Effect of the local anesthesia in the response to the pain. Study in the inguinal herniotomy

INTRODUCTION: The inguinal hemiotomy is a surgical procedure common in pediatric surgery and as in any operation the control of the pain is fundamental. The aim of this study is to verify the effect of the local anesthesia next to the general anesthesia, in the control of postsurgical pain. MATERIAL AND METHOD: A prospective study is made in 60 patients submitted for unilateral repair of hernia inguinal and hidrocele, under general anesthesia. The patients were designated at random in three equal groups after the anesthetic induction. In group I ilio-inguinal blockade is made, before the surgical incision. In group II local infiltration is made after the closing of the aponeurosis and in group III the anesthetic is not infiltrate. The age of the patients included was between 1 and 13 years. For the valuation of the pain and comparison between the three groups we used: 1) Measurements of conductual type. 2) Measurements of biological type before and after the intervention: Arterial tension, cardiac frequency, respiratory frequency... 3) Laboratory measurements: cortisol levels, prolactose, insulin and glucose. Two extractions are made, first after the anesthetic induction and second 60 minutes after the intervention. The results were analyzed using computer statistical program SPSS. A probability value of < 0,05 was considered significant. RESULTS: 1) Conductual measurements: the differences between groups I and II in relation to the III were significant. This conductual difference also was related to the age of the patients. 2) Measurements of biological type: in groups I and II the postoperative arterial tension average was smaller, but only in group I the difference was significant. The heart rate decreased in the three groups, but was significant only in group I, like the respiratory frequency. 3) Laboratory measurements: in groups I and II the levels of cortisol and glucose diminished in the postoperative period, but only in group I the difference was significant. The values of prolactose diminished in the postoperative period in group I but was not significant. Insulin experienced an increase in the three groups, although smaller in group I. CONCLUSIONS: 1) The results of the study demonstrate specially that the local infiltration of anesthetic diminishes the metabolic answer and reduces the intensity of the postoperating pain, when is made before the beginning of the surgery. 2) In the conductual answer to the pain not only influences the use of the anesthetics but the age of the patient.