Paediatric day case anaesthesia: estimate of its quality at home

Postoperative analgesia in pediatric herniotomy - Comparison of caudal bupivacaine to bupivacaine infiltration with diclofenac suppository

CONTEXT

Perioperative analgesia in paediatric herniotomies demand safe, effective and less invasive strategies. Local infiltration with Bupivacaine, rectal Diclofenac and caudal Bupivacaine are widely used for pain relief.

AIMS

To compare the analgesic effects of caudal epidural using 1 mlkg(-1) of 0.25% Bupivacaine against a combination of local infiltration 0.25% Bupivacaine 0.5 mlkg(-1) with Diclofenac suppository 2 mgkg(-1) in the management of post-operative pain following paediatric inguinal herniotomy.

SETTINGS AND DESIGN

This is an observational study from a tertiary care teaching hospital.

METHODS AND MATERIAL

A total of 60 children for elective unilateral inguinal herniotomy were assigned to two groups of 30 each. Patients who received caudal block with 1 mlkg(-1) of 0.25% Bupivacaine were allocated to Group A and who received Diclofenac suppository 2 mgkg(-1) and infiltration with 0.25% Bupivacaine 0.5 mlkg(-1) were allocated to Group B. Post operative Pain was assessed using Hannallah's modified objective pain scale. At score ≥3 rescue analgesic oral Paracetamol 15 mgkg(-1) was given. Pain was assessed at 0,15,30,45,60 minutes and half hourly thereafter until 8 hours following surgery or until patient requires rescue analgesic whichever happens first.

STATISTICAL ANALYSIS USED

Employed SPSS software. Data was analysed using sample t test and P-value was calculated.

RESULTS

The demographic profile was comparable between two groups. The mean analgesic duration in group A and group B was 228.5 and 331.0 minutes respectively and is found to be statistically significant (P < 0.05).

CONCLUSIONS

Diclofenac suppository with local infiltration is a less invasive and effective alternative to caudal Bupivacaine for analgesia in paediatric herniotomy.

[Ambulatory surgery in France: practical and medicolegal considerations]

In France, ambulatory anaesthesia and surgery seem to be well codified. Many recommendations have been published by the Health Authority and the professional associations: they are summarized in this review. However, numerous practical problems persist: for example, two situations specific to paediatric practice are problematic parental comprehension and application of the information provided and poor access to strong analgesics outside the hospital. Despite this, the paediatric population is an ideal target for ambulatory care because of its usual good health and quicker recovery after minor injury as proven by the small percentage of failure and readmission.

Does take-home analgesia improve postoperative pain after elective day case surgery? A comparison of hospital vs parent-supplied analgesia

BACKGROUND

More children are undergoing same-day surgery. While advances have been made in pediatric pain management, there have been few studies addressing pain management in the home (Br J Anaesth, 82, 1999 and 319). We wished to investigate whether issuing parents with take-home analgesia would improve postoperative pain scores and/or parental satisfaction following hospital discharge.

METHODS

Two hundred children, and their parents, attending for day case surgery at our institution were randomized into two groups. One group received advice regarding the management of postoperative pain and were given a pack containing discharge medications: group 'dispensed'. The other group received the same advice, but did not receive any medication: group 'advised'. Telephone interviews were conducted to assess pain scores, PONV, functional activity, analgesia requirements, and satisfaction rates.

RESULTS

Data were available for 181 patients (median age, 4 years; range, 0-12 years): 89 children in group 'dispensed' and 92 children in group 'advised'. Postoperative instructions were followed by 86% in group 'advised' and 89% in group 'dispensed' (P = 0.68). Although all parents received analgesia advice, only 85/181 (48%) recalled the information. Rates for no/mild pain and moderate/severe pain were similar between the two groups: 59% (group 'advised') vs 62% (group 'dispensed') and 41% (group 'advised') vs 38% (group 'dispensed') (P = 0.78).

DISCUSSION

Our study did not show any differences in the incidence of pain/parental satisfaction between the two groups. Analgesia advice given to parents was poorly retained, suggesting that other methods for disseminating information should be considered.

Patient care after discharge from the ambulatory surgical center

An important and often forgotten aspect of postoperative care occurs after the patient is discharged from the ambulatory surgical center. With more than 60% of all surgeries and procedures occurring on an ambulatory basis, what happens after the patient is no longer in continuous professional care is of concern to the ambulatory nurse. Numerous physical postoperative complaints are common and expected sequelae of anesthesia and surgery in the ambulatory patient. In this article, important postdischarge complications are reviewed and contemporary management options discussed. The information contained in this review article is valuable to the provider in educating patients regarding their anticipated course of postoperative recovery.

OBJECTIVES

-Based on the content of this article, the reader should be able to (1) identify important postdischarge complications to provide patients with comprehensive discharge instructions regarding their continued recovery at home; (2) discuss contemporary management options available to treat postdischarge complications; (3) realize the incidence of specific postdischarge complications and how that relates to patient satisfaction with the surgical experience; (4) recognize signs and symptoms of postdischarge complications; and (5) identify risk factors of patients for developing specific complications in the postoperative phase.

Recovery after paediatric daycase herniotomy performed under spinal anaesthesia

In this prospective survey, recovery in hospital and at home was evaluated in 195 children aged 6 months to 10 years who had undergone herniotomy under spinal anaesthesia as a daycase procedure. Spinal anaesthesia was successful in most of the children, with only two patients being given general anaesthesia. Eighty-three percent of the children had pain at home and 19% had moderate or severe pain. Eighty-five percent of the children needed pain medication at home; the median dose of analgesics was 4 (1-9, 10th and 90th percentiles). Vomiting was noted in two of 195 children in hospital and in 10 of 192 children at home. Eleven children developed a mild position-dependent headache. Most of the children (183/191) recovered their normal daily activities during the first three postoperative days. We conclude that spinal anaesthesia is a safe and effective technique for paediatric herniotomy. Moreover, pain is common following herniotomy and children should be given analgesics for the first two or three postoperative days.