Postoperative analgesia in pediatric patients: comparative study among local anesthetics, opioids and non-steroidal anti-inflammatory drugs.

BACKGROUND AND OBJECTIVES: The treatment of postoperative pain in children has been given special attention in the last decades. This study aimed at analyzing postoperative analgesia in children, considering analgesia quality and duration, evaluation methods reliability and the incidence of side effects resulting from different analgesia techniques.

METHODS: Participated in this study 100 children, aged 2 to 12 years, allocated in 5 groups of 20 children each, who received, right after anesthesia, the following analgesics: group B, 0.25% bupivacaine with epinephrine (1:400,000) 0.5 to 1 ml kg(-1); group F, 1.5 microg kg(-1) fentanyl; group M, 30 microg kg(-1) morphine; group S, 0.3 microg kg(-1) sufentanil, all by epidural caudal block and group D, who received rectal diclofenac (1 mg kg(-1)). Pain was evaluated by two different methods: one, predominantly behavioral and objective and the other subjective and self-evaluated, during the first 4 hours and then up to the 24th hour. Side effects were observed and treated.

RESULTS: In the first 4 hours, groups B, F, M and S patients presented similar behavior, with a minimum need for complementary analgesia. In the remaining 20 hours, the longest analgesia duration was seen in group S, which did not differ from groups F and M, but was significantly longer than for groups B and D. Rectal diclofenac has not promoted effective pain relief. There has been a higher incidence of side-effects in group M, which did not differ from group S, but was significantly higher than for groups F, B and D. There has been a positive and significant correlation between both pain scales.

CONCLUSIONS: Spinal opioids are safe and effective for postoperative analgesia in children, but when compared to bupivacaine, there have been no significant differences and a higher incidence of side effects. Rectal diclofenac was not effective as a single analgesic as compared to other techniques.