European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
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Randomized Controlled Trial Comparative Study
Wound infiltration with levobupivacaine: an alternative method of postoperative pain relief after inguinal hernia repair in children.
The aim of the study is to evaluate the efficacy of post-incisional wound infiltration with levobupivacaine in preventing the postoperative pain associated with inguinal hernia repair in children. Thirty boys, ASA I - II, aged 2 - 12 yrs., undergoing unilateral inguinal hernioplasty under general anaesthesia as day-case patients were allocated randomly to have postoperative analgesia either with post-incisional wound infiltration with levobupivacaine 1.25 mg/kg or with paracetamol 30 mg/kg administered rectally. Postoperative pain was assessed initially in the Post-Anaesthesia Care Unit and on the ward by an observer and afterwards for the next 24 h by the parents, using the Poker Chip Tool for preschoolers and the Visual Analogue Scale for older children, respectively. ⋯ The duration of the postoperative analgesia was estimated based on the time when rescue analgesia was first given. Assessment of the quality of postoperative analgesia was based on the children's behaviour. The wound infiltration group showed an increased duration of postoperative analgesia (p < 0.001) and early mobilisation, while the efficacy of postoperative analgesia tended to be more adequate, although no statistically significant difference was noted.
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Pulmonary function testing remains part of the routine preoperative investigations in patients with pectus excavatum, although there is evidence that reduced exercise capacity is predominantly due to impaired cardiovascular performance rather than ventilatory limitation. ⋯ Our findings indicate that pulmonary function improves in patients after completion of minimally invasive repair of pectus excavatum. However, a review of the literature suggests that, in all probability, following surgery, patients benefit more with regard to enhanced cardiovascular performance than from improved pulmonary limitations. The value of routine testing of pre- and postoperative lung function in patients with pectus excavatum is questionable.