Intercostal nerve block with Bupivacaine for post-thoracotomy pain relief in children.

The purpose of the study is to evaluate the efficacy of Intercostal Nerve Block (ICB) with Bupivacaine (BUP) to produce satisfactory analgesia after thoracotomy in children. We studied 20 children aged between 5 and 12 years, scheduled for thoracotomy under general anaesthesia. The children were randomly divided into two groups. In the first group (n = 10) 3 mg/kg BUP 0.5 % with epinephrine 1 : 200 000 was injected by the surgeon under direct vision, into the intercostal space where thoracotomy was performed. In the control group (n = 10) meperidine 1 mg/kg was administered i.v. at the same surgical time, and afterwards the chest was closed. Postoperatively the vital signs, the side effects and the total postoperative analgesic requirements were recorded. The mean duration of postoperative analgesia produced was longer in the BUP group (p < 0.001). None of the children in BUP group suffered from BUP toxicity, while in the control group a high incidence of vomiting and nausea was noticed (p < 0.005). It is concluded that ICB with BUP produces satisfactory and safe analgesia for the early postoperative period after thoracotomy in children.

Impact of an anesthesia discharge scoring system on postoperative monitoring after circumcision in children: a randomized trial.

BACKGROUND: Ambulatory surgery in children, combined with new anesthetic methods, leads to shorter hospital stays and an increase in patient and parental satisfaction. AIM: Aim of the study was to determine the feasibility and safety of transferring children directly to the ward without a previous stay in a post anesthesia care unit (PACU), after undergoing circumcision for phimosis under regional anesthesia and non-opioid analgesia. METHODS: 187 healthy children undergoing circumcision were studied in a randomized manner. After surgery, children who met predefined inclusion criteria in the operating room were randomly assigned to one of two groups. Children in the first group (Group A) bypassed the PACU and were admitted directly to the ward, after undergoing assessment using the White and Song scoring system. Children in the second group (Group B) were first transferred to a PACU and then to the ward. The children in Group A who did not meet the criteria of the White and Song scoring system represent the level of risk associated with direct transfer to the ward and no PACU stay. Recovery in the PACU and the ward, parental satisfaction, number of readmissions and the number of parental contacts for medical problems after discharge were recorded and compared between the two study groups. RESULTS: 157 children were randomly assigned into two groups (79 children in Group A and 78 in Group B). Demographic data, the duration of surgery, and recovery in the PACU or the ward were similar for the two groups. No readmissions were observed and most parents were very satisfied with the procedure. CONCLUSION: Children undergoing circumcision do not routinely require admission to a PACU and if the appropriate criteria are met, it is safe to transfer them directly to the ward.

Prevention of postoperative nausea and vomiting after laparoscopic gynaecological surgery. Combined antiemetic treatment with tropisetron and metoclopramide vs. metoclopramide alone.

BACKGROUND AND OBJECTIVE: Female patients undergoing gynaecological procedures, especially laparoscopically, are at high risk of postoperative nausea and vomiting. No available antiemetic is entirely effective. This double-blinded randomized trial examines the efficacy and safety of tropisetron and metoclopramide in combination and compares the results with metoclopramide alone in laparoscopic gynaecological surgery. METHODS: One hundred and twenty female patients scheduled for minor gynaecological laparoscopy, aged 27-43 years, were randomly allocated to receive pretreatment with metoclopramide 10 mg intravenously (n=57) or tropisetron 5 mg with metoclopramide 5 mg (n=63). RESULTS: Fewer patients in the combined treatment group experienced postoperative nausea and vomiting (14% vs. 37%, P=0.008) or needed rescue antiemetic treatment (3% vs. 16%, P=0.038). No significant adverse events were observed. CONCLUSIONS: The combination of the antiemetics was superior, which is probably explained by the fact that the two drugs have different sites of action, thus preventing emesis by blocking different pathways.