DOI: https://doi.org/10.53350/pjmhs2115103494 ORIGINAL ARTICLE 3494 P J M H S Vol. 15, No.10, OCT 2021 Comparison of The Analgesic Outcomes of Local Wound Infiltration using Bupivacaine with Tramadol in Pediatric Inguinal Hernia Repair NAZEER AHMED 1 , MUHAMMAD ARIF BALOCH 2 , MUHAMMAD SHARIF 3 , ZAFARULLAH 4 , YASIR REDA TOBLE 5 1 Associate consultant Anesthetist, Hamad Medical Corporation (HMC), Qatar. 2 Specialist Anesthetist, Hamad Medical Corporation (HMC) Qatar. 3 Registrar Anesthesia, Lateefa Hospital Dubai. 4 (FCPS) 5 Senior consultant Anesthetist, HMC Qatar. Correspondence to: Arif Baloch, Email: marifbaloch@gmail.com ABSTRACT Objective: To compare the time for first analgesic requirement after local wound infiltration with tramadol and bupivacaine in pediatric inguinal herniotomy. Materials and Methods: A total of 130 children aged 4 to 12 years who underwent inguinal herniotomy were included in this randomized comparative study. The study was conducted in anesthesiology unit of a tertiary care center in Qatar from Nov-2020 to July-2021. Patients in Group T received wound infiltration by Inj. Tramadol 2 mg/kg diluted in 10cc distilled water while patients in Group B received Inj. Bupivacaine 1mg/kg diluted in 10 cc distilled water. Postoperatively Pain score using Wong Baker Faces Scale was noted from ½ hour to 6 hours after surgery. Time of first rescue analgesia was noted. Results: The mean age was 7.98±2.40 years in group B versus 7.49±2.58 years in group T (p-value 0.26). There were 42 (64.6%) in group B versus 45 (69.2%) in group T (p-value 0.93). Mean surgery duration was 46.66±4.73 minutes in group T and 45.50±4.37 minutes in group B. The Wong-Baker pain score at different time intervals was significantly lower in group T in comparison to group B. Time of first analgesia requirement was 6.87±0.76 hours in group P versus 5.67±0.97 hours in group P, this duration was significantly prolonged in group T with p-value <0.001. Conclusion: Local wound infiltration with tramadol provides a longer time for first analgesic requirement as compared to the bupivacaine in children undergoing inguinal hernia repair. Keywords: Inguinal hernia, wound infiltration, tramadol, bupivacaine, post-operative pain. INTRODUCTION The Pain is a nasty sensory and emotive experience related to or explained in terms of existing or prospective tissue damage." 1 Pain causes a wide range of alterations and has a variety of consequences for regular physiological activities. Hypertension, tachycardia, increased myocardial irritability, increased minute breathing, reduced tidal volume, increased CO2 generation, increased sympathetic tone, and excessive release of catabolic hormones are some of the most prevalent side effects. 2 Pain relief is achieved by using systemic drugs like opioids, paracetamol and NSAIDS, local nerve blocks, central neuraxial blocks, Transcutaneous electrical nerve stimulation (TENS), use of adjuncts like antidepressants, anticonvulsants and magnesium sulphate, acupuncture, psychological interventions, cryoanalgesia 5 and radiofrequency ablation. 3,4 Inguinal hernia is a frequent occurrence in children, and the defect is treated with a herniotomy or repair. 5 It's usually done under general anaesthetic, and the most frequent complaint afterward is discomfort. 6 Infiltration of local anesthetic into the surgical site reduces pain at the incision site and is often utilized as part of multi-modal analgesia regimens. The most frequent local anaesthetic for this function is 0.25 percent bupivacaine. However, because of the cardiotoxic effects of Bupivacaine, numerous additional medicines have been explored for local wound infiltration as a stand-alone agent or as a supplement to 0.25 percent Bupivacaine. 7,8 Tramadol's local anesthetic effects have recently been documented. Studies have reported that locally wound infiltration with tramadol provide better postoperative analgesia than bupivacaine and reduced the need for postoperative analgesics. 9 In this study we compared the time for first analgesic requirement after local wound infiltration with tramadol and bupivacaine in children undergoing inguinal hernia repair. MATERIALS AND METHODS A total of 130 children who underwent inguinal herniotomy were included in this randomized comparative study. The study was conducted in anesthesiology unit of a tertiary care center in Qatar from Nov-2020 to July-2021. Children of age 4 to 12 years, planned for elective inguinal herniotomy were included. While patients having obstructed inguinal hernia requiring emergency herniotomy and having hypersensitivity to local anesthetics or tramadol were excluded. After taking informed consent from the parents of the child, patients meeting the inclusion criteria were enrolled. Patients were randomly divided into 2 equal groups by lottery method. All patients were given standard general anaesthesia with appropriate doses of Nalbuphine, Midazolam, Propofol, Atracurium, Endotracheal intubation with IPPV (Intermittent Positive Pressure Ventilation). Reversal with Glycopyrrolate and Neostigmine was done. Standard monitoring like SpO2, Pulse rate and ECG was applied. At the end of surgery, patients in Group T received skin infiltration by Inj. Tramadol 2 mg/kg diluted in 10cc distilled water while patients in Group B received Inj. Bupivacaine 1mg/kg diluted in 10 cc distilled water. Skin