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Updated: Oct 22, 2025
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children
Eilidh S Bruce1, Sesi A Hotonu2, Merrill McHoney3
1University of Edinburgh, Edinburgh, UK.
Insights
Paediatric laparoscopic hernia repair may require more analgesia than open repair. However, caudal blockade and intraperitoneal local anaesthetic infiltration can reduce postoperative pain and analgesic needs in laparoscopic procedures.
Area of Science:
- Pediatric surgery
- Anesthesiology
- Pain management
Background:
- Inguinal hernia repair is common in children.
- Laparoscopic surgery offers potential benefits but may impact postoperative pain.
- Optimizing analgesia is crucial for pediatric surgical outcomes.
Purpose of the Study:
- To compare analgesic strategies in pediatric laparoscopic versus open inguinal hernia repair.
- To evaluate the effectiveness of anaesthetic blockade and local anaesthetic infiltration in reducing postoperative pain.
Main Methods:
- Retrospective review of 155 laparoscopic and 150 open pediatric hernia repairs.
- Comparison of anaesthetic blockade use (caudal blockade), analgesic consumption, and postoperative pain scores.
- Analysis of intraperitoneal local anaesthetic infiltration in a subset of laparoscopic cases.
Main Results:
- Laparoscopic repair was associated with higher recovery analgesia needs (10.1% vs 1.3%).
- Open repair utilized caudal blockade more frequently (62.7% vs 21.6%).
- Intraperitoneal infiltration significantly reduced analgesic consumption in laparoscopic cases (p=0.038).
- Caudal blockade was associated with reduced analgesic consumption, particularly in younger children (<2 years).
Conclusions:
- Laparoscopic inguinal hernia repair in children is linked to increased postoperative analgesic requirements.
- Caudal blockade is effective in reducing the need for rescue and postoperative analgesia.
- Intraperitoneal local anaesthetic infiltration is a valuable strategy for reducing postoperative analgesia in pediatric laparoscopy.
- A combined approach of caudal and intraperitoneal infiltration may offer optimal pain management for pediatric laparoscopic surgery.
Background:
This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair.
Method:
A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups.
Results:
155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days-14 years) in the laparoscopic group, 6 months (17 days-13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption.
Conclusions:
Laparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.
