Postoperative pain relief in children. A comparison between caudal bupivacaine and intramuscular diclofenac sodium. 1994

P Ryhänen, and J Adamski, and K Puhakka, and J Leppäluoto, and O Vuolteenaho, and J Ryhänen
Department of Anaesthesiology, University of Oulu, Finland.

Two hundred and fifty children undergoing herniotomy or orchidopexy under general anaesthesia were randomly allocated to receive pre-operatively either diclofenac sodium 1 mg.kg-1 given intramuscularly or a caudal injection of bupivacaine 0.25% 1 ml.kg-1 with or without adrenaline or no analgesia. Plasma diclofenac and beta-endorphin concentrations were determined in eight and 21 patients respectively. Postoperative pain was assessed by ward nurses who were blinded to the group allocation. Comparison with the control group showed diclofenac to be an effective analgesic. Caudal bupivacaine provided more pain-free children during the early postoperative hours, but later the need for pethidine as rescue analgesic was lower among the children who had received intramuscular diclofenac. Caudal analgesia abolished the stress-induced increase in plasma beta-endorphin level which was found in the children given diclofenac and in those who served as controls. Total plasma clearance of intramuscular diclofenac sodium appears to be higher in children than in adults. A single intramuscular dose of diclofenac significantly reduces the need for an opioid analgesic in children after inguinal herniotomy or orchidopexy, and owing to its long duration of action, it offers an alternative or complementary method of pain relief to caudal analgesia.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D008614 Meperidine A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. Isonipecain,Pethidine,Demerol,Dolantin,Dolargan,Dolcontral,Dolin,Dolosal,Dolsin,Lidol,Lydol,Meperidine Hydrochloride,Operidine EPJ-I,Operidine EPJ I
D010149 Pain, Postoperative Pain during the period after surgery. Acute Post-operative Pain,Acute Postoperative Pain,Chronic Post-operative Pain,Chronic Post-surgical Pain,Chronic Postoperative Pain,Chronic Postsurgical Pain,Pain, Post-operative,Persistent Postsurgical Pain,Post-operative Pain,Post-operative Pain, Acute,Post-operative Pain, Chronic,Post-surgical Pain,Postoperative Pain, Acute,Postoperative Pain, Chronic,Postsurgical Pain,Postoperative Pain,Acute Post operative Pain,Chronic Post operative Pain,Chronic Post surgical Pain,Chronic Postsurgical Pains,Pain, Acute Post-operative,Pain, Acute Postoperative,Pain, Chronic Post-operative,Pain, Chronic Post-surgical,Pain, Chronic Postoperative,Pain, Chronic Postsurgical,Pain, Persistent Postsurgical,Pain, Post operative,Pain, Post-surgical,Pain, Postsurgical,Post operative Pain,Post operative Pain, Acute,Post operative Pain, Chronic,Post surgical Pain,Post-operative Pains,Post-surgical Pain, Chronic,Postsurgical Pain, Chronic,Postsurgical Pain, Persistent
D011292 Premedication Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (ANTIBIOTIC PROPHYLAXIS) and anti-anxiety agents. It does not include PREANESTHETIC MEDICATION. Premedications
D002045 Bupivacaine A widely used local anesthetic agent. 1-Butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide,Bupivacain Janapharm,Bupivacain-RPR,Bupivacaina Braun,Bupivacaine Anhydrous,Bupivacaine Carbonate,Bupivacaine Hydrochloride,Bupivacaine Monohydrochloride, Monohydrate,Buvacaina,Carbostesin,Dolanaest,Marcain,Marcaine,Sensorcaine,Svedocain Sin Vasoconstr,Bupivacain RPR
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003456 Cryptorchidism A developmental defect in which a TESTIS or both TESTES failed to descend from high in the ABDOMEN to the bottom of the SCROTUM. Testicular descent is essential to normal SPERMATOGENESIS which requires temperature lower than the BODY TEMPERATURE. Cryptorchidism can be subclassified by the location of the maldescended testis. Testis, Undescended,Abdominal Cryptorchidism,Bilateral Cryptorchidism,Cryptorchidism, Unilateral Or Bilateral,Cryptorchism,Inguinal Cryptorchidism,Testes, Undescended,Undescended Testis,Unilateral Cryptorchidism,Cryptorchidism, Abdominal,Cryptorchidism, Bilateral,Cryptorchidism, Inguinal,Cryptorchidism, Unilateral,Undescended Testes
D004008 Diclofenac A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt. Diclophenac,Dichlofenal,Diclofenac Potassium,Diclofenac Sodium,Diclonate P,Dicrofenac,Feloran,GP-45,840,Novapirina,Orthofen,Orthophen,Ortofen,SR-38,Sodium Diclofenac,Voltaren,Voltarol,Diclofenac, Sodium,GP 45,840,GP45,840,SR 38,SR38

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