Unilateral Inguinal Hernia Surgery Research Articles

Comparison of the Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block and Ilioinguinal-Iliohypogastric Nerve Block in Paediatric Patients After Inguinal Hernia Surgery: A Prospective Randomized Controlled Trial.

To compare the postoperative analgesic efficacy of quadratus lumborum block (QLB) and ilioinguinal-iliohypogastric nerve block (IIIHB) in paediatric patients who have undergone unilateral inguinal hernia surgery. This prospective randomized controlled study was designed in a single center and included 60 paediatric patients aged 2-7 years who had undergone inguinal hernia repair surgery and received an American Society of Anesthesiologists score of 1-2. Patients were randomized into two groups: those receiving ultrasound-guided QLB and those receiving IIIHB. The primary outcomes of the study were patients' face, legs, activity, cry, and consolability (FLACC) scores at 1, 2, 6, 12, and 24 hours post-surgery. The mean heart rate 15 and 30 minutes post-surgery in the QLB group was lower than that of the IIIHB group, and the difference at both times was statistically significant (P < 0.001). The mean FLACC score of the QLB group was lower than that of the IIIHB group at 6, 12, and 24 hours post-surgery, and the differences were statistically significant (P=0.004, P=0.006, and P < 0.001, respectively). Between the groups, there was no statistically significant difference in the number of patients who were administered rescue analgesics or oral ibuprofen, the time of first ibuprofen administration, or the frequency of complications (P=1.000, P=0.145, P=0.195, and P=1.000, respectively). Compared with IIIHB, QLB achieves superior postoperative analgesic effects in paediatric patients who have undergone inguinal hernia surgery, as evidenced by longer analgesic periods, lower pain scores, and lower analgesic consumption.

Efficacy of Adding Midazolam to Bupivacaine (0.5%) on the Duration of Spinal Anesthesia in Unilateral Inguinal Hernia Surgery

Introduction: Inguinal hernia is the most common type of abdominal hernia which is 7 times more common in men than women. Surgical treatment is performed under general or local anesthesia (spinal or epidural). Neuraxial anesthesia has a greater advantage than general anesthesia. Today, spinal block anesthetics with local drug anesthetics along with adjuvant drugs is widely used for surgery. Midazolam is one of these adjuvants whose spinal injection, in addition to its appropriate analgesic effect, enhances the effect of local anesthetics. Aim: The aim of this study was to determine the effect of intrathecal midazolam (1 mg) to bupivacaine (0.5%) on the quality and timing of sensory block, motor block and hemodynamic changes during of inguinal herniation surgery. Materials and Methods: 64 patients with ASAI / II criteria (30-70 years old) were randomly divided into two groups of 32 patients under spinal anesthesia for inguinal herniation surgery. The anesthesiologist and the patient did not know the status of the studied drugs. Group 1 received 0.5 ml of bupivacaine 0.5% + 0.2 ml of normal saline and group 2 received 3 ml of bupivacaine 0.5% + 0.2 ml of midazolam (1 mg). The return time of sensory block and the return time of motor block, the time of the first request for analgesics, the degree of satisfaction and the hemodynamic status were compared between these group. Results: The return time of sensory block in group 1 was 124.81 ± 16.15 minutes and in group 2 was 193.18± 34.53 minutes, which was statistically significant and in group 2 the return time of sensory block was longer (001 ≤. ˂P). reaction block return time: in group 2: (140.43 ± 27.46) minutes, group: 1 (107.78 ± 13.82) minutes were shorter and statistically significant (P≤ .001). The time of the first analgesic request by patients in group 1 was 157.87 ±16.32 minutes and in group 2, 264.59 ± 50.17 minutes, which was statistically significant (P ≤ .001). Satisfaction index and hemodynamic changes were not significant between groups (P ˃ 0.05). Conclusion: Addition of 1 mg of midazolam in spinal anesthesia with bupivacaine 0.5% increased of the duration of analgesia and the time of first request for analgesia without changing the hemodynamic status in patients with inguinal herniation surgery.

