Comparison of caudal bupivacaine alone, caudal combined with rectal diclofenac and rectal paracetamol postoperative analgesia effectiveness in pediatric patient undergoing inframbilical surgery at tikur anbessa specialized hospital, Addis Ababa, Ethiopia 2018/2019.

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Addis Ababa University


Background: Despite limited duration of action, different additives are used to improve effectiveness of caudal block with some associated side effects. Combining rectal diclofenac and paracetamol to caudal block also enhance effectiveness of analgesia with devoid of side effects. Objective: To assess postoperative analgesic effectiveness of caudal bupivacaine alone, caudal bupivacaine combined with rectal Diclofenac and rectal paracetamol in pediatric patients undergoing elective infra-umbilical surgery. Methodology: An institutional based prospective cohort study design was conducted on 90 patients who assigned randomly into three equal groups aged 1- 10 years. Data collection methods include preoperative chart review, intraoperative and postoperative observation by trained nurses and one supervisor. The primary endpoint of the study was pain score. The secondary endpoint of the study was duration of analgesia, postoperative analgesia consumption and adverse effects during 24 hour follow up period. Parametric data were analyzed using (ANOVA) and non-parametric data using Kruskal-Wallis H rank test. Chi-square test used for categorical variable. P value < 0.05 considered as Statistical significance. Result: The postoperative NRS/FLACC score were lower in both CP and CD group than CA with p value < 0.001 at 4th and 8th hour. Furthermore, Time to first analgesic request was significantly longer within Bupivacaine+Diclofenac 735 (540 - 1200 min) compared to paracetamol 445(240 - 840 min p=0.029) and caudal alone 315(240 - 720 min p<0.001). Conclusion and Recommendation: combination of caudal+diclofenac reduce pain score and provide longer duration of analgesia than both caudal combined with rectal paracetamol and caudal alone in patients undergoing infra umbilical surgery. Based on these we recommend to use caudal+diclofenac combination for infra umbilical procedures to provide effective analgesia.



Caudal block, Rectal paracetamol, Rectal diclofenac, infra umbilical surgery.