Comparison of The Analgesic Outcomes of Local Wound Infiltration using Bupivacaine with Tramadol in Pediatric Inguinal Hernia Repair

Objective: To compare the time for first analgesic requirement after local wound infiltration with tramadol and bupivacaine in pediatric inguinal herniotomy. Materials and Methods: A total of 130 children aged 4 to 12 years who underwent inguinal herniotomy were included in this randomized comparative study. The study was conducted in anesthesiology unit of a tertiary care center in Qatar from Nov-2020 to July-2021. Patients in Group T received wound infiltration by Inj. Tramadol 2 mg/kg diluted in 10cc distilled water while patients in Group B received Inj. Bupivacaine 1mg/kg diluted in 10 cc distilled water. Postoperatively Pain score using Wong Baker Faces Scale was noted from ½ hour to 6 hours after surgery. Time of first rescue analgesia was noted. Results: The mean age was 7.98±2.40 years in group B versus 7.49±2.58 years in group T (p-value 0.26). There were 42 (64.6%) in group B versus 45 (69.2%) in group T (p-value 0.93). Mean surgery duration was 46.66±4.73 minutes in group T and 45.50±4.37 minutes in group B. The Wong-Baker pain score at different time intervals was significantly lower in group T in comparison to group B. Time of first analgesia requirement was 6.87±0.76 hours in group P versus 5.67±0.97 hours in group P, this duration was significantly prolonged in group T with p-value <0.001. Conclusion: Local wound infiltration with tramadol provides a longer time for first analgesic requirement as compared to the bupivacaine in children undergoing inguinal hernia repair. Keywords: Inguinal hernia, wound infiltration, tramadol, bupivacaine, post-operative pain.

Comparative study of single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for pediatric inguinal herniotomy

To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy.The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs & symptoms of wound infection appear.50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days.Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively).Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI.

Criteria of efficiency of inguinal herniotomy in children under various techniques

Purpose. To improve outcomes of congenital inguinal hernia treatment in children by improving a technique of extracorporal herniorrhaphy and by ligature guide modification. Outcomes after surgeries performed with different techniques were assessed by the level of postoperative pain and by the quality of life. Material and methods. Outcomes were analyzed in 60 children operated on for inguinal hernia with 3 different approaches: Duhamel, LASSO, LOD . The intensity of postoperative pain syndrome was assessed 4 hours after surgery and on the next postoperative day. The quality of life was assessed in 24 patients out of 60 on the next postoperative day. Results. The analysis on distribution to normality for postoperative pain did not reveal any statistical differences on sex, age and diagnosis. Boys (average age 69.6 - 84 months) prevailed. In 4 hours after the surgery, patients who had laparoscopic intervention had less number of scores in comparison to those who had open herniorrhaphy. There were no difference in laparoscopic groups. On the next postoperative day, pain syndrome in all groups was about the same. The quality of life in patients differed only by their physical status and by the total number of scores; and these parameters were higher in LOD group (32.8 scores versus 89.4 scores). Conclusion. A modified LOD technique improves the quality of life in operated patients. Four hours after laparoscopic herniorrhaphy, a pain syndrome is less pronounced.

Subcutaneous ketamine prolongs the analgesic effect of local infiltration of plain Bupivacaine in children undergoing inguinal herniotomy

Background: Inguinal herniotomy is one of the commonest paediatric surgical procedures at the University of Benin Teaching Hospital. Incisional infiltration with plain bupivacaine has been used to provide postoperative analgesia for this procedure but with a short duration of action, 4- 6hours. Aims/Objectives: The aim of this study therefore was to evaluate the efficacy of subcutaneous ketamine on post-operative analgesia in children undergoing unilateral inguinal herniotomy. Methods: Forty-six (46) ASA I or II patients aged three to seven years scheduled for unilateral inguinal herniotomy were recruited. The patients were randomized to receive surgical wound site infiltration with plain bupivacaine plus subcutaneous injection of ketamine for group I or surgical wound site infiltration plain bupivacaine plus 2ml of saline subcutaneously for group II at the end of surgery. Data obtained were analyzed using SPSS version 20. Continuous data were compared using student t-test while categorical data were compared using Chi-square or Fisher's exact test. P- value <0.05 was considered statistically significant. Results: In group, I, the mean time to first analgesic request was 667.7 minutes (11.12hours) and in group II, it was 371.3min- utes (6.2 hours) with p<0.001. The pain scores were better and more favourable in group I from the 8th hour and above of the assessment period. The mean post-operative analgesic consumption in 24 hours was less in group I (19.35±5.4mg) than in group II (27.32±5.8 mg) with p-value <0.001. Conclusion: The study showed that subcutaneous ketamine prolonged the analgesic effect of plain bupivacaine surgical wound site infiltration in children undergoing unilateral inguinal herniotomy. Keywords: Subcutaneous ketamine, inguinal herniotomy, children, postoperative analgesia.