Aim: To compare the analgesic efficacy of caudal block with diclofenac suppository and local anesthetic
infiltration in children undergoing laparoscopy.
Methods: We studied 50 children undergoing laparoscopy for diagnostic and therapeutic purposes.
Their ages ranged from 3 to 13 years, and all belonged to American Society of Anesthesiologists
(ASA) class I or II. Anesthesia was carried out using the standard procedure. Patients were
randomly assigned to one of two groups. Group 1 received caudal block with bupivacaine 1 mL/kg
after anesthetic induction. Group 2 received diclofenac suppository 3 mg/kg postinduction and local
anesthetic infiltration at the port sites at the end of the procedure. Pain was assessed using the
Hannallah objective pain scale at 15, 30, 60, 120, and 360 minutes postextubation.
Results: The pain scores were comparable in both groups at all times. Twelve percent of caudal
block patients and 20% of diclofenac patients needed rescue analgesic, a statistically insignificant
difference. In 2 patients, caudal block was technically difficult and they were excluded from the
study. The incidence of side effects was low in our study.
Conclusion: We find the analgesic efficacy of diclofenac suppository combined with local anesthetic
infiltration at port sites comparable to caudal block. Given the necessarily invasive nature of
caudal block, we suggest the combined use of diclofenac suppository with local anesthetic infiltration
at port sites as a useful and more economical alternative for analgesia following pediatric laparoscopy.
