The effect of local wound infiltration vs caudal block on wound infection and healing after inguinal herniotomy in pediatrics − a double-blinded randomized study

Abstract

Purpose The aim was to compare the use of local wound infiltration (LWI) vs caudal block (CB) on wound infection and healing after inguinal herniotomy in pediatrics. Patients and methods A total of 50 patients were assigned randomly into two groups (n=25/group) that received LWI using up to 1 mg/kg bupivacaine 0.25% or CB in group C using 1 mg/kg bupivacaine 0.25%. The authors measured wound infection and healing (primary outcome) using Southampton scoring system and postoperative analgesia (secondary outcome) using Faces Legs Activity Cry Consolability tool scale. Results There was a statistically significant difference regarding Southampton scoring system between the two studied groups, with higher number of patients with higher scores in group L (P=0.008). Comparison between the two groups according to preoperative and postoperative white blood cell count shows statistically significant increase in group C on day 7 postoperatively (P=0.015). There was a statistically significant decrease in pain score scale in group C compared with group L at 15 min (P=0.035), 60 min (P=0.007), and 3 h postoperatively (P=0.049). Analgesic requirement shows a statistically significant increase in group L at 15 and 60 min postoperatively (P=0.022). Postoperative complication was not statistically significant (P=1.000). Conclusion LWI is a safe and satisfactory analgesia option for surgery, and compared with CB, it is not overwhelming. CB provides better and longer analgesia; however, complications are more common. Wound healing was found to be better with CB, but it was clinically insignificant, as all patients healed normally. LWI did not cause wound infection in any of the patients included in the study and showed decrease in white blood cells in group L on day 7 postoperatively.