Comparative Study Between Caudal Block And Local Wound Infiltration In Inguinal Hernia Repair In Pediatric Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Azza Mohamed Shafeek Abdel Mageed ◽  
Wael Reda Hussaein ◽  
Rania Hassan Abdel Hafiez ◽  
Tarek Atef Abdullah Hammouda
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Pain Score ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Caudal Block ◽  
Wound Infiltration ◽  
Unilateral Inguinal Hernia ◽  
Significant Difference

Abstract Background Postoperative analgesia can be provided by a multimodal approach includes opioids, nonsteroidal anti-inflammatory drugs, paracetamol infusion and regional anesthetic techniques such as local infiltration or nerve blocks. In contrast to opioids, local anesthetics can be administered safely and in recent guidelines regional anesthesia is accepted as the cornerstone of postoperative pain relief in the pediatric patients. Objective Compare the postoperative analgesic effectiveness of local wound infiltration of bupivacaine against bupivacaine administered caudally in pediatric patients undergoing unilateral inguinal hernia repair. Patients and methods This study was carried out in Ain Shams University hospitals on 40 pediatric patients of both sexes aged from 6 months to 7 years belonging to ASA I or II undergoing elective unilateral inguinal hernia repair. They were randomly allocated into two groups: group C receiving caudal block, group L receiving local wound infiltration. Hemodynamic changes, postoperative pain score using FLACC pain score, postoperative analgesia and complications were recorded. Results There was no significant difference between the two groups as regard demographic data or hemodynamic variables. Pain score shows no statically significant differences between two groups in the first hour. But statistically significant decrease in FLACC score after (1, 2 and 3 hours) in group C in comparison with group L.decreased significantly in group C after 1 hour postoperative. Duration of analgesia longer in group C with no significant difference in total amount of postoperative analgesia. There was significant increase in incidence in complications in group C than group L Conclusion Caudal block provides better and longer analgesia but requires experience and may lead to complications. In contrast, wound infiltration is simple without significant side effects. Therefore, local wound infiltration may be a preferred technique for producing postoperative analgesia in pediatric inguinal hernia repair.

scholarly journals Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

2020 ◽  
Vol 45 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Gözen Öksüz ◽  
Mahmut Arslan ◽  
Aykut Urfalıoğlu ◽  
Ahmet Gökhan Güler ◽  
Şeyma Tekşen ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Parent Satisfaction ◽  
Caudal Block ◽  
Double Blind ◽  
Quadratus Lumborum

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia.Materials and methodsAfter approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded.ResultsThe study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014).ConclusionAccording to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries.Trial registration numberNCT03294291.

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

2016 ◽  
Vol 4 (1) ◽  
pp. 89-93
Author(s):  
Aleksandra Gavrilovska-Brzanov ◽  
Biljana Kuzmanovska ◽  
Andrijan Kartalov ◽  
Ljupco Donev ◽  
Albert Lleshi ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Pediatric Patients ◽  
Caudal Block ◽  
Wound Infiltration ◽  
Analgesic Requirement ◽  
Local Infiltration ◽  
Recovery Profile ◽  
The Difference

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 weren’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.

scholarly journals Ultrasound Guided Transversus Abdominis Plane (TAP) Block versus Caudal Block in Pediatrics Undergoing Inguinal Hernia Repair

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N M A Fahmy ◽  
A M Hazem ◽  
M A A Tolba ◽  
S A Mostafa
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Surgical Procedures ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Transversus Abdominis ◽  
Anesthetic Techniques ◽  
Tap Block ◽  
Caudal Block

Abstract Background Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics are caudal block and TAP block. Objective This study was to compare the effectiveness and safety of US guided TAP block versus caudal block as a part of multimodal analgesia in pediatric patients undergoing inguinal hernia repair. Patients and Methods The study was conducted on 90 randomly chosen patients in Ain Shams University Hospitals after approval of the Medical Ethical Committee. Patients were divided randomly into two groups, each group consisted of 45 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Results The results of the study revealed that US guided TAP block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal block in pediatric patients undergoing inguinal hernia. Both analgesic techniques are safe. Conclusion The current study revealed that US guided TAP block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal block in pediatric patients undergoing inguinal hernia. Both analgesic techniques are safe.

scholarly journals Laparoscopic versus open mesh repair of unilateral inguinal hernia: a comparative study

2017 ◽  
Vol 4 (3) ◽  
pp. 921
Author(s):  
Sudarshan P. B. ◽  
Sundaravadanan B. S. ◽  
Kaarthik V. P. ◽  
Prabu Shankar S.
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Return To Work ◽  
Inguinal Hernia Repair ◽  
Laparoscopic Group ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Unilateral Inguinal Hernia ◽  
Laparoscopic Inguinal Hernia ◽  
Post Operative Pain ◽  
Significant Difference

