Pain control with low-dose alfentanil in children undergoing minor abdominal and genito-urinary surgery

The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in children.

During sevoflurane-nitrous oxide atracurium anaesthesia for minor abdominal or genito-urinary surgery, three groups of children aged 0-8 yr received 25 microg kg(-1) alfentanil intravenously (n = 28), or peripheral nerve blockade using 1 mLkg(-1) ropivacaine 0.475% (n = 24), or 12.5 microg kg(-1) alfentanil intravenously with peripheral nerve blockade using 1 mL kg(-1) ropivacaine 0.475% (n = 30). Changes in blood pressure and heart rate were measured during the procedures. Postoperative pain was assessed using the face, legs, activity, cry, consolability (FLACC) observational tool for quantifying pain behaviour and a numerical scale scored by nurses, doctors, parents and children.

There was no significant difference in intra- or postoperative analgesic efficacy among the three groups. Patients who received alfentanil had significantly lower heart rates than those who received nerve blockade only (96.0+/-15.6 vs. 115.9+/-23.2 beats min(-1), P < 0.001). FLACC and numerical scale scores did not differ among the groups. There were no significant differences in incidence of vomiting or use of pain medications.

It was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain during and after minor abdominal and genito-urinary surgery.