Journal Article

Pain Management for Unilateral Orchidopexy in Children: An Effective Regimen

Saeed, A., Campbell, R., Samuel, M., Aslam, A., Brain, J., Brennan, L., Williams, M. P. L., Khan, A. R., Lee, V.

2009

Overview

Background The reported high incidence of 30–60% postoperative pain after an elective day surgical orchidopexy is undesirable. We evaluated the efficacy of our analgesic regimen for unilateral orchidopexy in preschool children performed as a day surgical procedure. Methods Between January 2004 and December 2006, 247 children (mean age: 3.3 ± 1.6 years) underwent a unilateral orchidopexy as a day surgical procedure. They were prospectively analyzed for postoperative pain during a period of 48 h by using the Visual Analogue Scale (VAS). After standardized general anesthesia, all children had a 0.25% levo-bupivacaine hydrochloride ilio-inguinal block and a rectal diclofenac sodium suppository. Orchidopexy was performed through transverse inguinal and scrotal incisions. The wounds were infiltrated with 0.25% levo-bupivacaine hydrochloride at the end of the operation. Postoperatively acetaminophen and ibuprofen were given orally at regular intervals for 48 h. Results On first assessment in the recovery room, 148 out of 247 (60%) patients were pain-free, and 99 of 247 (40%) patients had pain: VAS score ranged from 3 to 10. By 3 h, 27 (11%) had mild-to-moderate pain, with VAS scores between 3 and 7. All children were discharged home at 4 h with no pain. At home, 95% were pain-free at 10 h and 97% by 24 h, with a declining pain score. All children were pain-free at 32, 40, and 48 h. Pain scores were unrelated to the duration of surgery ( r s  = 0.54). Conclusion Clinical effectiveness of our institution analgesic regime justifies the performance of unilateral orchidopexy as a day-case procedure.

• Publisher: Springer-Verlag,Springer‐Verlag,Springer,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Ambulatory Surgical Procedures - methods / Analgesia - methods / Analgesic Regimen / Biological and medical sciences / Cardiac Surgery / Child, Preschool / Cryptorchidism - surgery / Emla / General aspects / General Surgery / Humans / Laryngeal Mask Airway / Male / Medical sciences / Medicine / Medicine & Public Health / Pain Measurement / Pain, Postoperative - prevention & control / Prospective Studies / Surgery / Thoracic Surgery / Vascular Surgery / Visual Analogue Scale Assessment / Wound Infiltration