Comparison of two regional techniques for postoperative analgesia in children following herniotomy and orchidopexy

Abstract

Summary This study compares the quality and duration of analgesia in two groups of patients aged between I and Key wordsPain; postoperative. Anaesthetic techniques, regionah caudal, iliohypogastric and ilio-inguinal block.Conventional postoperative analgesia for paediatric surgery involves the administration of either opioid injections or oral analgesics. However, repeated intramuscular injections are unpopular with children and also often cause nausea, vomiting and unwanted sedation; furthermore, the administration of such injections requires trained nursing staff and hospitalisation prevents early discharge home. The selective use of regional anaesthetics administered during general anaesthesia is able to provide pain-free recovery which, with the use of the longeracting local anaesthetic agents, can last well into the postoperative period and reduce the need for either conventional intramuscular injections or oral analgesics.Both caudal anaesthesia and an iliohypogastric and ilio-inguinal nerve block using plain bupivacaine 0.25% have been used to provide postoperative analgesia in children who undergo orchidopexy.' In the present study, caudal anaesthesia using plain bupivacaine 0.25% was compared with an iliohypogastric and ilioinguinal nerve block augmented by skin infiltration of the incisional site using bupivacaine with adrenaline. The investigation monitored the duration and quality of the postoperative analgesia provided by the two techniques, following hcrniotomy and orchidopexy in children. MethodForty-one patients between the ages of 1 and 13 years about to undergo either herniotomy or orchidopexy, were randomly allocated to receive either an iliohypogastric and ilio-inguinal nerve block with skin infiltration, or caudal anaesthesia. Patients with spinal cord defects, bleeding diathesis or infection at the site of injection were not studied. The children were premedieated with papaveretum 0.3 mg/kg and hyoscine 0.006 mg/kg given one hour pre-operatively. Anaes-

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.…”

Elective orchidopexy in the paediatric population: a trial of intra-operative spermatic cord block

“…Post-operative analgesic use and vomiting were decreased in the LA group. Again combining IH and orchidopexy in 41 patients, Cross found no difference between IIB or caudal block in duration or quality of analgesia, vomiting or delayed micturition [18]. Markham also included hydrocele correction with IH and orchidopexy in his randomised trial comparing IIB to caudal block in 52 boys.…”

“…Unfortunately, many of these studies combine IH, hydrocele correction and orchidopexy with no attempt to separate the responses [17][18][19]. However, these combined studies provide some useful information.…”

“…However the concentrations were well below potentially toxic levels [22]. Despite the possible advantages of caudal block, the disadvantages include; more time-consuming than IIB; paraesthesia in the lower extremities (or inability to walk) in some children; urinary retention in older children; higher dose of LA required than IIB; inadvertent intra-vascular injection; and haematoma [11,[18][19][20].…”

Butorphanol: an opioid for day-care paediatric surgery

“…This is in agreement with Caruso et al n The overall observed incidence of postoperative vomiting is comparable to the published rates of 20-70% after similar paediatric surgery/anaesthesia. 12,13 The aetiology of the decreased emesis is unknown.…”