PREEMPTIVE CAUDAL BUPIVACAINE AND MORPHINE FOR POSTOPERATIVE ANALGESIA IN CHILDREN

We designed this double-blind study to evaluate the efficacy of preemp tive epidural bupivacaine and small-dose morphine for postoperative an algesia in children after herniorraphy. Sixty children, ASA physical s tatus I or II, who were undergoing elective hernia repair under genera l anesthesia were randomly allocated into two groups. Group I(preempti ve group) received 0.66 mL/kg 0.25% bupivacaine with morphine 0.02 mg/ kg caudally after the induction of anesthesia but 15 min before surger y. Group II (postincisional group) received the same drug mixture afte r surgery. Pain was assessed using an objective pain scale (OPS). Time to first postoperative analgesics (TFA), the number of supplementary analgesic used, and the amount of morphine consumed over the ensuing 2 4-h period were noted. The OPS score was significantly less in Group I at 0.5, 4, and 8 h (P < 0.05) than in Group II after surgery. The med ian OPS score recorded over 24 h was 0 for Group I and 2 for Group II, which was significantly different (P < 0.05). The TFA in Group I (12. 55 +/- 3.06 h) was significantly (P < 0.05) prolonged compared with Gr oup II (10.62 +/- 3.18 h). The total postoperative morphine consumptio n in Group I (2.24 +/- 1.4 mg) was significantly (P < 0.05) less than that in Group II (3.34 +/- 2.29 mg). Nevertheless, the incidence of na usea and vomiting was not significantly different between the groups. In this study, we demonstrated that preemptive epidural bupivacaine an d small-dose morphine administration is superior to the same mixture g iven at the conclusion of surgery for pain relief. Implications: This study was performed on two groups of 30 children undergoing hernia rep air. Group I received a bupivacaine-morphine mixture caudally before s urgery, and Group II received the same drugs caudally at the completio n of surgery. Postoperative assessment demonstrated longer and better pain relief in Group I.