Addition of morphine to local anesthetic infiltration does not improve analgesia after pediatric dental extractions.

BACKGROUND: Opioid receptors have been noted in the peripheral nerve endings of afferent neurons. Blockade of these receptors with peripherally administered opioids is believed to result in analgesia. METHODS: In a prospective, randomized, double-blind study, we studied the analgesic effects of adding a subsystemic dose of morphine to local anesthetic infiltration (lidocaine hydrochloride) during pediatric dental extractions. Forty-two subjects, aged 2-7 years of ASA physical status I-II, were randomized to receive submucous infiltration with either morphine 25 microg.kg(-1) in 2% lidocaine hydrochloride with 1 : 1 00 000 epinephrine (morphine group) or 2% lidocaine hydrochloride with 1 : 1 00 000 epinephrine (control group) at the end of surgery. RESULTS: There was no difference in postoperative analgesic requirements within the first 24 h. In-hospital acetaminophen consumption was 85% in the morphine group compared with 81% in the control group. CONCLUSION: We conclude that there is no benefit of adding a subsystemic analgesic dose of morphine to local anesthetics for analgesia after dental extractions in children.

Topical lidocaine and oral acetaminophen provide similar analgesia for myringotomy and tube placement in children.

PURPOSE: Preoperative oral acetaminophen (30 mg x kg(-1)) was compared with topical 2% lidocaine ear drops for postoperative analgesia following bilateral myringotomy and tube placement (BMT) in children. METHODS: In a randomized, prospective, double-blind trial, we studied 124 patients, six months to eight years, ASA physical status I or II, undergoing elective BMT under general anesthesia. The patients in Group I received acetaminophen 30 mg x kg(-1) orally in a grape flavoured syrup 30 to 60 min before surgery and 0.9% saline drops (placebo) in each ear upon insertion of tympanostomy tube. Patients in Group II received a placebo (grape flavoured syrup) before surgery and 2% lidocaine, 0.5 mL in each ear when ear tubes were inserted. Postoperative pain assessments were recorded every five minutes in the postanesthesia care unit, and every 15 min in the day care surgical unit (DCSU) using the modified Children's Hospital of Eastern Ontario pain scale (mCHEOPS), a ten-point scale. Pain at home was documented by parents using a 0 (no pain) to 10 (worst pain imaginable) scale. RESULTS: The median (range) mCHEOPS scores in the DCSU at 15 and 30 min were similar, i.e., 5 (4-9) in the acetaminophen group and 4 (4-8) in the lidocaine group. The proportion of patients receiving supplemental analgesics in the 24 hr following surgery was similar in both groups (45% and 42% respectively). CONCLUSION: Topical lidocaine and oral acetaminophen in a dose of 30 mg x kg(-1) provide similar analgesia following BMT.

Amethocaine or ketorolac eyedrops provide inadequate analgesia in pediatric strabismus surgery.

PURPOSE: Corrective strabismus surgery is associated with moderate pain after surgery. Postoperative analgesia for these patients may include topical local anesthetic agents and topical non-steroidal anti-inflammatory drugs. In this prospective randomized, double-blind placebo controlled clinical trial we compared the effect of placebo to intraoperative 0.5% topical amethocaine or 0.5% topical ketorolac on pain control after strabismus surgery in children. METHODS: Following Institutional Ethics Committee approval and parental consent, we prospectively studied 51 healthy children between the ages of two and seven years who were undergoing elective bilateral recession surgery in a randomized, double-blind controlled clinical trial. Children were randomized to receive either placebo (normal saline), 0.5% amethocaine or 0.5% ketorolac eye drops at the start and end of strabismus repair surgery. Pain was assessed with a modified Children's Hospital of Eastern Ontario Pain Score in the recovery room. If the pain score was greater than 6, the patient was administered a single oral dose of acetaminophen (20 mg x kg(-1)). RESULTS: The groups had similar demographic data. Duration of surgery and anesthesia, time spent in recovery room and length of hospital stay between the three groups were similar. Pain scores and analgesic requirements while in the hospital were also similar between the groups as was the time to first analgesic administration. There were no side effects observed in any of the three treatment arms. CONCLUSION: We conclude that there is no improvement in postoperative pain control after the intraoperative administration of topical 0.5% ketorolac or 0.5% amethocaine when compared to placebo in children undergoing strabismus surgery.