title: Postoperative analgesia in pediatric herniotomy - Comparison of caudal bupivacaine to bupivacaine infiltration with diclofenac suppository.
abstract: BACKGROUND
  Perioperative analgesia in paediatric herniotomies demand safe, effective and less invasive strategies. Local infiltration with Bupivacaine, rectal Diclofenac and caudal Bupivacaine are widely used for pain relief.
  
  
  OBJECTIVE
  To compare the analgesic effects of caudal epidural using 1 mlkg(-1) of 0.25% Bupivacaine against a combination of local infiltration 0.25% Bupivacaine 0.5 mlkg(-1) with Diclofenac suppository 2 mgkg(-1) in the management of post-operative pain following paediatric inguinal herniotomy.
  
  
  METHODS
  This is an observational study from a tertiary care teaching hospital.
  
  
  METHODS
  A total of 60 children for elective unilateral inguinal herniotomy were assigned to two groups of 30 each. Patients who received caudal block with 1 mlkg(-1) of 0.25% Bupivacaine were allocated to Group A and who received Diclofenac suppository 2 mgkg(-1) and infiltration with 0.25% Bupivacaine 0.5 mlkg(-1) were allocated to Group B. Post operative Pain was assessed using Hannallah's modified objective pain scale. At score ≥3 rescue analgesic oral Paracetamol 15 mgkg(-1) was given. Pain was assessed at 0,15,30,45,60 minutes and half hourly thereafter until 8 hours following surgery or until patient requires rescue analgesic whichever happens first.
  
  
  METHODS
  Employed SPSS software. Data was analysed using sample t test and P-value was calculated.
  
  
  RESULTS
  The demographic profile was comparable between two groups. The mean analgesic duration in group A and group B was 228.5 and 331.0 minutes respectively and is found to be statistically significant (P < 0.05).
  
  
  CONCLUSIONS
  Diclofenac suppository with local infiltration is a less invasive and effective alternative to caudal Bupivacaine for analgesia in paediatric herniotomy.
authors.affiliation: Department of Anesthesiology, Government Medical College, Thrissur, Kerala, India.
authors.forename: C M
authors.initials: CM
authors.lastname: Amminnikutty
authors.affiliation: Department of Anesthesiology, Government Medical College, Thrissur, Kerala, India.
authors.forename: Asish
authors.initials: A
authors.lastname: Karthik
authors.affiliation: Department of Anesthesiology, Government Medical College, Thrissur, Kerala, India.
authors.forename: Abish K
authors.initials: AK
authors.lastname: Kodakkat
keywords: Caudal block; Hannallah objective pain scale; diclofenac; duration of analgesia; local infiltration