The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperative analgesia in children

Abstract

SummaryBoth caudal anaesthesia and non-steroidal anti-inflammatory drugs have been used in the management of postoperative pain in children. The aim of the present study was to evaluate the combination of caudal analgesia and rectally administered diclofenac in the treatment of pain following minor surgery in children. Thirty-nine, ASA grade 1 or 2, children undergoing inguinal or penoscrotal surgery were randomly assigned to receive either a caudal block using 0.125% bupivacaine with adrenaline or a similar caudal block in combination with rectally administered diclofenac 1 mg.kg-'. Children given a caudal block alone were more likely to need analgesia in thejirst 24 h postoperatively. It would appear that the combination of a caudal block and rectal diclofenac in children undergoing minor lower abdominal surgery reduces the need for subsequent analgesia.

A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

“…The median time for Group C was 11 min (interquartile range [5][6][7][8][9][10][11][12][13][14][15], and for Group P the median was 9 min (interquartile range [5][6][7][8][9][10][11][12][13][14], P 5 n.s. There was no difference in time to micturition.…”

“…It is common in paediatric practice to use adjuvant caudal drugs to prolong analgesia [7] Ketamine prolongs the effect of caudal bupivacaine [8] more than clonidine or epinephrine [9]. The use of concurrent rectal diclofenac has also been shown to prolong the duration of analgesia after caudal bupivacaine in children [10].…”

Patient comfort during regional anesthesia

“…Diclofenac premedication reduced the analgesic requirements during the first 8 hours after varicose vein repair with spinal anesthesia [23]. Diclofenac suppositories used perioperatively improved analgesia in adult [24,25] and pediatric [26] patients when combined with regional anesthesia. Perioperative administration of dexketoprofen 25 mg every 8 hours orally markedly improved analgesia and decreased opioid requirements after hip arthroplasty with spinal anesthesia [27].…”

Anaesthesia for thoracic surgery in children

“…The use of nonsteroidal anti‐inflammatory drugs such as diclofenac in the management of postoperative pain in children has become commonplace ( 133–135). Although mostly described for use in procedures resulting in moderate pain, e.g.…”