scholarly journals The ropivacaine concentration required for ultrasound-guided rectus sheath block in pediatric patients undergoing laparoscopic inguinal hernia repair surgery

Author(s):  
Keitaro Tachi
Author(s):  
Nashwa Atef Badawy ◽  
Mona Blough El Mourad ◽  
Ahmed Said AL Gebaly ◽  
Yasser Mohamed Amr

Background: Inguinal hernia repair is one of the most common surgical procedures in the pediatric age group and it is associated with significant post-operative discomfort. The aim of this study is to compare the safety, reliability, and efficacy of ultrasound-guided transverses abdominis plane (TAP) block versus erector spinae plane (ESP) block for postoperative pain control in pediatrics undergoing laparoscopic inguinal hernia repair. Methods: This prospective randomized study was carried out on 90 pediatric patients of both sexes aged (2 -7) years with ASA physical status I/II scheduled for elective laparoscopic inguinal hernia repair. Patients were divided into 3 equal groups. Group C received general anesthesia alone. group T received bilateral ultrasound-guided TAP block after induction of general anesthesia with the injection of 0.4 ml/kg bupivacaine 0.25%. group E received bilateral ultrasound-guided ESP block after induction of general anesthesia with the injection of 0.4 ml/kg bupivacaine 0.25%. Results: According to CHEOPS, we found no statistically significant difference between ESP and TAP groups but significant increase in the control group. also, There was a significant decrease in total rescue analgesia (intra-operative & postoperative ) in the T group and E as compared to group C. Also there was a significant delay in onset of first rescue analgesia post operatively between group T&E in comparison to group C. The mean value of heart rate between the 3 groups showed no statistically significant difference between TAP and ESP groups intra-operatively but significant increase in heart rate in the control group in all stages of the operation as compared to T& E groups. Mean arterial blood pressure changes were insignificant between three groups in all stages of operation. Conclusions: TAP block and ESP block are effective and safe techniques for postoperative pain control in pediatric patients undergoing laparoscopic inguinal hernia repair with more hemodynamic stability, less intra and postoperative analgesia requirement.


2020 ◽  
Vol 13 (2) ◽  
pp. e232780
Author(s):  
Mohammed Al-Zubaidi ◽  
Nicholas Bayfield ◽  
Shelbin Neelankavil

Totally extraperitoneal (TEP) laparoscopic inguinal hernia repair is a surgical method of inguinal hernia repair that avoids entry into the peritoneum, thus significantly reducing likelihood of intra-peritoneal complications. Herein, we describe a rare case in which a 42-year-old man presented with acutely strangulated small bowel in an internal hernia through the peritoneum and posterior rectus sheath 6 days postelective TEP laparoscopic inguinal hernia repair. He presented with acute onset severe abdominal pain and intractable vomiting. After CT diagnosis, emergent laparotomy was performed, and 20 cm of non-viable small bowel required resection, with enteric anastomosis. The peritoneal defect was identified and repaired. The patient was discharged 4 days postoperatively with an uneventful postoperative course.


2020 ◽  
Vol 24 (5) ◽  
Author(s):  
Carla Hipólito ◽  
Vicente Vieira ◽  
Virginia Antunes ◽  
Petra Alves ◽  
Adriana Rodrigues ◽  
...  

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia. Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management. Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade. Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade. Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5): Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020


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