Comparison of postoperative analgesia methods in pediatric lower abdominal surgery

Objective: In this study, we compared the efficiency and side effects of the postoperative analgesia methods in pediatric population undergoing outpatient lower abdominal surgery.
Study design: After induction of anesthesia, patients were randomly divided into 3 groups. At the end of surgery, the first group of patients (n-10) were administered 1 mg/kg 0,25 % bupivacain in incision site, the second group (n-10) received 20- 25 mg/kg rectal paracetamol. The third group (n-10) had caudal block with 2mglkg bupivacain diluted with saline to obtain Iml/kg solution. Peroperatively, patients’ heart rale and 02 saturation levels were monitorised and during 6 hours postoperatively, respiratory> rate, heart rate, sedation and modified TPPPS pain scale were noted for all the patients every hour In the next 6 hours, the same parameters were followed up by phone, in discharged patients. According to modified TPPPS pain score, rectal 20-30 mg/kg paracetamol were administered to the patients who had a score level more than 3. And this treatment was continued at home.Chi-square and Fisher’s exact test were used for statistical analyses. p<0,05 was considered statistically significant.
Results: The recovery time was significantly long in the 3rd group and the first hour pain score in the 2nd group was statistically high. (p<0,05) In 3 patients of the 3rd group, side effects such as nausea and vomiting, urine retention were observed.
Conclusion: We believe that the infiltration of local anesthetic in incision site or the administration of rectal paracetamol may be a good alternative to caudal block in pediatric patients undergoing outpatient lower abdominal surgery.

Pediatrik alt batýn cerrahisinde postoperatif analjezi yöntemlerinin karþýlaþtýrýlmasý

Amaç: Bu çalýþmada, pediatrik günübirlik alt batýn operasyonlarý için postoperatif analjezi yöntemlerinin etkinlik ve yan etkilerini karþýlaþtýrmayý amaçladýk.
Gereç ve yöntem: Anestezi indüksiyonu sonrasý, rastgele üç gruba ayrýlan hastalardan 1. gruba (n-10) operasyon bitiminde yara dudaklarýna 1 mg/kg %0,25 bupivakain infiltrasyonu yapýldý. 2. gruba (n=10) yine operasyon bitiminde rektal 20-25 mg/kg parasetamol suppozituar verildi. 3. gruptaki (n-10) hastalara, kaudal epidural aralýða girilerek 2 mg/kg bupivakain Ýml/kg serum fizyolojik ile tamamlanarak yapýldý. Operasyon boyunca olgular, kalp tepe atýmý ve oksijen satürasyonu açýsýndan monitorize edildi. Postoperatif dönemde ilk 6 saat boyunca saat baþý solunum frekansý, KTA, sedasyon ve modifiye TPPPS aðrý skalasýna göre takip yapýldý. Daha sonraki 6 saatte sedasyon ve modifiye aðrý skalasý taburcu edilen hastalarýn evlerinden telefonla takip edildi. Modifiye TPPPS aðrý skalasýna göre skoru 3’ün üzerinde olan hastalara, rektal 20-30 mg/kg parasetamol verildi ve evde de ayný doz önerildi. Ýstatistiksel deðerlendirmelerde, Ki-kare ve Fisher‘s exact test kullanýldý. p<0,05 anlamlý kabul edildi.
Bulgular: 3. grubun uyanma süresi diðer gruplardan istatistiksel olarak anlamlý derecede uzun, 2. grubun 1. saatteki aðrý skoru ise yüksek bulundu. (p<0,05) 3. grupta 3 olguda bulantý-kusma, idrar retansiyonu gibi yan etkiler görüldü.
Sonuç: Sonuç olarak, çocuklarda günübirlik, alt batýn operasyonlarýnda parasetamol kullanýmýnýn ve yara dudaklarýna lokal anestezik infiltrasyonu uygulamasýnýn kaudal bloða alternatif olabileceði kanaatine vardýk.