CAUDAL BUPIVACAINE VERSUS INTRAVENOUS MORPHINE ON TIME TO FIRST ANALGESIC REQUIREMENT
Status:
Completed
Trial end date:
2015-12-01
Target enrollment:
Participant gender:
Summary
Pain is a subjective sensation which in children can only be experienced and most times not
expressed. Pain management in children thus falls short of their adult counterparts. Acute
pain of surgery causes significant suffering and stress. In children, pain management has
lagged behind because of the belief that children's pain receptors are less well developed
than their adult counterparts. However this has been proven to be false as development of
pain receptors has been shown by 26th week of gestation. Caudal analgesia with plain
bupivacaine has been used for effective post operative analgesia. Resources sometimes limit
acquisition of additives to bupivacaine to be delivered into the intrathecal space.
The fear of pharmacological adverse effects of opioids has restricted their use especially
among the anesthesia officers who deliver the bulk of anesthesia services in Uganda and this
has led to poor pain management in pediatric populations Mulago national referral hospital is
a resource limited centre with regards to human resource, equipment and drugs. This is mainly
due to lack of sufficient funds and large volume of patients with the nursing staff being
overwhelmed by the patient capacity. Drug administration is often not done on time and
continuous assessment of pain scores in children is not adequate resulting in poor post
operative pain management. Pain control thus will depend on analgesia provided at the time of
operation creating a need for prolonged pain control measures.
Studies done have compared intravenous morphine administration versus caudal analgesia and
are mostly focused of sub umbilical surgery however none has been done in our setting.
Bupivacaine and morphine are now more readily available and can be used for post operative
analgesia. However studies on the timing to the next analgesic requirement have not been
compared/done in Mulago national referral hospital.