Preemptive Analgesia for Pediatric Peritoneoscopy, Comparing Caudal Block and Acetaminophen

Abstract

Background and Purpose: Although caudal block and acetaminophen have shown efficacy in postoperative pediatric pain management, they have not been compared in efficacy following peritoneoscopy. Patients and Methods: The study population were ASA I or II children from 55 weeks postconceptual age to 10 years of age having peritoneoscopy. They were randomly assigned to preoperative caudal block using bupivacaine 0.6 mL/kg or preoperative rectal acetaminophen 30 mg/kg, with each group receiving acetaminophen 20 mg/kg per 6 hours for four doses. A blinded observer using the Objective Pain Scale assessed the children on awakening, in the PACU, and at discharge. A phone survey of satisfaction occurred on day 1. Acetaminophen was used in 18 patients, and 14 had a caudal block. Results: The initial PACU score was 4.1 ± 3.1 for acetaminophen and 2.3 ± 3.0 for caudal block (P = 0.03). Fifty-six percent of the acetaminophen group needed added narcotic, whereas only 22% of those with caudal block did (P = 0.02). Forty three percent of the acetaminophen group had nausea compared with 11% of the caudal block group (P = 0.023). There was no difference in satisfaction or in parental perception of pain control at home. Conclusion: Our results suggest that pediatric patients undergoing inguinal procedures received better pain control from caudal blocks and experienced less nausea than from high-dose acetaminophen suppositories. Our results support the use of a caudal block for postoperative pain control for pediatric inguinal operations with peritoneoscopy.