A comparative study of unilateral vs bilateral spinal anaesthesia using hyperbaric bupivacaine with buprenorphine in unilateral inguinal hernia surgery

Unilateral spinal anaesthesia can be used for inguinal hernia surgery. The advantage is that it provides a stronger block on the side of surgery and accelerated recovery of the nerve block, with better maintenance of cardiovascular stability. Hence it can be a valuable technique for high-risk patients.&#x0D; The aim: This randomized controlled trial was designed to evaluate the onset and duration of Sensory and motor block in both unilateral and bilateral spinal anaesthesia and the adverse effects of buprenorphine given intrathecally with 0.5 % bupivacaine for Spinal anaesthesia in patients scheduled for unilateral inguinal hernia surgery.&#x0D; Materials and methods: it is a сomparative two group randomized clinical study with 60 patients with 30 patients in Group U (UNILATERAL) and 30 patients in Group B (BILATERAL) is undertaken to study the changes in haemodynamics and side effects. Whereas, within the group (for the unilateral group) comparison of the time taken to reach L1, T12, T10 and the Bromage time between the surgical side and non-surgical side sides of surgery was done.&#x0D; Results: T10 -T12 spinal anaesthesia was achieved in both groups; the average time to anaesthetic onset in the unilateral group was 5.27±1.2 min, and in the bilateral, it was 5.90±1.02 min (p-value=0.32). Sensory and motor block lasted longer in the bilateral group when compared to the unilateral group; the incidence of side effects was limited to the occurrence of hypotension and bradycardia in the unilateral group than in the bilateral group. The success rate of unilateral spinal anaesthesia in our study was 100 %.&#x0D; Conclusion: Because of haemodynamic stability and faster recovery characteristics of unilateral spinal block, it can be used as a suitable technique in patients with a limited cardiovascular reserve and for outpatient anaesthesia.

Postoperative Analgesic Efficacy Of Ilioinguinal-Iliohypogastric Block In Inguinal Hernia Surgeries: A Prospective Randomized Single-Blind Study

Introduction: Ilioinguinal-iliohypogastric (II/IH) nerve block is used for postoperative analgesia in lower abdominal surgeries. We aimed to compare the postoperative analgesic efficacy of ultrasound (US) guided II/IH nerve block, tramadol, and paracetamol in patients scheduled for unilateral inguinal hernia surgery. Materials and Methods: The study population consisted of patients who underwent surgery diagnosed with inguinal hernia. Sixty male cases aged 18-65 years and ASA I-II were included in the study. After spinal anesthesia, those who underwent II/IH nerve block under US guidance for postoperative analgesia were classified as Group B (n=20), those who received tramadol were classified as Group T (n=20), and those who received paracetamol were classified as Group P (n=20). Demographic characteristics, hemodynamic parameters, time before postoperative first analgesic requirement, amount of analgesic used in the first 24 hours, additional analgesic requirement, Visual Analogue Scale (VAS) score, and patient satisfaction were recorded. Results: There was no significant difference between the groups regarding demographic data, ASA score, and operation. Up to 24 hours postoperatively, patient satisfaction in Group B was significantly higher than in the other two groups. While the time before the first analgesic requirement was 295 minutes in Group B, it was 129.5 minutes in Group T and 122 minutes in Group P (p=0.001). While the VAS scores in the first 12 hours postoperatively were lower in Group B, they were similar in all three groups after the 12th hour. Conclusion: The study findings demonstrated II/IH nerve block reduces the need for analgesia in the first 24 hours postoperatively in inguinal hernia operations performed under spinal anesthesia. In addition, it was determined that II/IH nerve block ensures better postoperative patient satisfaction and prolongs the first analgesic requirement time.

Kingsnorth's modified score as predictor of complications in open inguinal hernia repair

PurposeThis study aims to analyse the postoperative complications (30 days) on unilateral primary inguinal hernia repair and prove their correlation with the preoperative modified scoring system of Kingsnorth (KN).MethodsProspective study design collecting data from patients who underwent surgery for unilateral primary inguinal hernia in a University Hospital. The data were collected in the National Inguinal Hernia Registry (EVEREG). A statistical analysis to assess the association between the presence of postoperative complications and the preoperative and intraoperative variables was performed. The patients were classified depending on their KN score. Surgical complications and their relationship with the classification were specifically analysed. Study design was performed following STROBE statements.ResultsThe sample included 403 patients who met the inclusion criteria from which 62 (15.3%) subjects presented postoperative complications. The variables that presented a statistically significant relationship with the appearance of complications were a KN score of 5–8 (OR 2.7; 95% CI 1.07–4.82; P = 0.03) and the involvement of a member of the abdominal wall surgery unit in the procedure (OR 0.28; 95% CI 0.08–0.92; P = 0.03). The KN score correlated with a longer duration of surgery (Pearson's correlation 0.291; P < 0.0001).ConclusionThe KN classification can predict the onset of surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5–8 has a higher probability of wound complications. When surgery is performed by the abdominal wall surgery unit, the chances of postoperative complications decrease.

