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Intraoperative bupivacaine during outpatient hernia repair in children: a randomized double blind trial
Insights
Intraoperative bupivacaine significantly reduced postoperative pain and analgesic needs in children undergoing outpatient hernia repair. This treatment also promoted earlier ambulation and improved activity levels post-surgery.
Area of Science:
- Pediatric Anesthesiology
- Surgical Pain Management
Background:
- Postoperative pain is a significant challenge in pediatric ambulatory surgery.
- Effective pain management is crucial for recovery and patient satisfaction after pediatric procedures.
Purpose of the Study:
- To evaluate the efficacy of intraoperative bupivacaine infiltration in managing postoperative pain in children undergoing outpatient inguinal herniorrhaphy.
- To assess the impact of bupivacaine on analgesic requirements and early ambulation.
Main Methods:
- A double-blind, randomized study involving 99 children (aged 1-7 years) undergoing outpatient inguinal herniorrhaphy.
- Patients received either bupivacaine or saline infiltration of the ilioinguinal and iliohypogastric nerves.
- Postoperative pain, analgesic use, and activity levels were assessed using standardized measures.
Main Results:
- Fewer patients in the bupivacaine group required immediate postoperative analgesics (17 vs. 39, P < .01).
- Bupivacaine group showed reduced codeine and acetaminophen consumption over 48 hours (P < .05).
- Significantly higher activity levels were observed in the bupivacaine group post-surgery and at home (P < .05).
Conclusions:
- Intraoperative bupivacaine effectively reduces postoperative pain and analgesic requirements in pediatric hernia repair.
- Bupivacaine administration promotes enhanced early ambulation and improved activity levels in ambulatory pediatric surgical patients.
- Local bupivacaine infiltration is a valuable strategy for optimizing pain control and recovery in pediatric outpatient surgery.
Abstract:
Postoperative pain is a major problem following surgery in the ambulatory child. A study was undertaken to test the effect of intraoperative bupivacaine on postoperative pain in children undergoing outpatient hernia repair. Ninety-nine children aged 1 to 7 years underwent outpatient inguinal herniorrhaphy under general anesthesia. Each was randomly assigned to receive bupivacaine (group 1) or saline (group 2), infiltrating the ilioinguinal and iliohypogastric nerves. Drug administration and patient evaluation were double-blinded. The groups were similar with respect to age, sex, side of procedure, and length of operation. In the immediate postoperative period, 17 group 1 patients required analgesics compared with 39 in group 2 (P less than .01); total codeine dosage was lower in group 1 (4.0 +/- 7.1 mg v 11.8 +/- 10.5 mg, P less than .05). Activity level 45 minutes after surgery (using a standardized scale) was greater in group 1 (P less than .05). Acetaminophen requirements at home were lower in group 1 on the day of surgery (3.1 +/- 4.3 mL v 5.7 +/- 7.4 mL, P less than .05) and over the following 48 hours (1.5 +/- 3.4 mL v 4.9 +/- 10.7 mL, P less than .05). Activity level at home on the day of surgery did not differ significantly between groups, but activity level over the following 48 hours was higher in group 1 (P less than .05). The two groups were similar with respect to all other parameters. We conclude that intraoperative bupivacaine decreases post-operative pain and analgesic use, and promotes early ambulation in children undergoing hernia repair.