POST OPERATIVE ANALGESIA FOR CIRCUMCISION IN PAEDIATRIC PATIENTS IN TERTIARY CARE HOSPITAL
Abstract
According to the International Association for the Study of Pain (IASP) pain is define as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain is most feared symptom of disease in which person always trying to reduce and defeat since ages. In children excessive crying, restlessness anxiety leads to pain which is difficult to manage post operatively by nurses and parents. Therefore early ambulation and rapid recovery is of prime importance. There are many techniques have been recommended for anaesthetic techniques including administration of parenteral narcotics, caudal block, non steroidal anti inflammatory drugs, ring block at base of penis, topical anesthesia and dorsal nerve block. After operative local anaesthetics, often used to relieve pain are usually administered by caudal epidural injection. There is belief that suggested human child does not feel pain and it is dangerous to give powerful analgesia because of the risk of addiction to children[i]. For the treatment of post-operative pain even in the children and newborns may trigger physiologic stress response, biochemical and cause impairments in pulmonary neuro endocrinal, gastrointestinal, cardiovascular, immunological, and metabolic functions. Many anaesthetic techniques have been introduce for administration of parenteral narcotics, non steroidal anti inflammatory drugs, caudal block, ring block at base of penis, topical anesthesia and dorsal nerve block. In children rectal administration of drugs is a safe and convenient route. Acetaminophen and Diclofenac are commercially available in pediatric suppository formulation. Caudal block is very effective whereas performing a central block for minor surgery is controversial.
Aim: The main aim of this study is to study different method of post operative analgesia for circumcision in paediatric patients.
Material and Methods: The present study was carried out in the department of anaesthesia at Prakash Institute of Medical Science and Research Urun-Islampur Maharashtra. All paediatric patients which undergoing circumcision was included in this study. Total 60 paediatric patients were included in this study with the age range from 2 years to 15 years. From all the patients for the records of data as documentation was collect by physical examination, past and present history and medical assistance and investigation were taken through pre-anesthetic check-up and routine investigations were carried out. Parents of children were explained about procedures and informed consent was obtained. as per guidelines patients were kept nill by mouth (NBM) before the scheduled of surgery and were randomly allocated in the following three groups of 20 patients.
Result: The study was conducted in 60 children with age ranging 2 to 15 years. After initiation with general anaesthesia. Patients were given Penile block was given with Bupivacaine plain 0.5% 2 mg/kg at 2 O'clock & 10 O'clock positions at root of penis in group A. Diclofenac sodium 2- 3 mg/kg was inserted per rectally in group B and Lignocaine jelly 2%, 1-2 ml applied locally at the operative site in group C. all the patients were comparable in all groups demographically (p > 0.05). O2 saturation was stable in the surgery in all groups (p > 0.05).
Conclusion: Satisfactory pain relief in immediate post operative period Penile block given for 5-6 hours whereas Diclofenac sodium given for post induction shows higher pain score for initial half an hour but no need for analgesics up to 8-14 hours. Analgesic required immediate post operative period for some patients. at operative site Lignocaine jelly (2%) applied after completion of surgery provides post operative analgesia for 4- 5 hours. Therefore Diclofenac sodium suppository is superior to penile block in respect to Lignocaine jelly (2%) duration of analgesia. Hence for immediate postoperative period Lignocaine jelly or Penile block application appeared to be better in terms of low pain score.
Keywords: Post operative analgesia, circumcision, Lignocaine jelly, Diclofenac sodium.
