Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

Aleksandra Gavrilovska-Brzanov; Biljana Kuzmanovska; Andrijan Kartalov; Ljupco Donev; Albert Lleshi; Marija Jovanovski-Srceva; Tatjana Spirovska; Nikola Brzanov; Risto Simeonov

doi:10.3889/oamjms.2016.023

Authors

Aleksandra Gavrilovska-Brzanov University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Biljana Kuzmanovska University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Andrijan Kartalov University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Ljupco Donev University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Albert Lleshi University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Marija Jovanovski-Srceva University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Tatjana Spirovska University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Nikola Brzanov University Clinic of Surgery, ER Department, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje
Risto Simeonov University Clinic for Pediatric Surgery, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2016.023

Keywords:

Caudal block, Local wound infiltration, Pediatric analgesia, Hernia Inguinalis, Buivacaine

Abstract

AIM: The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration.

MATERIAL AND METHODS: In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well.

RESULTS: The two groups did not differ in terms of patient characteristic data and surgical profiles and there werenâ€™t any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were two major points - on one hand it was statistically significant p < 0.05 whereas on the other hand time to first analgesic administration was not statistically significant p = 0.40. There were significant differences in the incidence of adverse effects in caudal and local group including: vomiting, delirium and urinary retention.

CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Lao OB, Fitzgibbons RJ, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surgical Clinics of North America. 2012;92(3):487â€“504.

http://dx.doi.org/10.1016/j.suc.2012.03.017 DOI: https://doi.org/10.1016/j.suc.2012.03.017

PMid:22595705

JÓ§hr M. Regional anesthesia in neonates, infants and children. Eur J Anaesthesiol. 2015;32:289-297.

http://dx.doi.org/10.1097/EJA.0000000000000239 DOI: https://doi.org/10.1097/EJA.0000000000000239

PMid:25693139

Association of Pediatric Anesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain management. 2nd edition. Pediatr Anesth. 2012;22 (Suppl 1):1-79. DOI: https://doi.org/10.1111/j.1460-9592.2012.03838.x

Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multiinstituional study of the use and incidences of complications of pediatric regional anesthesia. Amesth Analg. 2012;115:1353-1364.

http://dx.doi.org/10.1213/ANE.0b013e31825d9f4b DOI: https://doi.org/10.1213/ANE.0b013e31825d9f4b

PMid:22696610

Cook TM, Counsell D, Wildsmith JA. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anesthetist. Br J Anesthesia. 2009;102:179-190.

http://dx.doi.org/10.1093/bja/aen360 DOI: https://doi.org/10.1093/bja/aen360

PMid:19139027

Schindler M, Swarm M, Crawford M. A comparison of postoperative analgesia provided by wound infdtration or caudal analgesia. Anaesth Intensive Care. 1991;19:46-9. DOI: https://doi.org/10.1177/0310057X9101900108

PMid:2012294

Fell D, Derrington MC, Taylor E, Wandless JG. Paediatric postoperative analgesia. A comparison between caudal block and wound infdtration of local anaesthetic. Anaesthesia. 1988;43:107-10.

http://dx.doi.org/10.1111/j.1365-2044.1988.tb05475.x

PMid:3354802

Splinter WM, Bass J, Komocar L. Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia. Can Journal of Anesthesia. 1995;42(3):197-200.

http://dx.doi.org/10.1007/BF03010675

PMid:7743568

Crellin D, Sullivan TP, Babl FE, O'Sullivan R, Hutchinson A. Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting. Paediatr Anaesth. 2007;17:720â€“33.

http://dx.doi.org/10.1111/j.1460-9592.2007.02218.x DOI: https://doi.org/10.1111/j.1460-9592.2007.02218.x

PMid:17596217

Willis MH, Merkel SI, Voepel-Lewis T, Malviya S. FLACC Behavioral Pain Assessment Scale: a comparison with the child's self-report. Pediatr Nurs. 2003;29:195â€“8.

PMid:12836995

Practice guidelines for postanesthetic care: a report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2002;96:742â€“52.

http://dx.doi.org/10.1097/00000542-200203000-00033 DOI: https://doi.org/10.1097/00000542-200203000-00033

Shanthanna H, Singh B, Guyatt G. A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncauda Regional Techniques for Inguinal Surgeries in Children. BioMed Research International. 2014;890626:17. DOI: https://doi.org/10.1155/2014/890626

Machotta A, Risse A, Bercker S, Streich R, and Pappert D. Comparison between instillation of bupivacaine versus caudalanalgesia for postoperative analgesia following inguinal herniotomyin children. Paediatric Anaesthesia. 2003;13(5):397â€“402.

http://dx.doi.org/10.1046/j.1460-9592.2003.01080.x DOI: https://doi.org/10.1046/j.1460-9592.2003.01080.x

PMid:12791112

Lafferty PM, Gordon NH, and Winning TJ. A comparison of postoperative pain relief techniques in orchidopexy. Annals of the RoyalCollege of Surgeons of England. 1990;72(1):7â€“8.

http://dx.doi.org/10.1097/00132586-199008000-00043 DOI: https://doi.org/10.1097/00132586-199008000-00043

Hosseini Jahromi SA, Sadeghi Poor S, Hosseini Valami SM, and Javadi A. Effects of suppository acetaminophen, bupivacaine wound infiltration and caudal block with bupivacaine on postoperative pain in pediatric inguinal herniorrhaphy. Anesthesiology and Pain Medicine. 2012;1(4):243â€“247.

http://dx.doi.org/10.5812/aapm.3551 DOI: https://doi.org/10.5812/aapm.3551

PMid:24904808 PMCid:PMC4018710

Fell D, Derrington MC, Taylor E, and Wandless JG. Paediatric postoperative analgesia: a comparison between caudal block and wound infiltration of local anesthetic. Anesthesia. 1988;43(2):107â€“110.

http://dx.doi.org/10.1111/j.1365-2044.1988.tb05475.x

Conroy JM, Othersen HB, Dorman HB, Gottesman JD, Wallace CT, and Brahen NH. A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy. Journal of Pediatric Surgery. 1993;28(4):565â€“567.

http://dx.doi.org/10.1016/0022-3468(93)90617-T DOI: https://doi.org/10.1016/0022-3468(93)90617-T

Splinter MW, Bass J, Komocar L. Regional anesthesia for hernia repair in children: local vs caudal anesthesia. Can J Anesth. 1995;42(3):197-200.

http://dx.doi.org/10.1007/BF03010675 DOI: https://doi.org/10.1007/BF03010675

PMid:7743568

Ejlersen E, Andersen HB, Eliasen K, Mogensen T. A comparison between Preincisional and Postincisional Lidocaine Infiltration and Postoperative Pain. Anesth Anaig. 1992;74:4958.

http://dx.doi.org/10.1213/00000539-199204000-00004 DOI: https://doi.org/10.1213/00000539-199204000-00004

Fell D, Derrington MC, Taylor E, Wandless JG. Paediatric postoperative analgesia. A comparison between caudal block and wound infdtration of local anaesthetic. Anaesthesia. 1988;43:107-10.

http://dx.doi.org/10.1111/j.1365-2044.1988.tb05475.x DOI: https://doi.org/10.1111/j.1365-2044.1988.tb05475.x

PMid:3354802