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CLINICAL INVESTIGATION
Year : 2008  |  Volume : 52  |  Issue : 6  |  Page : 794

A Multimodal Approach to Post-Operative Pain Relief in Children Undergoing Ambulatory Eye Surgery


1 Consultant, Department of Anaesthesiology, Sankara Nethralaya, Vision Research Foundation, Chennai, India
2 Director, Department of Anaesthesiology, Sankara Nethralaya, Vision Research Foundation, Chennai, India
3 Deputy Director, Department of Anaesthesiology, Sankara Nethralaya, Vision Research Foundation, Chennai, India

Correspondence Address:
V V Jaichandran
Department of Anaesthesiology, Vision Research Foundation, 18, College Road, Chennai 600 006
India
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Source of Support: None, Conflict of Interest: None


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This study was carried to assess the efficacy of multimodal analgesia using ketorolac and fentanyl, for post­operative pain relief in children undergoing ambulatory eye surgery. Total of 161 children, aged 1 to 5 years, were randomly stratified to three different analgesic regimens: Group A Ketorolac 0.75 mg.kg -1 I.M. , Group B Fentanyl 0.75 µg.kg -1 I.V. and Group C Ketorolac 0.50mg.kg -1 I.M. and Fentanyl 0.50µg.kg -1 I.V. Ketorolac I.M. was given 45 minutes before extubation and fentanyl I.V. was given soon after extubation in the respective groups. Post-operative pain was assessed in a double blinded manner using Children's Hospital of Eastern Onatario Pain Scale (CHEOPS) scoring system and by recording the heart rate at 10, 30 and 60 minutes. If the score was above 8, the child was left with the parents. In case the score did not improve and persisted to be greater than 8, fentanyl 0.50µg.kg -1 I.V. was given as the rescue analgesia. The incidence of nausea, vomiting, sleep disturbances or any other complaints were recorded by a staff nurse 24 hours post operatively. Mean CHEOPS score at 10, 30 and 60 minutes and mean heart rate at 10 and 30 minutes were significantly higher for Group A compared with Group C. Mean pain score emerged significantly higher for Group B compared with Group C at 30 and 60 minutes, (P<0.01). Rescue analgesia required was significantly higher in Group A compared to Groups B and C, (P<0.0001). Post-operatively, significant incidence of drowsiness was reported in children in Group B compared to Groups A and C, (P<0.01). A multimodal approach using both ketorolac and fentanyl at low doses produce effective and safe analgesia in children undergoing ambula­tory eye surgery.


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