Effect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy.
OBJECTIVE
To evaluate the effect of a 20- or 60-second instillation period using 0.5% bupivacaine with epinephrine for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy.


METHODS
In a randomized, double-blind study, 103 children (aged 1 to 12 years, American Society of Anesthesiologists [ASA] physical status I or II) were allocated into 4 groups after induction of anesthesia. Group 1: normal saline 0.25 mL/kg instilled, which remained in the wound for 20 or 60 seconds before wound closure. Group 2: 0.25 mL/kg 0.5% bupivacaine with epinephrine 5 microg/mL instilled, which remained in the wound for 20 seconds. Group 3: the same quantity and dose of drug 2 instilled as group, but remained in the wound for 60 seconds. Group 4: an ilioinguinal and iliohypogastric block performed before operation using 0.5 mL/kg 0.25% bupivacaine with epinephrine. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Aldrete-Kroulik recovery scores were used to monitor postoperative pain and recovery status. Analgesic was given when the CHEOPS score was >/= 7 despite other supportive therapy.


RESULTS
The number of patients requiring analgesics within 2 hours in group 1 (73.1%) was more than groups 2, 3, and 4 (23.1%, 20.8%, and 16%, respectively, P <.001). The median time to first analgesic in group 1 (50 minutes) was also less than groups 2, 3, and 4 (420, 525, and 425 minutes, respectively, P <.0001).


CONCLUSIONS
0.5% Bupivacaine with epinephrine for as short an instillation period as 20 or 60 seconds can provide a good analgesic alternative after herniorrhaphy and hydrocelectomy in pediatric patients. All studied blocks had comparable duration of action.
Suraseranivongse
Suwannee
S
Department of Anaesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. sisur@mahidol.ac.th
Chowvanayotin
Sumitra
S
Pirayavaraporn
Sangsom
S
Kongsayreepong
Suneerat
S
Gunnaleka
Panidaporn
P
Kraiprasit
Kanitha
K
Petcharatana
Suppat
S
Montapaneewat
Thunyanit
T
D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D006848:Testicular Hydrocele / Q000601:surgery*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine