title: Analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum in children. Caudal block versus ilioinguinal/iliohypogastric block.
abstract: The authors prospectively evaluated the efficacy of caudal epidural block versus local infiltration combined with ilioinguinal/iliohypogastric block for analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum. During standardized anesthetic care, 24 children were randomized to Group I (caudal epidural block with 1.2 mL/kg of 0.25% bupivacaine) or to Group II (local infiltration with an ilioinguinal/iliohypogastric block). Postoperative pain scores were significantly lower at all four evaluation points in Group I than in Group II. Patients in Group I had a significantly decreased requirement for supplemental intravenous fentanyl. Intra-operative requirements for isoflurane were decreased in Group I. The expired concentration of isoflurane was 0.4 +/- 0.1 (mean +/- SEM) in Group I and 1.5 +/- 0.3 in Group II. Time to extubation was 3.8 +/- 0.5 minutes in Group I and 8.2 +/- 1.1 minutes in Group II. The time from arrival in the postanesthesia care unit until discharge home was 113 +/- 3 minutes in Group I and 152 +/- 11 minutes in Group II. Caudal epidural block was more effective than local infiltration in controlling pain after herniorrhaphy with laparoscopy in children and resulted in earlier discharge home.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: G W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: J W
authors.initials: JW
authors.lastname: Brock
authors.forename: W M
authors.initials: WM
authors.lastname: Morgan
authors.forename: N
authors.initials: N
authors.lastname: O'Dell
authors.forename: S
authors.initials: S
authors.lastname: Lowe
authors.forename: G E
authors.initials: GE
authors.lastname: Rasmussen
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007001:Hypogastric Plexus; D007085:Ilium / Q000294:innervation; D007223:Infant; D007264:Inguinal Canal / Q000294:innervation; D007275:Injections, Intravenous; D007530:Isoflurane / Q000008:administration & dosage; D010535:Laparoscopy; D008297:Male; D016343:Monitoring, Intraoperative; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies