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Open Access Maced J Med Sci. 2016 Mar 15; 4(1):89-93. 89
ID Design 2012/DOOEL Skopje, Republic of Macedonia
Open Access Macedonian Journal of Medical Sciences. 2016 Mar 15; 4(1):89-93.
http://dx.doi.org/10.3889/oamjms.2016.023
eISSN: 1857-9655
Clinical Science
Evaluation of Anesthesia Profile in Pediatric Patients after
Inguinal Hernia Repair with Caudal Block or Local Wound
Infiltration
Aleksandra Gavrilovska-Brzanov
1
*, Biljana Kuzmanovska
1
, Andrijan Kartalov
1
, Ljupco Donev
1
, Albert Lleshi
1
, Marija
Jovanovski-Srceva
1
, Tatjana Spirovska
1
, Nikola Brzanov
2
, Risto Simeonov
3
1
University Clinic of Surgery, KARIL, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of
Macedonia;
2
University Clinic of Surgery, ER Department, Faculty of Medicine, Ss Cyril and Methodius University of Skopje,
Skopje, Republic of Macedonia;
3
University Clinic for Pediatric Surgery, Faculty of Medicine, Ss Cyril and Methodius
University of Skopje, Skopje, Republic of Macedonia
Citation: Gavrilovska-Brzanov A, Kuzmanovska B,
Kartalov A, Donev L, Lleshi A, Jovanovski-Srceva M,
Spirovska T, Brzanov N, Simeonov R. Evaluation of
Anesthesia Profile in Pediatric Patients after Inguinal
Hernia Repair with Caudal Block or Local Wound
Infiltration. Open Access Maced J Med Sci. 2016 Mar 15;
4(1):89-93. http://dx.doi.org/10.3889/oamjms.2016.023
Keywords: Caudal block; Local wound infiltration;
Pediatric analgesia; Hernia Inguinalis; Buivacaine.
*
Correspondence: Dr. Aleksandra Gavrilovska-Brzanov.
University Clinic of Surgery, KARIL, Faculty of Medicine,
Ss Cyril and Methodius University of Skopje, Skopje,
Republic of Macedonia. E-mail:
gavrilovska.aleksandra@gmail.com
Received: 14-Jan-2016; Revised: 23-Jan-2016;
Accepted: 24-Jan-2016; Online first: 03-Feb-2016
Copyright: © 2016 Aleksandra Gavrilovska-Brzanov,
Biljana Kuzmanovska, Andrijan Kartalov, Ljupco Donev,
Albert Lleshi, Marija Jovanovski-Srceva, Tatjana
Spirovska, Nikola Brzanov, Risto Simeonov. This is an
open access article distributed under the terms of the
Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited.
Competing Interests: The authors have declared that no
competing interests exist.
Abstract
AIM: The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after
inguinal hernia repair with caudal block or local wound infiltration.
MATERIAL AND METHODS: In this prospective interventional clinical study, the anesthesia and
recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled
children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal
blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2
ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative
care and assessments. Postoperative pain was assessed. Motor functions and sedation were
assessed as well.
RESULTS: The two groups did not differ in terms of patient characteristic data and surgical profiles
and there weren’t any hemodynamic changes between groups. Regarding the difference between
groups for analgesic requirement there were two major points - on one hand it was statistically
significant p < 0.05 whereas on the other hand time to first analgesic administration was not
statistically significant p = 0.40. There were significant differences in the incidence of adverse
effects in caudal and local group including: vomiting, delirium and urinary retention.
CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration
insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not
overwhelming. Caudal block provides longer analgesia, however complications are rather common.
Introduction
Prophylactic analgesia with local anesthetics
is an attractive concept, especially in pediatric
practice, because the evaluation of pain can be very
challenging in young children [1]. In contrast to
opioids, local anesthetics can be administered safely,
and in recent guidelines regional anesthesia is
accepted as the cornerstone of post-operative pain
relief in the pediatric patients [2]. Although regional
anesthesia holds a good safety record overall [3], the
global experience with pediatric regional anesthesia is
still quite low; even the most commonly performed
procedure, caudal block, represents only 2.5% of all
central neuraxial blocks performed [4]. Determining
the risk-benefit ratio is rather difficult for techniques
that are relatively rarely performed. Wound infiltration
can produce reliable analgesia for superficial skin
surgery. Infiltration itself is extensively used by
pediatricians, surgeons and emergency physicians for
skin laceration repair or minor superficial surgery [1].
Several studies have compared the local anesthesia