Comparison of caudal morphine and buprenorphine for post-operative analgesia in children.

Sixty five children aged from 1-10 years who underwent herniotomy, cystolithotomy or orchidopexy received either buprenorphine 4 micrograms kg-1 (n = 33) or morphine 50 micrograms kg-1 (n = 32) by the caudal epidural route; each thus received 0.5 ml kg-1 body weight. General anaesthesia was given for surgery. Post-operative pain and behaviour were assessed by an independent observer at 1, 4, 8, 16 and 24 h post-operatively. Caudal morphine and buprenorphine were equally effective for post-operative analgesia in children, but buprenorphine was better because of its longer duration of action and lower incidence of side effects.

Caudal buprenorphine for postoperative analgesia in children: a comparison with intramuscular buprenorphine.

This study was conducted on 44 children aged 1-10 years, who had undergone lower extremity orthopaedic surgery under general anaesthesia. Patients were divided into two groups: Group 1 (n = 23) received buprenorphine caudally and Group 2 (n = 21) received buprenorphine intramuscularly, at the completion of the surgery. The dose of buprenorphine used in both the groups was 4 micrograms.kg-1 body weight. The quality and duration of postoperative analgesia were evaluated by a single observer using a 5-point score for the first 24 h postoperatively. The time until the patient required postoperative analgesic was recorded. The duration of analgesia was significantly greater with caudal buprenorphine (median 20.20 h) than with intramuscular buprenorphine (median 5.20 h). Of the patients in the caudal group, 43% did not require any supplemental analgesia during the first 24 h, whereas all the patients in the intramuscular group required supplements within 10 h postoperatively. Caudal buprenorphine (4 micrograms.kg-1 body weight) provided 10.8 h to more than 24 h of analgesia in children, with fewer side effects.

Postoperative analgesia in children who have genito-urinary surgery. A comparison between caudal buprenorphine and bupivacaine.

A study conducted on 40 children, aged 1-11 years, who had genito-urinary surgery compared the quality and duration of analgesia after caudal blocks in two groups of patients. Group 1 (n = 20) received caudal bupivacaine 0.25% and group 2 (n = 20) caudal buprenorphine 4 micrograms/kg; each received 0.5 ml/kg body weight. Patients were operated on under general anaesthesia. Postoperative behaviour and severity of pain were measured on a 3-point scale. The results indicate that caudal buprenorphine provides excellent postoperative analgesia in children comparable to caudal bupivacaine in the early postoperative period. Buprenorphine proved better in the late postoperative period. Analgesia lasted from 20 hours to more than 24 hours after caudal buprenorphine with fewer side effects.

Multiple benign strictures of the oesophagus in the paediatric age-group--modified technique of antegrade dilatation.

Accidental ingestion of strong acids and alkalines still remains the commonest cause of benign strictures of the oesophagus in our country, particularly in children from the poor socio-economic strata, who are left alone to fend for themselves. Once the stricture is well-formed, repeated antegrade dilatations are required in order to dilate the lumen gradually. The procedure is done with the utmost care and gentleness in order to avoid rupture of the cicatricial wall of the oesophagus. The present series consisting of 10 cases of multiple, benign, mostly permeable, strictures of the oesophagus were successfully managed with Jackson's antegrade dilatation technique. During one of the dilatation sessions we observed that instead of pushing the bougie gently, it seemed to be sucked down entirely on its own, a few millimeters at a time (described in case 3) and traversed the entire stricture. This procedure appears safer for the patient and has now become routine with us. There was no mortality in our series. In all, a total of 168 dilatations have been done. The average lumen achieved in all our cases was 6 mm (Jackson's bougie No. 18) which was well maintained in all our cases on a permanent basis.