Apstrakt
Background: Herniotomy is one of the most common procedures performed by the paediatric surgeon. Its most common complication is post-operative pain. Furthermore, is the known stress response associated with surgery, which may also have deleterious effects. Analgesics are effective in reducing both these effects. This study compares the effectiveness of two analgesic options- rectal diclofenac and woundinfiltrated bupivacaine, on post-operative pain and stress response.
Methods: This was a prospective, double blinded clinical study. Seventy two children undergoing herniotomy were randomized into group 1 (Bupivacaine group) and group 2 (Diclofenac group). The children were similar in all other aspects except for the treatment they received. Pain was evaluated by a blinded assessor on arrival of the patient in the recovery room using the FLACC scale. Blood samples were taken following induction of anaesthesia and at the end of surgery for cortisol and glucose estimations.
Results: The mean pain scores were similar in both groups post-operatively and it remained below a score of 4 throughout the study period. There was no significant difference between the pre- and post-operative serum cortisol and glucose levels in both groups (p > 0.05)
Conclusion: Rectal diclofenac provides a comparative effectiveness of analgesia to wound-infiltrated bupivacaine in children undergoing herniotomy.
Keywords: Paediatric herniotomy, Rectal Diclofenac, stress response, pre-incisional wound infiltration, Bupivacaine, post-operative pain.
Résumé
Contexte: L’herniotomie est l’une des procédures les plus courantes effectuées par les chirurgiens pédiatriques. Sa complication la plus fréquente est la douleur post-opératoire. En outre, est la réponse au stress connue associée à la chirurgie, qui peut également avoir des effets délétères. Les analgésiques sont efficaces pour réduire ces deux effets. Cette étude compare l’efficacité de deux options analgésiques - le diclofénac rectal et la bupivacaïne infiltrée par la plaie, sur la douleur post-opératoire et la réponse au stress.
Méthodes: Ceci était une étude clinique prospective, aveuglement doublée. Soixante-douze enfants subissant une herniotomie ont été randomisés dans le groupe 1 (groupe bupivacaïne) et groupe 2 (groupe diclofénac). Les enfants étaient dans tous les autres aspects sauf pour le traitement qu’ils ont reçu. La douleur a été évaluée par un évaluateur aveugle à l’arrivée du patient dans la salle de réveil en utilisant l’échelle FLACC. Des échantillons de sang ont été prélevés après l’induction de l’anesthésie et à la fin de la chirurgie pour les estimations de cortisol et de glucose.
Résultats: Les scores de douleur moyens étaient similaires dans les deux groupes après l’opération et ils sont restés sous le score de 4 tout au long de la période d’étude. Il n’y avait pas de différence significative entre les niveaux de cortisol et de glucose sériques pré- et post-opératoires dans les deux groupes (p> 0,05)
Conclusion: Le diclofénac rectal fournit une efficacité comparative de l’analgésie à la bupivacaïne infiltrée par la plaie chez les enfants subissant une herniotomie.
Mots clés: Herniotomie pédiatrique, diclofénac rectal, réponse au stress, infiltration pré-incision, bupivacaïne, douleur postopératoire.
Correspondence: Dr. A.E. Ajao, Department of Surgery, Collegeof Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: kayogundoyin@gmail.com
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