Postoperative analgesia in pediatric inguinal surgeries: comparison of caudal block, wound infiltration, and paracetamol suppositories

Abstract

Background: In pediatrics, acute postoperative pain is commonly treated with simple analgesics that often are not very effective and frequently are used at doses lower than would be optimal. Effective pain therapies to block or modify the physiologic responses to pain and stress have become an essential component of modern pediatric anesthesia and surgical practice.

Aim of study: to compare the analgesic efficacy and to evaluate complications of caudal block, local infiltration, with paracetamol suppository in children undergoing inguinal surgeries.

Patients and Methods: A prospective, randomized, controlled study of 120 children with one of the inguinal surgical conditions (inguinal hernia, hydrocele, or undescended testis) scheduled for elective surgical repair over a period of 13 months from January 2017 to February 2018 in Baghdad. Preoperatively the patients were randomized in to three groups according to the operation waiting lists. Group 1; caudal block with bupivacaine, group 2; local infiltration with bupivacaine. group 3; paracetamol suppository. For all the patients included in this study, a standardized anesthetic protocol was used.

Results: A total of 120 patients were divided into three groups according to the type of analgesia received, Group 1 were (38 patients 31.7%), Group 2 were (42 patients 35%), and Group 3 were (40 patients 33.3%), the mean age was (3.6years), mean time of anesthesia was (36.5min) and the mean time of surgery was (28.7min), no major complication was reported. Pain score was low in the first two groups in the 1% and 2™

hours postoperatively compared to the 3™ group. Time for walking was significantly

delayed in patients receiving caudal block.

Conclusion: Caudal block and Local wound infiltration, for postoperative pain management are highly effective and safe for surgical procedures in the inguinoscrotal region.