A Comparison of Continuous Sciatic Nerve Block and Patient Controlled Analgesia with Morphin For Postoperative Analgesia in Children Undergoing Major Foot Surgery

Abstract

Objective: Peripheral nerve catheter for postoperative analgesia is new method in children. In this study, we aimed to compare the efficacy of systemic opioid use with continuous sciatic nerve blocks after foot surgery in children. Material and Methods: A total of 32 patients aged between 2-8 years were randomized into two groups prospectively. After general anesthesia, Group I (n= 16): Patients in the systemic opioid group were administered patient controlled analgesia (PCA) 30 minutes before the end of surgery and were administered 0.5 ml.mg.(-1) of morphine with a rate of 0.02 mg.kg.(-1) hour(-1). Bolus dose was adjusted as 0.01 mg.kg.(-1), lock out time was determined as 15 minutes and four hour limit was determined as 4 mg. Group II (n= 15): The sciatic nerve catheter was inserted using nerve stimulator under ultrasound and 0.4 ml.kg.(-1) of %0.5 bupivacain was injected and 0.2% bupivacain with a rate of 0.1 ml.kg.(-1) hour(-1) was administered with PCA at recovery through sciatic nerve catheter. Visual pain scale (VPS) (0-100 mm 0= no pain, 100= the worst pain) was used for evaluation of postoperative pain in children and CHIPPS (children and infants postoperative pain score) was used for children under 7 years for evaluation of pain When VAS>40 and CHIPPS >3, 15 mg.kg.(-1) paracetamol IV was administered, and if this was not enough to decrese the scores, 0.02 mg.kg.(-1) morphine was given. Pain scores, rescue analgesics, adverse effects and family satisfaction were recorded. Results: A statistically significant difference was not found between study groups when compared for demographic features, VPS and CHIPPS scores. Rescue analgesic administration, nausea, vomiting, pruritus and urinary retention was found higher in group I and the difference was statistically significant. Parent satisfaction was statistically significantly higher in PNC group. Conclusion: Sciatic nerve catheter is as effective as opioid use with PCA for children after appropriate operations and has fewer adverse effects, less need for rescue analgesics and better parent satisfaction.