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Abstract

THE EFFECT OF LOCAL ANESTHETIC INSTILLATION ON POST OPERATIVE ANALGESIA DURING SINGLE INCISION LAPAROSCOPIC PEDIATRIC INGUINAL HERNIA REPAIR USING EPIDURAL NEEDLE

Abdullah M. Ahmed*, Rafik Shalaby and Maged Ismail

ABSTRACT

Background: Laparoscopic inguinal hernia repair has been shown to be safe and effective in the pediatric population but has been associated with perioperative pain. The use of local anesthetic either by infiltration or intra-peritoneal instillation is an emerging technique used for pain relief. Objective: this study aimed to evaluate the effectiveness of intraperitoneal infiltration of l-bupivacaine during laparoscopic herniotomies in pediatrics in reducing postoperative pain, delaying the onset and reducing the total dose of rescue analgesia, and improving perioperative hemodynamics. Settings and Design: This is a prospective, randomized-controlled study conducted at Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt; between June 2014 and July 2016. Patients and methods: A total of 240 ASA I and II children were scheduled for elective laparoscopic inguinal herniotomy and assigned to two groups: Group B: l-bupivacaine 0.5% instilled into the peritoneal cavity through epidural needle immediately after gas insufflation at a dose 2 mg/kg and Group S: normal saline was instilled instead of l-bupivacaine. All patients were subjected to preincisional periportal lidocaine 1% infiltration. Heart rate (HR) and blood pressure were recorded at 5 min intervals starting from the preoperative period until 6 h postoperatively. The Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score was used and the onset of rescue analgesia were recorded. Results: Duration of analgesia is significantly longer in Group B compared to Group S (p<0.001). Heart rate (HR) and mean arterial blood pressure (MAP) were lower in group B compared to group S. Onset of rescue analgesia demand was delayed in group B and the median pain score and total dose of pethidine were significantly lower in group B (p=0.016 and P < 0.001 respectively). Conclusion: Intraperitoneal bupivacaine infiltration in pediatric laparoscopy, after pneumoperitoneum, extends duration of analgesia, reduces postoperative pain and improves perioperative hemodynamics.

Keywords: Anesthesia, bupivacaine, laparoscopy, pediatrics.


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