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Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia
W M Splinter1, J Bass, L Komocar
1Department of Anaesthesia, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Local anaesthesia (LA) and caudal anaesthesia (CA) show similar postoperative care outcomes for pediatric inguinal hernia repair. While LA patients had shorter recovery times, both methods had comparable pain scores and opioid use.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Pain Management
Background:
- Postoperative care following pediatric inguinal hernia repair requires effective pain management.
- Local anaesthesia (LA) and caudal anaesthesia (CA) are common techniques, but their comparative effects on recovery are not fully elucidated.
Purpose of the Study:
- To compare the efficacy of local anaesthesia (LA) versus caudal anaesthesia (CA) in the postoperative care of children undergoing inguinal hernia repair.
Main Methods:
- A randomized, single-blind study involving 202 children (aged 1-13 years) comparing LA and CA.
- Pain assessment using mCHEOPS and VAS, alongside monitoring of opioid use, vomiting, ambulation, and urination.
- Specific anesthetic agents and dosages for both LA and CA groups were detailed.
Main Results:
- No significant differences in postoperative pain scores or opioid consumption between LA and CA groups.
- LA group required more acetaminophen post-operatively.
- LA group experienced shorter recovery room stays, while the CA group had a slightly prolonged overall postoperative stay.
Conclusions:
- Local anaesthesia and caudal anaesthesia demonstrate comparable outcomes in pediatric inguinal hernia repair postoperative care.
- Minor differences observed in recovery room and overall postoperative stay durations, suggesting LA may offer a slight advantage in recovery time.
Abstract:
The purpose of this study was to compare the effect of local anaesthesia (LA) with that of caudal anaesthesia (CA) on postoperative care of children undergoing inguinal hernia repair. This was a randomized, single-blind investigation of 202 children aged 1-13 yr. Anaesthesia was induced with N2O/O2 and halothane or propofol and maintained with N2O/O2/halothane. Local anaesthesia included ilioinguinal and iliohypogastric nerve block plus subcutaneous injection by the surgeon of up to 0.3 ml.kg-1 bupivacaine 0.25% with 5 micrograms.kg-1 adrenaline. The dose for caudal anaesthesia was 1 ml.kg-1 up to 20 ml bupivacaine 0.2% with 5 micrograms.kg-1 adrenaline. Postoperative pain was assessed with mCHEOPS in the anaesthesia recovery room, with postoperative usage of opioid and acetaminophen in the hospital, and with parental assessment of pain with a VAS. Vomiting, time to first ambulation and first urination were recorded. The postoperative pain scores and opioid usage were similar; however, the LA-group required more acetaminophen in the Day Care Surgical Unit. The incidence of vomiting and the times to first ambulation and first urination were similar. The LA-patients had a shorter recovery room stay (40 +/- 9 vs 45 +/- 15 min, P < 0.02). The postoperative stay was prolonged in the CA group (176 +/- 32 vs 165 +/- 26 min, P = 0.02). We conclude that LA and CA have similar effects on postoperative care with only slight differences.