Paediatric Inguinal Herniotomy Research Articles

The efficacy of transversalis fascia plane block in pediatric inguinal herniotomy: a randomized controlled study.

The post-operative analgesic efficacy of transversalis fascia plane (TFP) block is controversial in pediatric patients undergoing herniotomy. This study aims to compare the efficacy of TFP block and standard analgesic methods. Sixty patients aged 1-8 years who underwent the open procedure of herniotomy were randomly divided into two groups TFP block (n = 30) or control group (n = 30). The TFP group received 0.25% bupivacaine at 0.5 mL/kg. Routine analgesia protocol was applied to Group C. Pain scores (FLACC), family satisfaction, block complications, nausea, sedation score, and additional analgesic requirements were recorded. FLACC pain scores at post-anesthesia care unit (PACU), 1st, 2nd, and 4th h were statistically significantly lower in Group TFP compared to group control (p < 0.05). Three patients in Group TFP and 12 in group control required rescue analgesics at PACU (p = 0.015). Ibuprofen was required in two patients in Group TFP and 11 in Group Control (p = 0.010). Parental satisfaction is higher in the TFP group than in Group Control (p < 0.001). There was no statistically significant difference between the groups in terms of post-operative nausea and sedation scores (p > 0.05). We conclude that TFP block in pediatric patients is an appropriate approach as a part of multimodal analgesia. It creates fewer pain scores in the early post-operative period, requires less additional analgesia, and increases family satisfaction.

Randomized Comparative Study of Analgesic Effects of Ilioinguinal and Iliohypogastric Nerve Block with Levobupivacaine (0.25%) versus Diclofenac Suppository in Pediatric Patients Undergoing Inguinal Herniotomy under General Anesthesia

Context: Pain management intraoperatively and postoperatively in the pediatric age group is a matter of concern. On the one hand, children are poorer at precisely conveying the extent of pain all the while being more susceptible to pain-related complications such as laryngospasm. On the other hand, children are less suited to use of potent opioids due to associated complications which can often lead to catastrophe. Therefore, a multimodal approach is desirable to optimize pain management in children. A nerve block is a highly effective and popular modality nowadays. In this single-blinded, parallel group, monocentric, and randomized protocol study, we have compared the efficacy of pain control achieved in the use of nonsteroidal anti-inflammatory drugs as analgesic versus iliohypogastric ilioinguinal (IIIH) nerve block in herniotomy in pediatric age group. Materials and Method: The parallel-group prospective study recruited 104 participants who were randomly allocated into two groups of 52 each, such that both groups received 1 mcg/kg fentanyl and sevoflurane during induction of GA. For analgesia, Group 2 was given diclofenac suppository intraoperative after induction of GA. Group 1 was given IIIH nerve block under nerve stimulator guidance for perioperative analgesia. Both groups were studied for the following parameters which included: time to get the 1st dose of rescue analgesic, total dose of rescue analgesic, visual analog scale (VAS) score, and hemodynamic parameters. Results: We observed that Group 1 showed a statistically significant difference in the form of longer duration of analgesia after surgery (9.67 ± 1.80 h vs. 6.35 ± 0.84 h) and lower total dose of rescue analgesic requirement (69.23 ± 2 [22.77] vs. 106.23 ± 2 [21.49]) while having a better hemodynamic profile and lower cumulative VAS score (7.71 ± 1.39 vs. 12.04 ± 1.72). Conclusion: Based on the above findings, we deduce that preincisional nerve stimulator-guided IIIH block by levobupivacaine (0.25%, 0.3 ml/kg) and rectal diclofenac (2 mg/kg) is both safe approaches to provide postoperative analgesia in pediatric inguinal herniotomy under general anesthesia. However, nerve stimulator-guided IIIH nerve block by levobupivacaine is a safe and better choice as it provides more intense analgesia for a longer duration compared to diclofenac suppository in the immediate postoperative period.

