to rate the pain as none, mild, moderate, severe and very
severe. Total analgesic consumption at home among the two groups was
compared.

The mean duration to first analgesia in the caudal group was 239±24.6 minutes
compared to 167.6±43.2 (SEM) minutes in the diclofenac group (p <0.0001).
This study showed immediate postoperative pain control was significantly better in
the caudal group than the diclofenac group.

The mean pain score in the first 2 hours in the caudal group was 0.0±0.0 while it
was 2.8± 2.9 in the diclofenac group (p<0.001). Details of Paracetamol consumption
at home in the latter part of the study showed that diclofenac group had better
pain control than the caudal group.

No complication was attributed or seen in any of the techniques in the immediate
and in the late postoperative.