Posterior quadratus lumborum block versus posterior transversus abdominis plane block for unilateral inguinal hernia surgery.

Ultrasound-guided truncal nerve blocks are increasingly used for postoperative pain relief after abdominal surgery. The aim of this prospective and randomized study was to compare posterior transversus abdominis plane block (pTAPB) with posterior quadratus lumborum block (pQLB) for postoperative analgesic efficacy in patients undergoing unilateral inguinal hernia surgery under general anesthesia (GA). A total of 90 adult patients were randomized into 3 groups: group pTAPB (n = 30), group pQLB (n = 30), and group Control (n = 30). The patients in groups pQLB and pTAPB received a unilateral block using 20 ml of 0.25% bupivacaine after the induction of GA. Intravenous (IV) tramadol patient control group analgesia (PCA) and paracetamol were used in the postoperative period as a part of the multimodal analgesic regimen in both groups. Postoperative pain was assessed using a visual analog scale (VAS) during postoperative 24 h. Dexketoprofene was used as a rescue analgesic when VAS is >3. The primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesics and the amount of tramadol delivered by PCA. P <0.05 was considered statistically significant. Mean VAS scores were significantly lower in the group pQLB than group pTAPB and group Control at all-time points (pQLB < pTAPB < Control; P < 0.001). Rescue analgesic was not required in group QLB. Rescue analgesic consumption, the number of bolus demand on PCA, and total PCA dose were highest in group Control and lowest in the pQLB group (Control > pTAPB > pQLB; P < 0.001). It is concluded that both pQLB and pTAPB provided effective pain relief after unilateral inguinal hernia surgery. pQLB was superior to pTAPB due to lower pain scores and analgesic consumption.

P116 “KIGNSNORTH MODIFIED SCORE” FOR OPEN INGUINAL HERNIA REPAIR COMPLICATIONS PREDICTION. POINTHER STUDY

Abstract Aim Aim of our study is to analysis of postoperative outcomes (30 days) after elective unilateral open anterior inguinal hernia repair and prove correlation to modified Kingsnorth (MK) score classification system. Material and Methods Prospective registered (NTC 04806828) study of all consecutive unilateral open anterior groin hernia repair performed at a University Hospital General Surgery Department from January 2019 to December 2020. Data was stored at National Spanish Groin Hernia Registry (EVEREG). All patients were preoperatively classified using MK score. Statistical analysis of postoperative complications and their relation to preoperative modified Kingsnorth scale was performed. Results 403 patients were included. 61% were performed as ambulatory surgery. 15.7% had more than 5-8 MK punctuation. A total of 62 patients had postoperative complications, 81% of all complications were classified as Clavien I. Higher Surgery duration was directly related to higher MK (Pearson's correlation 0.291; P &amp;lt; 0.0001score.) Statistically significant relationship with the presence of higher rate of complications were a KN score of 5-8 (OR 2.7; 95% CI 1.07-4.82; P = 0.03) whereas performance of surgery by an abdominal wall surgery specialist had less complications (OR 0.28; 95% CI 0.08-0.92; P = 0.03) Conclusions MK classification predicts surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5-8 had a higher probability of wound complications. When surgery was performed by a specialist in abdominal wall surgery, less postoperative complications were observed.

Efficacy of Hyperbaric Bupivacaine a nd Clonidine Combination Used as Unilateral Versus Bilateral Spinal Anesthesia During Unilateral Inguinal Hernia Surgery

The lump in the groin of patients with Inguinal hernias goes away with the application of slight pressure or by making the patient lie down. This study compared the efficacy of hyperbaric bupivacaine with clonidine in unilateral versus bilateral spinal anaesthesia during unilateral inguinal hernia surgery. The study was conducted in Chitwan Medical College from September 2019 to February 2020 including 50 patients aged 25-60, ASA grade of I -II and undertaking elective hernioplasty. Patients were randomized into the following groups: Group A received unilateral Inj. Bupivacaine 0.5% heavy 12.5mg + Inj. Clonidine 15mg in the sub-arachnoid block; Group B received bilateral Inj. Bupivacaine 0.5% heavy 12.5mg + Inj. Clonidine 15mg in the subarachnoid block. Variation in the motor block, duration of sensory, hemodynamic parameters, onset, and peak level were noted. The mean ‘onset of sensory block’ in group A and group B was 1.52 minutes and 1.27 minutes, respectively. The ‘duration of sensory block’ was 237.1 minutes in group A and 218.4 minutes in group B. The ‘time to achieve peak’ was 8.32 minutes in group A and 8.12 minutes in group B. The ‘time to onset of motor block’ was 1.45 minutes and 1.72 minutes in group A and group B, respectively. However, ‘the duration of motor block’ was significantly higher in group A (210.5 minutes) than group B (198.1 minutes) (P&lt; 0.05). A significantly higher mean arterial pressure was found in group A than group B (P&lt; 0.05), which was recorded 1, 5, 15, 60, 90, and 120 minutes pre-operatively. Unilateral spinal anaesthesia achieves stable hemodynamics, adequate duration of the block for surgery, and rapid recovery compared to bilateral spinal anaesthesia.

Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair?

Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date. In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques. The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs). In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.

To evaluate the effect of quadratus lumborum block on the tramadol sparing effect in patients undergoing open inguinal hernia surgery: A randomised controlled trial.

Background and Aims:An ultrasound-guided quadratus lumborum (QL) block provides both somatic and visceral analgesia in abdominal surgeries. We aimed to evaluate the postoperative tramadol sparing effect of single-shot anterior QL block in inguinal hernia surgery patients.Methods:This prospective, randomised controlled trial was conducted in a single tertiary care centre over a period of 1 year. A total of 50 patients, American Society of Anaesthesiologists (ASA) physical status I–II of both sexes aged 18–80 years with body mass index (BMI) ≥20 to ≤35 kg/m2 undergoing uncomplicated unilateral inguinal hernia surgery under spinal anaesthesia (SA) were randomly allocated to either of the two groups. The block group (n = 25) received single-shot anterior QL block with 20 ml of 0.5% ropivacaine and the control group (n = 25) received no block. Postoperatively, patients received intravenous (IV) paracetamol 1g every 6 h and tramadol patient-controlled analgesia up to 24 h. Primary outcome was total tramadol consumption at 24 h postoperatively.Results:The total tramadol consumption mean ± SD [95% CI (range)] at 24 h in the block group was 84.00 ± 37.86 [68.37–99.63 (20–160)] mg versus 93.60 ± 34.99 [79.16–108.04 (20–160)] mg in control group, (p value = 0.36). Postoperative VAS score, haemodynamics, and patient satisfaction score were similar in both the groups. No adverse events were reported.Conclusion:A single-shot anterior QL block did not establish a postoperative tramadol-sparing effect at 24 h as compared to no block in patients undergoing inguinal hernia surgery under SA.

Comparison of unilateral versus bilateral spinal anaesthesia using hyperbaric bupivacaine with clonidine in unilateral inguinal hernia surgery - A randomized controlled trial

Introduction: Unilateral spinal anaesthesia can be used for inguinal hernia surgery. The advantage is that it provides a stronger block on the side of surgery, accelerated recovery of the nerve block with better maintenance of cardiovascular stability. Hence it can be a valuable technique for high risk patients. Materials and Methods: The study design was randomized controlled trial including 60 patients undergoing elective hernioplasty. Patients were allocated to either group unilateral (U) or group bilateral (B) and received Inj Bupivacaine 0.5% heavy 12.5mg + inj Clonidine 15 microgram in sub-arachnoid block. Patients were kept in lateral position for 10min for group U & made supine immediately on the OT table for group B. Variation in hemodynamic parameters, onset, peak level, duration of sensory and motor block were noted. Results: At 10, 15 and 20 min minutes after giving anaesthesia, the mean heart rate, systolic and diastolic blood pressures, mean arterial pressure were significantly higher in patients receiving unilateral anaesthesia. Mean duration of sensory and motor block, total duration of analgesia were significantly more in bilateral anaesthesia. Conclusion: Unilateral spinal anaesthesia achieved stable hemodynamics, adequate duration of block for surgery and rapid recovery. So it can be a valuable technique in high risk patients. Keywords: Spinal anaesthesia, Unilateral spinal anaesthesia.

Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial.

