| dc.description.abstract | Postoperative nausea and vomiting (PONV) and pain are unpleasant experiences in children, as well as in adults, which can, apart from the discomfort, result in delayed recovery. The general aims of this work were to identify current problems with PONV and pain following paediatric surgery and to evaluate the efficacy of specific interventions. Methods: The postoperative recovery of 917 children was assessed during at least 24 hours in five prospective studies. In a survey including 485 children, the incidence of PONV was related to patient factors, anaesthetic methods and type of surgery. The influence of an antiemetic drug, dixyrazine was evaluated in children subjected to squint surgery and in children using patient controlled analgesia (PCA) with morphine after major surgery. Following day case surgery, pain and PONV were surveyed in hospital and at home. In a controlled study on penile day case surgery the effects of a caudal block with ropivacaine and of an intravenous administration of a low dose of fentanyl on pain and PONV were studied. Results: After general surgery the incidence of PONV was 25%. The majority of emetic episodes were recorded after the immediate recovery period. PONV was most common after squint surgery. For the same type of surgery, maintenance of anaesthesia with halothane resulted in a lower incidence of nausea than anaesthesia with fentanyl-pancuronium. Prophylactic administration of dixyrazine 0.25 mg kg-1 reduced the incidence of vomiting after squint surgery in children given either opioid (69% to 21% ) or halothane anaesthesia (45% to 10%). Dixyrazine also reduced the incidence of vomiting in children using morphine PCA in the recovery room (30% and 3%) and on the ward (83% and 57%). The need for rescue antiemetics was also reduced after dixyrazine. The immediate postoperative analgesia for 200 day case children was adequate in most patients. At home almost half of the patients rated more than mild pain. The highest incidence of pain was found after orchidopexies. The incidence of PONV was 28%. Caudal block with ropivacaine provided satisfactory pain relief for 7 hours (median) after out-patient penile surgery. An increased need for postoperative analgesics was observed when the effect of the block had disappeared. Fentanyl 1 _g kg-1 increased the incidence of PONV without any significant contribution to pain relief. Conclusions: PONV is still a common problem after paediatric anaesthesia especially after squint surgery and in children using PCA with morphine. The incidence of PONV can be reduced with prophylactic dixyrazine treatment. Opioids, even in low doses increase the incidence of PONV after minor surgery. A caudal block provides good immediate pain relief after penile day-case surgery. Further treatment with analgesics is needed in order to prevent the onset of pain when the block wears off. | en |
