When to add supplemental rectal paracetamol for postoperative analgesia with caudal bupivacaine in children? A prospective, double-blind, randomized study.

BACKGROUND: The aim of this study was to investigate whether a supplemental dose of rectal paracetamol at the third or fourth hour would enhance the quality of analgesia provided by caudal epidural blockade in children.

METHODS: Two hundred and two ASA I patients aged 1-12 years undergoing inguinal surgery were randomized into three groups in the postanesthesia care unit by drawing lots. Patients in the control group did not receive any analgesic until they had a pain score of 5 or higher, patients in the group P3 received rectal paracetamol (20-25 mg x kg(-1)) at the third hour, and patients in the group P4 received the same dose of rectal paracetamol at the fourth hour after caudal epidural injection. Pain was assessed by VAS (Visual Analog Scale) and supplementary rescue analgesic need was recorded.

RESULTS: There was no difference between the demographic data or the duration and variety of surgery among the groups. A significantly lower number of patients required rescue analgesia at the sixth postoperative hour in group P3 and also lower pain scores were again obtained in group P3 at the sixth and eighth postoperative hours.

CONCLUSIONS: Supplemental rectal paracetamol at the third hour of caudal blockade enhances the quality of postoperative analgesia better than its addition at the fourth hour in children undergoing inguinal surgery.