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Pain management for unilateral orchidopexy in children: an effective regimen
1Department of Paediatric Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Hills Road, P.O. Box 267, Cambridge, CB2 0QQ, UK. dryes4@hotmail.com
Insights
This study shows that a multimodal analgesic regimen effectively manages postoperative pain in preschool children undergoing same-day surgery for unilateral orchidopexy, making it a safe outpatient procedure.
Area of Science:
- Pediatric Surgery
- Pain Management
- Anesthesiology
Background:
- Postoperative pain following elective day surgical orchidopexy in children is a significant concern, with reported incidences ranging from 30-60%.
- Effective pain management is crucial for the success of day-case surgical procedures in pediatric populations.
- This study addresses the need for optimized analgesic strategies in pediatric orchidopexy.
Purpose of the Study:
- To evaluate the efficacy of a specific multimodal analgesic regimen for unilateral orchidopexy in preschool children.
- To assess the incidence and severity of postoperative pain in children undergoing day-case orchidopexy.
- To determine the suitability of unilateral orchidopexy as an outpatient procedure with effective pain control.
Main Methods:
- A prospective analysis of 247 preschool children (mean age 3.3 years) undergoing unilateral orchidopexy as a day surgical procedure.
- Administration of ilio-inguinal block with levo-bupivacaine, rectal diclofenac suppository, and wound infiltration with levo-bupivacaine.
- Postoperative oral acetaminophen and ibuprofen were administered for 48 hours, with pain assessed using the Visual Analogue Scale (VAS).
Main Results:
- Initially, 60% of patients were pain-free in the recovery room; by 3 hours, 11% experienced mild-to-moderate pain (VAS 3-7).
- All children were discharged home pain-free at 4 hours post-surgery.
- At home, 95% were pain-free by 10 hours and 97% by 24 hours, with complete pain resolution by 48 hours.
Conclusions:
- The implemented analgesic regimen demonstrates clinical effectiveness in managing postoperative pain after unilateral orchidopexy.
- The successful pain control supports the feasibility and safety of performing unilateral orchidopexy as a day-case procedure.
- This approach enhances patient comfort and supports the efficiency of pediatric surgical services.
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.