Background: Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. Laparoscopic inguinal hernia repair was started in year 1999 and since then has gained popularity over the last 2 decades. The introduction of a laparoscopic technique has sparked a debate in the literature over the superiority of this method versus open repair. Even though for bilateral and recurrent inguinal hernias, laparoscopic approach is recommended, there is not enough literature to recommend its routine use in unilateral inguinal hernia repair.Methods: A randomised prospective study was conducted at a tertiary care teaching hospital, comparing both Laparoscopic inguinal hernia repair and lichensteins tension free mesh repair as treatment modalities for unilateral inguinal hernia. Total number of patients in the study group was 60. Patients who were willing for the study were selected for the open or laparoscopic procedure in a randomised way. Open procedure was done by 2 senior surgeons and laparoscopic procedure was performed by 2 other senior surgeons at associate professor designation. Various parameters like the complication rate, post-operative pain, post-operative stay and time to return to work were analysed.Results: Out of the 60 patients, 30 patients underwent open inguinal hernia repair and another 30 patients underwent Laparoscopic inguinal hernia repair. The mean age group was 46.73 in open surgery group and 42.10 in laparoscopic group. 23.3% of the patients in open hernioplasty developed seroma, hematoma in the post-operative period. Whereas 10% had seroma collection in laparoscopic group. No incidence of recurrence in both the groups. No significant difference in pain score between both the groups during immediate post-operative period on POD 0, however there was significant difference in pain score on POD 3 (mean pain in open group 4.13 and lap group 2.87) and POD 7(mean pain in open group 2.90 and lap group 1.23). Mean duration of stay in hospital for open hernioplasty was 7.8 days and for Laparoscopic hernioplasty was 3.07 days. Mean duration of return to work in open hernioplasty was 14.37 days and in laparoscopy group was 9.13 days.Conclusions: There are potential benefits for laparoscopic inguinal hernia repair over lichtenstein’s repair for unilateral inguinal hernias in terms of post-operative pain, hospital stay and early return to work.

scholarly journals Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Abeer Ahmed ◽  
Maher Fawzy ◽  
Mohamed A. R. Nasr ◽  
Ayman M. Hussam ◽  
Eman Fouad ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Anesthesia ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Comparative Trial ◽  
Opioid Consumption ◽  
P Value ◽  
Ultrasound Guided ◽  
Unilateral Inguinal Hernia

Abstract Background Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. Methods Forty patients, aged from 18 to 50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. Results Duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 h versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 h postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. Conclusions Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. Trial registration ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018.

scholarly journals Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches.

2019 ◽  
Author(s):  
Abeer Ahmed ◽  
Maher Fawzy ◽  
Mohamed AR. Nasr ◽  
Ayman M. Hussam ◽  
Eman Fouad ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Anesthesia ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Comparative Trial ◽  
Opioid Consumption ◽  
P Value ◽  
Ultrasound Guided ◽  
Unilateral Inguinal Hernia

Abstract Background : early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia. Methods: Forty patients, aged from 18-50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded. Results : duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 hours versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 hrs postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively. Conclusions : Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia. Trial Registration : ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018

scholarly journals A comparative study examining laparoscopic and open inguinal hernia repair in children: a retrospective study from a single center in China

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jie Liu ◽  
XiongWei Wu ◽  
WenLi Xiu ◽  
XiWei Hao ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Operation Time ◽  
Indirect Inguinal Hernia ◽  
Bilateral Inguinal Hernia ◽  
Pediatric Inguinal Hernia ◽  
Advantages And Disadvantages ◽  
Unilateral Inguinal Hernia ◽  
Significant Difference

Abstract Background Pediatric inguinal hernia (PIH) is a common disease in children. Laparoscopic hernia repair (LHR) has developed rapidly in recent years, but there are still different opinions compared with traditional open hernia repair (OHR). The purpose of this study was to compare the advantages and disadvantages of LHR and OHR in the treatment of pediatric inguinal hernia. Methods We performed a retrospective review of all children (< 14 years) who underwent repair of inguinal hernia in the pediatric surgery center of the Affiliated Hospital of Qingdao University from January 2015 to December 2015. We collected the medical records of all the children and analyzed the clinical characteristics, operation-related information and follow-up. Results In the OHR group, 202 cases underwent unilateral inguinal hernia repair, and 43 cases underwent bilateral inguinal hernia repair. In the LHR group, 168 cases underwent unilateral inguinal hernia repair, and 136 cases underwent bilateral inguinal hernia repair. There was a significant difference in the operation time between the two groups, but there were no significant differences in postoperative hospitalization time and incidence of ipsilateral recurrent hernia between the two groups. The incidence rates of metachronous contralateral hernia (MCH) and surgical site infection in LHR group were significantly lower than those in the OHR group. Conclusion Our study shows that compared with OHR, LHR has the advantages of concealed incision, minimal invasiveness, reduced operation time, detection of contralateral patent processus vaginalis, and reduced incidence of MCH. In conclusion, LHR is safe and effective in the treatment of pediatric indirect inguinal hernia.

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