TRIAL OF 3 METHODS OF INTRAOPERATIVE BUPIVACAINE ANALGESIA FOR PAIN AFTER PEDIATRIC GROIN SURGERY

Purpose: To evaluate the relative effectiveness of three techniques of regional anaesthesia in the provision of postoperative analgesia in c hildren. Methods: Random assignment was made of 183 children scheduled for groin surgery to one of three groups. Bupivacaine 0.5% plain (2 m gkg(-1)) was injected by the surgeon after skin incision. Group A rece ived wound infiltration. Group B had regional nerve blockade, Group C had a combination of both methods. Postoperatively, pain was assessed using the CHEOPS behavioural scale at half hourly intervals until disc harge home. Satisfactory pain control was arbitrarily defined as a CHE OPS score of less than or equal to six. Potential differences among th e groups were sought using graphical representation of mean pain score s, the frequencies of maximum pain:scores, and the incidence of postop erative vomiting and oral analgesic consumption. Results: Fifteen pati ents had to be excluded from analysis. This left 61 patients in Group A, 55 in Group B, and 52 in Group C. There were no demographic differe nces among the groups, No differences were demonstrated among the grou ps either in CHEOPS pain scores at any observation point (P = >0.8), o r in the incidence of vomiting or need for postoperative analgesia. (P = 0.52 and P = 0.41 respectively). Overall, 80% of the observations m ade (1135/1425) met our definition-of satisfactory pain control. A pos t hoc calculation of the power of the study confirmed sufficient power to detect a 5% difference among groups. Conclusion: Al three methods achieved analgesia with 80% of the pain scores meeting our definition of satisfactory pain control. None of the techniques enjoyed any appar ent advantage.