BackgroundLevobupivacaine is an attractive alternative to racemic bupivacaine for spinal anesthesia due to the lower potential for cardio-toxicity and faster recovery profile. This study was designed to compare isobaric levobupivacaine with hyperbaric racemic bupivacaine with respect to intraoperative quality of anesthesia and the postoperative recovery profile in patients undergoing inguinal hernia surgery.MethodsA total of 100 American Society of Anesthesiologists 1 and 2 patients, aged 18–60 years, undergoing elective daycare unilateral inguinal hernia surgery, were randomized into two groups. Group L received spinal anesthesia with 3 ml of 0.5% plain levobupivacaine. Group B received 3 ml of 0.5% hyperbaric racemic bupivacaine. Quality of anesthesia, sensory and motor block characteristics, duration of effective analgesia, time to mobilization, and incidence of side effects were compared.ResultsThe quality of anesthesia was comparable between the two groups. No difference was observed in the block onset time or maximum block height. The duration of anesthesia was significantly shorter in group L compared with that in group B (206.2 ± 18.9 min vs. 224.1 ± 15.6 min, P < 0.001), as was duration of motor block (185.9 ± 20.3 min vs. 196.4 ± 21.2 min, P = 0.016) and time to walk unaided (321.9 ± 19.2 min vs. 356.7 ± 26.6 min, P < 0.001). The incidence of hypotension was less in group L (12%) compared to group B (32%) (P = 0.028).ConclusionsLevobupivacaine is an effective alternative to bupivacaine for patients undergoing unilateral inguinal hernia surgery. It has a shorter duration of sensory and motor block, allowing earlier mobilization in daycare surgeries, and a lower incidence of intraoperative hypotension.

Effects of hydromorphone in prevention of shivering after spinal anesthesia

Eighty patients(American Society of AnesthesiologistsⅠ-Ⅱ)scheduled for elective unilateral inguinal hernia surgery with spinal anesthesia between January and June 2016 were randomized into two groups with 40 in each group. Patients were intravenously injected with normal saline (5 ml) in control group or hydromorphone 5 μg/kg (diluted to 5 ml) in intervention group after spinal anesthesia. Tympanic temperature and the incidence of shrivering were measured before and after spinal anesthesia at predetermined intervals. Side effects during surgery and the first 48 h after surgery were recorded. Rescue drug tramadol 0.5 mg/kg was given intravenously to patients with grade ≥2 shivering for more than 5 min duration. Tympanic temperature decreased significantly compared to the baseline from 20 min in control group and from 10 min in intervention group after spinal blocking(P 0.05). The incidence of shivering was significantly lower in intervention group [17.5%(7/40) ] than that in control group [47.5%(19/40), χ2=8.205, P=0.004]. The incidence of nausea and vomiting was 5.0%(2/40)in intervention group and 0.0% (0/40) in control group (χ2=2.051, P=0.494). The incidence of sedation was not significantly different between control group [0.0%(0/40)] and intervention group[10.0%(4/10) , χ2=4.211, P=0.116]. The use of rescue tramadol was more frequently in control group [32.5%(13/40)] than that in intervention group [7.5%(3/40), χ2=7.812, P=0.01]. The results indicate that intravenous hydromorphone can significantly attenuate the incidence of shivering after spinal anesthesia for inguinal herniorrhaphy repair surgery with minimum side effects. Key words: Hydromorphone; Shivering; Anesthesia, spinal; Hernia, inguinal

Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery.

We hypothesized that cooling hyperbaric bupivacaine from 23 to 5°C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications. A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8ml of 0.5% hyperbaric bupivacaine intrathecally at either 5°C (group I, n=50) or at 23°C (group II, n=50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30min. The levels of sensory and motor block on the operative side were evaluated until complete resolution. The rate of unilateral spinal anesthesia at 15 and 30min was significantly higher in group I (p=0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p=0.014 and 0.037, respectively). The density and viscosity of the solution at 5°C was significantly higher than at 23°C (p<0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3min) and motor block recovery was shorter (157.6 vs 193.4min) (p<0.0001). Cooling of hyperbaric bupivacaine to 5°C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.

Effect of a single bolus of dexamethasone on intraoperative and postoperative pain in unilateral inguinal hernia surgery.

Background and Aims:Opioids are commonly used to provide perioperative analgesia, but have many side-effects. Addition of co-analgesics results in reducing the dosage and hence the side-effects of opioids. The objective of this study was to compare the analgesic efficacy of fentanyl (1 micro/kg−1) administered alone, with fentanyl (0.75 micro/kg−1) and dexamethasone (8 mg) combination, in patients undergoing day care unilateral inguinal hernia repair.Material and Methods:Patients scheduled for the day care unilateral inguinal hernia repair were randomized to receive either saline and fentanyl 1 micro/kg−1 (control group) or 8 mg dexamethasone with fentanyl 0.75 micro/kg−1 (study group) immediately before induction of anesthesia in a double-blind clinical trial. Anesthesia technique and rescue analgesia regimen were standardized. Intraoperatively, pain was assessed based on hemodynamic variability and postoperatively by visual analog scale.Results:The mean heart rate, systolic and the diastolic blood pressure at 1, 5, 20 and at 30 min after incision, were significantly higher in the control group (P ≤ 0.001) when compared to the study group. Intra-operative rescue analgesia was required in 32 (100%) and 19 (59.4%) patients in control group and study group respectively (P = 0.0002). Mean pain scores measured at fixed time periods postoperatively were significantly higher in the control group when compared to study group (P ≤ 0.001). Postoperative rescue analgesia was needed in 32 (100%) versus 24 (75%) patients in the control group and study group respectively, but this difference was not statistically significant (P = 0.285).Conclusion:We conclude that the addition of 8 mg of preoperative intravenous dexamethasone to 0.75 micro/kg−1 fentanyl was effective in reducing intraoperative and postoperative pain in the 1st h after unilateral inguinal hernia surgery.

