Preemptive Analgesia for Pediatric Peritoneoscopy, Comparing Caudal Block and Acetaminophen

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 4.16 3.1 for acetaminophen and 2.36 3.0 for caudal block (P 5 0.03). Fifty-six percent of the acetaminophen group needed added narcotic, whereas only 22% of those with caudal block did (P 5 0.02). Forty three percent of the acetaminophen group had nausea compared with 11% of the caudal block group (P 5 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 highdose acetaminophen suppositories. Our results support the use of a caudal block for postoperative pain control for pediatric inguinal operations with peritoneoscopy.