Letters to the Editor

Indian Pediatrics 2002; 39:979

Reply

In reference to the above letter from Singh and Raghuraman, we are to offer the following comments:

The day care surgery is being routinely performed in our Department over the past 15 years for surgeries like hernia, hydrocele, orchiopexy, circumcision, cystoscopy, biopsies, vesical calculus and recently we have extended for surgeries like cleft lip etc.

(a) The study was conducted on 100 children who underwent day care surgery. This implies that children are routinely discharged on the same day. For the purpose of this study, we kept all the children till at least 8 p.m. and discharged only those on the same evening, who had hardly any postoperative pain with medications. The observer for pain response was unaware of the medication used. Atleast two recordings were possible on all children. Some of the children were having postoperative pain and hence kept as in-patients. They stayed as in-patient for a day or two till they were free of pain. We agree two observers would have improved the strength of the study.

(b) All the children were seen in the early postoperative follow-up at one week, however it is true that in response to the postal request only 42% returned for follow-up two months later.

(c) On the basis of literature reports on the toxic effects of nimesulide over roughly five years of usage in Europe and India, 13 cases of severe liver injury have been reported. Majority have been reversible. The mean age among all reported cases have been 62 years, majority have been females (84%) and the mean duration of therapy has been 62 days(1). We have already suggested that further studies need to be done to evaluate the efficacy and safety of Nimesulide for day care surgery in children. In this study, the drug is used for a short period (1-3 days) in limited dose as the postoperative pain keeps resolving with time.

References

1. Conforti A, Leone R, Moretti U, Mozzo F, Velo G. Adverse drug reactions relating to the use of NSAIDs with a focus on Nimesulide; results of spontaneous reporting from a northern Italian area. Drug safety 2001; 24: 1081-1090.