Influence of dexmedetomidine on based anesthesia in undergoing unilateral inguinal hernia surgery infants

Objective To study dexmedetomidine on the adverse impact of ketamine based anesthesia and sedative effects in indirect inguinal hemia.Methods Eighty children underwent indirect inguinal hemia surgery were randomily divided into two groups after injected muscle with midazolam and ketamine,Group B was injectded with 0.5 μg/kg DEX,but Group A with normal saline,analgesia was with caudal block (lidocaine).The with hemodynamic,level of sedation,recovery time and CHW score were observed.The adverse reactions were recorded.Results Two groups of children have hemodynamically stable,and recovery time had no statistical significance.The two groups of CHW score in Group A (1.6 ± 0.5) points higher than in group B (0.9 ± 0.3) points (P ＜ 0.05).The restlessness rated group (1.52 ± 0.54) points was higher than in group B (0.51 ± 0.48) points (P ＜ 0.05).Compared with Group B,Group A had 12 cases of psychiatric symptoms,10 cases of involuntary movement of limbs,6 cases of severe postoperative agitation nausea,and 8 cases of vomiting (P ＜ 0.05).Conclusion 0.5μg/kg DEX can be safely and effectively used in the pediatric anesthesia,and reduce the adverse reactions caused by ketamine. Key words: Anesthesia; Dexmedetomidine; Ketamine; Hernia,Inguinal; Child

Henna as a Durable Preoperative Skin Marker

For many surgical procedures skin marking is required well before surgery and induction of anesthesia. In some cases, the patient may need to be standing or sitting while the skin area is marked. Marking of perforators and varicosities in chronic venous diseases, marking of stoma sites for urinary or fecal diversions are some examples. The side of surgery should ideally be marked preoperatively to avoid wrong side surgery. Marks made with conventional marking pens fade or disappear with preoperative skin preparation, whereas marks made with henna paste, which is orange to dark brown in color, last for up to 3weeks in spite of regular showers and skin cleansing, even with ethanol. This property of henna encouraged us to use it as a preoperative skin marker. Henna paste was used as a preoperative skin marker in 250 patients. In 154 patients with chronic venous diseases, perforators and varicosities were marked during duplex scanning. Henna was used to mark the colostomy site in 28 patients with carcinoma of the rectum prior to abdominoperineal resection of the rectum (APR) (four of them laparoscopic APR) and the aspiration site in 11 patients with liver abscesses and 4 patients with pleural empyemas, under ultrasonographic (USG) guidance. In addition, henna was used to mark the correct side of surgery in 47 patients undergoing unilateral inguinal hernia surgery. Marking was done from 1 to 8days before surgery. The marking with henna was clearly visible in all the cases even after preoperative skin preparation with ethanol up to 8days after application. There were no complications associated with the marking. All marks disappeared 4weeks after application. In terms of successful execution of the desired procedure, the use of henna marking was successful in all the cases. Henna is an ideal substance for use as a preoperative skin marker. It can be safely and effectively used as a marker for varicose vein surgery, ultrasound-guided identification of lesions, establishing the ideal site for stomas on the abdominal wall, and to identify the correct side of surgery. Markings made with henna are durable and do not fade with routine bathing or preoperative skin preparation. In most cases there are no associated complications. Henna is cheap, safe, and convenient, and indications for its use can be ubiquitous.

Patient education after inguinal hernia surgery did not differ from routine information for pain at rest at 7 days

J Glindvad Correspondence to: J Glindvad, Bispebjerg Hospital, Telefon, Denmark; jg02@bbh.regionh.dk In patients having surgery for inguinal hernia, does postoperative patient education at discharge and a follow-up telephone call reduce...