Caudal Block versus Wound Infiltration for Inguinal Procedures in Young Children: A Randomized Clinical Study

Abstract

Introduction Inguinal procedures in children are frequent and typically performed in an outpatient setting. We aimed to analyze whether there is a difference in postoperative pain scores and setup time (start of anesthesia management to incision time) when comparing caudal block (CB) with local wound infiltration. Materials and Methods We enrolled pediatric outpatients scheduled for inguinal procedures. Patients were randomized to receive either preincision CBs or end-of-procedure local wound infiltration. Postoperative pain scores until 24 hours postoperatively and setup time were analyzed. Results Fifty-two patients were included in the study. Thirty patients received a CB, and 22 patients received local infiltration (LI). There was no significant difference in postoperative pain scores. Setup time was significantly higher in the CB group: median 22.5 minutes IQR (16–46 minutes) compared with 17 minutes in the LI group IQR (10–35 minutes), p-value of 0.0026. Conclusion Both CB and LI result in good postoperative pain control after inguinal procedures in pediatric outpatients. Since LI is less time consuming and has lower risks for complications, we recommend this technique for inguinal procedures in pediatric outpatients. Our findings will need to be confirmed in larger cohorts, but we believe the evidence generated with this study has the potential to positively influence patient care, operating room efficiency, and costs.

Comparing Efficacy of Regional Analgesia Techniques after Pediatric Inguinal Procedures

“…With great interest we read the recent article by Zundel and colleagues, 1 which compared postoperative analgesic efficacy of caudal block and wound infiltration (WI) for inguinal procedures in young children. The primary outcome of this study was pain score within 24 hours postoperatively and a difference of 2 points in mean pain scores was considered as clinically relevant in sample size estimation.…”