Postoperative Analgesia After Inguinal Herniotomy in Children; A Comparison of Combination of Intravenous Paracetamol and Rectal Diclofenac with Caudal Bupivacaine

Objective: To compare the efficacy of intravenous paracetamol and rectal diclofenac combination with caudal block using 1ml/kg of 0.25% bupivacaine in the management of post-operative pain following paediatric inguinal herniotomy. Methodology: This quasi-experimental study was conducted at the Department of Anesthesia, Holy Family Hospital, Rawalpindi, from February 2020 to August 2020. A total of 342 children aged 2-12 years requiring inguinal herniotomy were enrolled after satisfying the inclusion and exclusion criteria. Computer-generated random numbers were used to split the patients into two groups. Group A received intravenous paracetamol (30 mg/kg) and rectal diclofenac (1mg/kg). Group B received a caudal block using 1ml/kg of 0.25% Bupivacaine. Pain was assessed postoperatively in the PACU by modified Objective Pain Scale (OPS) every 15 minutes for the 1st hour and hourly up till 8 hours. Effective analgesia was defined as a modified OPS score of ≤ 3 for upto 8 hours after shifting to PACU. If at any time, the score was &gt;3 and the patient required a rescue analgesic, effective anaglesia was not achieved. Results: Effective analgesia was achieved in 82.46% of the patients (n=141) in Group-A versus 87.13% patients (n=149) in Group-B (p-value: 0.23). Conclusion: There is no significant difference in the efficacy of analgesia in paracetamol/diclofenac combination group compared with caudal bupivacaine group.

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

Rationale: There is a diversity of methods in performing pediatric inguinal herniotomy, but no consensus on which is the gold standard. The two most common are the Ferguson technique and the Mitchell Banks technique. The objective of this meta-analysis was to compare the two techniques in terms of hernia recurrence and post-operative complications: namely hematoma, hydrocele, testicular ascent, and testicular atrophy. Methods: Three randomized controlled trials and one multi-center retrospective study were included in this meta-analysis. Using the Cochrane Collaboration tool and Newcastle-Ottawa quality assessment scale, all studies included were deemed to be of good quality and have low risk of bias. Revman 5.3 was used for all statistical analyses. Results: There was no significant difference in terms of hernia recurrence between the two techniques (OR = 0.85, 95% CI = 0.31- 2.36). For post-operative complications, hematoma (OR = 0.64, 95% CI = 0.37-1.13), testicular ascent (OR = 0.28, 95% CI = 0.05- 1.50), and testicular atrophy (OR = 2.02, 95% CI = 0.54-7.52) did not differ between the two techniques. Only the incidence of postoperative hydrocele significantly differed between the two techniques, being higher when the external oblique aponeurosis was opened (OR = 0.44, 95% CI = 0.27-0.70). Conclusion: Performing pediatric inguinal herniotomy without opening the external oblique aponeurosis is a safe procedure and may be recommended as an optimal choice of method for uncomplicated cases. Key words: Pediatric herniotomy, Mitchell-Banks, Ferguson, external oblique aponeurosis

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 &lt;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 &amp; 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.

A Prospective, randomized comparative study between ultrasound-guided posterior quadratus lumborum block and ultrasound-guided ilioinguinal/iliohypogastric nerve block for pediatric inguinal herniotomy.

