Abstract
Although both caudal block and acetaminophen have been shown to be effective in the management of postoperative pain in children, their efficacy after peritoneoscopy has not been compared. This study included 32 children with an American Society of Anesthesiologist (ASA) score of I or II who were undergoing peritoneoscopy. Their ages ranged from 55 gestational weeks to 10 years. The children were randomly assigned to receive a preoperative caudal block with 0.6 mL of bupivacaine per kilogram or preoperative rectal acetaminophen at a dose of 30 mg/kg. Each group also received 20 mg of acetaminophen per kilogram every 6 hours to a total of four doses. A blinded observer used the Objective Pain Scale to assess the patients on awakening, in the postanesthesia care unit (PACU), and at discharge. A telephone survey to assess satisfaction was conducted 1 day later. Acetaminophen was given to 18 patients, and 14 had a caudal block. The initial PACU score was 4.1 ± 3.1 for acetaminophen and 2.3 ± 3.0 for the caudal block (P = .03). Fifty-six percent of the acetaminophen group required additional analgesia, in comparison with 22% of the caudal block group (P = .02). Forty-three percent of the acetaminophen group experienced nausea, in comparison with 11% of the caudal block group (P = .023). The groups did not differ in regard to parental satisfaction or perception of pain control at home. In summary, our results suggest that caudal block controls pain more effectively and is associated with less nausea than high-dose acetaminophen suppositories in children undergoing inguinal procedures. Our results support the use of caudal block to control the pain of children undergoing peritoneoscopic inguinal surgery.
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