A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy

Effect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy

“…7,8 The requirement for rescue analgesics in the IG/IH group within 2 hours (16%) was higher than reported by Casey et al 6 (3%). In addition, the proportion of patients in instillation groups who required analgesics within 2 hours (BE20 group, 23.1%; BE60 group, 20.8%) was also higher than in the study by Casey et al 6 (3%).…”

“…The sample size was calculated based on the proportion of patients who required analgesics in the placebo group ϭ 0.73, 7,8 in the IG/ IH group ϭ 0.03 6 to 0.45 8 (average proportion ϭ 0.24), and in the instillation group ϭ 0.03 6 to 0.55 7 (average proportion ϭ 0.29). With a 2-sided type I error of 5% and study power at 80%, the number of patients required in each group to demonstrate a difference between the placebo group and the IG/IH group, or placebo group and instillation groups, was 24.…”

“…Various techniques of regional analgesia, such as caudal block, ilioinguinal and iliohypogastric (IG/IH) block, topical spray, and wound infiltration have been shown to provide effective postoperative analgesia without delaying discharge. [1][2][3][4][5][6][7][8] Instillation of 0.25% bupivacaine 0.25 mL/kg into the wound at the completion of surgery provides an analgesic effect comparable to IG/IH nerve block. 6 This approach seems to be simple, but there is still a problem of compliance secondary to the 2-minute instillation time reportedly required for this technique.…”

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

“…Our rationale was that failed interventions will always necessitate rescue analgesic. Conroy and colleagues reported that they did not follow the randomisation sequence appropriately as generated for the first 30 patients [16]. Hence, we decided that a sensitivity analysis is to be carried out by excluding this study and observing the change in estimate of effect.…”

Effects of ropivacaine infiltration on cortisol and prolactin responses to postoperative pain after inguinal hernioraphy in children

“…Regional analgesia in a variety of forms has been shown to afford effective postoperative pain relief after pediatric inguinal hernia repair with short hospitalization. Caudal and lumbar epidural block, [3][4][5][6] ilioinguinal nerve block, 4,6-9 wound infiltration, 5,9,10 wound instillation, 3,7 and topical administration of local anesthetics 11 have all been used with varying success. Recent studies have focused on the clinical implications of preemptive analgesia (local analgesia given before general anesthesia (GA) for the management of postoperative pain.…”