Ilioinguinal/iliohypogastric nerve block is commonly performed to control postherniotomy pain. The posterior quadratus lumborum block has been recently described as an effective analgesic technique for pediatric low abdominal surgery. No data were found regarding the use of posterior quadratus lumborum block in comparison with the traditional ilioinguinal/iliohypogastric nerve block in pediatric inguinal surgery. This randomized assessor-blinded study compared postoperative analgesic effects between ultrasound-guided posterior quadratus lumborum block and ilioinguinal/iliohypogastric nerve block in pediatric inguinal herniotomy. One- to seven-year-old children scheduled for unilateral open herniotomy were randomly assigned to receive either ultrasound-guided posterior quadratus lumborum block with 0.25% bupivacaine 0.5mL/kg or ultrasound-guided ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2mL/kg after induction of general anesthesia. The primary outcome was the proportion of patients who received postoperative oral acetaminophen. The required fentanyl in the recovery room, 24-hour acetaminophen consumption, success rate of regional blocks, block performance data, block-related complications, postoperative pain intensity, and parental satisfaction were assessed. This study included 40 patients after excluding four cases who were ineligible. The number of patients who required postoperative oral acetaminophen was significantly lower in the posterior quadratus lumborum block group (15.8% vs 52.6%; OR: 5.9; 95% CI: 1.3, 27.3; P=.022). The pain scores at 30minutes, 1, 2, 6, 12, and 24hours were similar between groups. There was no evidence of between-group differences in block performance time, the number of needle passes, block-related complications, and parental satisfaction. The posterior quadratus lumborum block with 0.25% bupivacaine 0.5mL/kg provided better pain control than the ilioinguinal/iliohypogastric nerve block with 0.25% bupivacaine 0.2mL/kg after open herniotomy in children. The ultrasound guidance technique for the posterior quadratus lumborum block is safe and as simple as the ultrasound-guided ilioinguinal/iliohypogastric nerve block for pediatric patients.

To Compare the Pre-emptive Analgesic Effect of I.V. Keterolac Versus I.V. Tramadol in Pediatric Inguinal Herniotomy and Penile Surgeries

To Compare the Pre-emptive Analgesic Effect of I.V. Keterolac Versus I.V. Tramadol in Pediatric Inguinal Herniotomy and Penile Surgeries

Paediatric inguinal herniotomy with and without exploration of inguinal canal

Paediatric inguinal herniotomy can be done with exploration of inguinal canal and without exploration of inguinal canal. The External Oblique Aponeurosis (EOA) should be closed if herniotomy was done by exploration of inguinal canal. On the other hand, herniotomy can be performed through superficial inguinal ring without exploration of inguinal canal; because superficial and deep inguinal ring were superimposed in pediatric patient. This prospective study was carried out in the department of Pediatric Surgery, M Abdur Rahim Medical College Hospital &amp; other private hospitals in Dinajpur from July 2013 to June 2017.Total number of the patients were 180. Among them herniotomy were done without exploration (group A) of inguinal canal in 90 patients and with exploration (group B) in 90 patients. Age ranged from 1 month to 10 years in both groups. Mean time was taken to complete the operation were 23 minutes and 29 minutes in group A &amp; group B respectively. Results were uneventful in 85 and 83 patients in group A &amp; group B respectively. Superficial wound infection occurred in 01 in group A and 02 patients of group B. Scrotal swelling occurred in 04 and 05 patients in group A and group B respectively. No recurrence or death was occurred in both groups of patients. The overall outcome of inguinal herniotomy was found better in group A patients. So Pediatric inguinal herniotomy without exploration of inguinal canal could be a better option than that of conventional procedure. Journal of Paediatric Surgeons of Bangladesh (2017) Vol. 8 (2): 43-46

Paediatric regional anaesthesia: Comparing caudal Anaesthesia and Ilioinguinal block for Paediatric Inguinal Herniotomy

Caudal anaesthesia and ilioinguinal block are effective, safe anaesthetic techniques for paediatric inguinal herniotomy. This review article aims to educate medical students about these techniques by examining their safety and efficacy in paediatric surgery, as well as discussing the relevant anatomy and pharmacology. The roles of general anaesthesia in combination with regional anaesthesia, and that of awake regional anaesthesia, are discussed, as is the administration of caudal adjuvants and concomitant intravenous opioid analgesia.

Paediatric Inguinal Herniotomy and Open Orchidopexy as a Day Care Surgery in a Tertiary Care Institute

Paediatric Inguinal Herniotomy and Open Orchidopexy as a Day Care Surgery in a Tertiary Care Institute

Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial.

