Postoperative analgesia in children after propofol versus sevoflurane anesthesia

Abstract

Objective: Postoperative analgesia remains a problem, especially in pediatric patients. We hypothesize that patients anesthetized with sevoflurane have more postoperative pain than with propofol.

Design: Randomized, prospective, double-blind study.

Setting: University teaching hospital.

Subjects: The subjects were 88 premedicated children, aged 3-6 years, and American Society of Anesthesiologists (ASA) Physical Status I or II.

Interventions: Subjectsunderwent hernia repair surgery.

Methods: Anesthesia was maintained with propofol (group P, N = 46) or sevoflurane (group S, N = 42) and fentanyl was administered during surgery. All children before surgical incision received 40 mg/kg paracetamol, rectally. Prior to wound closure, the margins were infiltrated with 0.5% bupivacaine.

Outcome measures: The primary outcome was pain score assessed by Faces Pain Scale (FPS) 2 hours postoperatively. The secondary outcomes included recovery time and adverse events within the first 2 hours.

Results: Group S had a significantly higher proportion of patients who exhibited postoperative pain than group P (24.3% vs 4.5%, respectively; P < 0.05). FPS score in group P was 1.2 ± 0.6, compared with 3.4 ± 1.5 in group S (P < 0.001). Mean recovery time in group S was significantly shorter than the corresponding mean for group P (10.1 ± 1.3 vs 16.5 ± 5.4 minutes, respectively; P < 0.001).

Conclusion: In children, anesthesia maintenance with propofol was associated with a significantly lower incidence of postoperative pain than with sevoflurane.