Background and Aims:Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous (IV) and caudal route on post-operative analgesia in paediatric inguinal herniotomy patients.Methods:One hundred and five paediatric patients undergoing inguinal herniotomy were included and divided into three groups. Each patient received a single caudal dose of ropivacaine 0.15%, 1.5 mL/kg combined with either corresponding volume of normal saline (Group 1) or caudal dexamethasone 0.1 mg/kg (Group 2) or IV dexamethasone 0.5 mg/kg (Group 3). Baseline, intra- and post-operative haemodynamic parameters, pain scores, time to rescue analgesia, total analgesic consumption and adverse effects were evaluated for 24 h after surgery. Unpaired Student's t-test and analysis of variance were applied for quantitative data and Chi-square test for qualitative data. Time to first analgesic administration was analysed by Kaplan–Meier survival analysis and log-rank test.Results:Duration of analgesia was significantly longer (P < 0.001), and total consumption of analgesics was significantly lower (P < 0.001) in Group II and III compared to Group I. The incidence of nausea and vomiting was higher in Group I (31.4%) compared to Group II and III (8.6%).Conclusions:Addition of dexamethasone both caudally or intravenously as an adjuvant to caudal 0.15% ropivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia with the significant advantage of caudal over IV route.

Efficacy of Three Doses of Tramadol With Bupivacaine for Caudal Analgesia in Paediatric Inguinal Herniotomy

Efficacy of Three Doses of Tramadol With Bupivacaine for Caudal Analgesia in Paediatric Inguinal Herniotomy

Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy

This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children. Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg(-1) (Group B; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1 mg kg(-1) (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1.5 mg kg(-1) (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 2 mg kg(-1) (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was >or=4. Duration of analgesia and requirement for additional analgesics was noted. Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed. Caudal tramadol 2 mg kg(-1), combined with bupivacaine 0.25% 0.75 ml kg(-1), provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg(-1) or 1.5 mg kg(-1) in children undergoing inguinal herniotomy.

Efficacy of three doses of Ketamine with Bupivacaine for caudal analgesia in pediatric inguinal herniotomy

Background and objectives Ketamine administered systemically is a potent analgesic at subanesthetic plasma concentrations. Addition of ketamine to bupivacaine for caudal epidural block significantly prolongs the duration of postoperative analgesia. The purpose of this prospective, randomized double-blind study is to identify the optimal dose of ketamine that produces the maximum duration of caudal analgesia with minimal adverse effects as an adjuvant to bupivacaine for caudal epidural block. Methods Sixty children, aged 6 months to 10 years, undergoing inguinal herniotomy were allocated randomly to receive 1 of 3 solutions for caudal epidural block. Group 1 received 0.75 mL/kg of bupivacaine 0.25% with preservative-free ketamine 0.25 mg/kg, group 2 received 0.75 mL/kg of bupivacaine 0.25% with ketamine 0.5 mg/kg, and group 3 received 0.75 mL/kg of bupivacaine 0.25% with ketamine 1 mg/kg. Postoperative pain was assessed using the All India Institute of Medical Sciences pain discomfort scale. Rescue analgesia in the form of pethidine 1 mg/kg intramuscularly was administered when this score exceeded 4. Results The mean duration of caudal analgesia was 8.8 hours in group 1 compared with 22.1 hours in group 2 ( P < .001) and 25.2 hours in group 3 ( P < .001). Supplemental analgesia requirements with pethidine were significantly less in group 2 (4 subjects) and group 3 (no subject) when compared with group 1 (18 subjects). There were no differences between the groups in the incidence of motor blockade, urinary retention, emesis, or sedation. Group 3 had a significantly higher incidence of behavioral side effects such as odd behavior, agitation, or restlessness than groups 1 and 2. Conclusions The optimal dose of ketamine in our study was 0.5 mg/kg added to 0.75 mL/kg bupivacaine 0.25% for caudal epidural block without an increase in side effects.

Efficacy of Three Doses of Ketamine With Bupivacaine for Caudal Analgesia in Pediatric Inguinal Herniotomy

Efficacy of Three Doses of Ketamine With Bupivacaine for Caudal Analgesia in Pediatric Inguinal Herniotomy