Combined Subfascial and Subcutaneous Bupivacaine Instillation for Inguinal Hernia Wounds
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Pethidine
The effects of varying the strength of bupivacaine used in epidurals for the relief of labour pain was examined. The trial randomly allocated sixty women in the first stage of labour to one of three groups. All women were of ASA status 1 or 2 and had uncomplicated pregnancies. Subjects in each group received pethidine 25 mg in 10 ml of either 0.125%, 0.1875%, or 0.25% bupivacaine. Pain scores for each patient were then assessed over the following thirty minutes. Duration of analgesia and subsequent dose requirements were examined. No difference in pain scores between groups at thirty minutes after injection of the test solutions was found. The 0.25% solution group did however have a more rapid onset of analgesia with the majority of patients in this group achieving their maximum effect between ten and twenty minutes after injection. Duration of analgesia was not prolonged by using the stronger solutions. This study suggests that when epidural pethidine 25 mg is added to local anaesthetic solutions of bupivacaine, adequate analgesia for the first stage of labour is achieved with the 0.125% bupivacaine solution. The use of stronger solutions of bupivacaine achieves no greater degree of analgesia nor longer duration of action, although the onset of analgesia may be faster with the stronger solutions. Further investigations are needed to determine if 25 mg of pethidine is the best choice of dose to use under these circumstances.
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Abstract Background Pediatric inguinal hernia (PIH) is a common disease in children. Laparoscopic hernia repair (LHR) has developed rapidly in recent years, but there are still different opinions compared with traditional open hernia repair (OHR). The purpose of this study was to compare the advantages and disadvantages of LHR and OHR in the treatment of pediatric inguinal hernia. Methods We performed a retrospective review of all children (< 14 years) who underwent repair of inguinal hernia in the pediatric surgery center of the Affiliated Hospital of Qingdao University from January 2015 to December 2015. We collected the medical records of all the children and analyzed the clinical characteristics, operation-related information and follow-up. Results In the OHR group, 202 cases underwent unilateral inguinal hernia repair, and 43 cases underwent bilateral inguinal hernia repair. In the LHR group, 168 cases underwent unilateral inguinal hernia repair, and 136 cases underwent bilateral inguinal hernia repair. There was a significant difference in the operation time between the two groups, but there were no significant differences in postoperative hospitalization time and incidence of ipsilateral recurrent hernia between the two groups. The incidence rates of metachronous contralateral hernia (MCH) and surgical site infection in LHR group were significantly lower than those in the OHR group. Conclusion Our study shows that compared with OHR, LHR has the advantages of concealed incision, minimal invasiveness, reduced operation time, detection of contralateral patent processus vaginalis, and reduced incidence of MCH. In conclusion, LHR is safe and effective in the treatment of pediatric indirect inguinal hernia.
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A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.
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Background: Worldwide, inguinal hernia repair is the commonest surgical procedure in general surgery, but the optimal repair technique for inguinal hernia has not been defined and accepted in most parts of Africa and other developing nations. The aim of this study was to determine the epidemiology of inguinal hernias and feasibility of mesh implants in our centre.
Methodology: This was a descriptive cross-sectional study of consecutive adult patients with uncomplicated inguinal hernias who received polypropylene mesh for repair of their inguinal hernias. Selection criteria included inguinoscrotal/inguinolabial hernia, recurrent or bilateral hernia or bubunoceles with wide defects. Descriptive statistics and tests of significance were done.
Results: Inguinal hernia represented 77.3% of all abdominal wall hernias encountered during the study. However, only 27.8% (100 patients) of the 360 patients that satisfied the inclusion criteria received mesh implants. Of the 100 patients studied, 31% had recurrent hernias, 48% harbored complete inguinoscrotal/inguinolabial hernia while 13% had incomplete inguinoscrotal hernia. Majority (86%) had unilateral hernia.The annual repair rates using mesh implants increased progressively from 4% in 2013 to 40% in 2017. A quarter (25%) had comorbidities. Majority (60%) of repairs were under general anesthesia. The overall postoperative complication rate was 14%. Wound infection rate was 3.5%. There was statistically significant difference in the rates of wound-related events between recurrent and primary inguinal hernias (p=0.000). There was no mortality or recurrence recorded in this study.
Conclusion: The uptake of mesh implants for inguinal hernia repair in our environment is low, though the trend is changing with higher proportions of patients accepting mesh implants in recent time. Elective inguinal hernia surgery with polypropylene mesh is feasible, safe, effective and reproducible in our setting.
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Abdominal Hernia
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Background: Laparoscopic inguinal hernia repair in adults require the use of prosthetic material. We aimed to investigate the acute postoperative pain in patients who underwent transabdominal preperitoneal inguinal hernia repair using heavy or light weight polypropylene mesh.
Methods: This observational, analytical study was conducted in172 adult patients, aged 18-80 years, who underwent transabdominal preperitoneal inguinal hernia repair from January 2017 - October 2019. The patients were divided into two groups as HWM group (heavyweight polypropylene mesh), n=81 and LWM group (light weight polypropylene mesh) n=91. The patients in both the groups were compared in terms of acute postoperative pain at 24 and 48 hours using visual analogue scale (VAS) score.
Results: The visual analogue scale (VAS) score of HWM group and LWM group at 24 hours was 5.42 ± 1.25 and 4.46 ± 1.61 respectively (p=0.00). The VAS score at 48 hours was 3.44 ± 1.07 and 2.74 ± 1.27 for HWM and LWM group respectively (p=0.00).
Conclusions: The post-operative pain at 24 and 48 hours following transabdominal preperitoneal inguinal hernia repair using light weight polypropylene mesh was less as compared to the patients whose hernia were repaired using heavy weight polypropylene mesh.
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The study of the effect of analgesics in the newborn is difficult in the clinical situation and resort must be made to animals. Pethidine given within 1 hour of delivery is believed to cause less depression than when the time interval is longer. This study investigates whether it is pethidine or its metabolites which cause respiratory depression by comparing the respiratory effects of pethidine and its metabolites in the newborn rabbit. Fentanyl and buphrenorphine were also investigated as alternative analgesics. The response in the newborn rabbit to anoxia, is periods of dyspnoea, primary apnoea, and gasping. The metabolites of pethidine increased the primary apnoea signifying depression almost as much as pethidine. Depression was also produced when anoxia was induced 5 minutes after pethidine. Fentanyl caused less depression than pethidine or its metabolites excepting normeperidinic acid. Buphrenorphine administration resulted in the least depression with little difference between the low and high doses. Thus both pethidine and its metabolites are factors in the persisting depression, while buphrenorphine compared well with pethidine and fentanyl.
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To review the occurrence of contralateral inguinal hernia in infants and children who presented with unilateral inguinal hernia and underwent herniotomy in order to establish whether simultaneous contralateral exploration is a necessity in our environment.A retrospective study.Muhimbili National Hospital Paediatric surgical ward.Seven hundred and thirty two children.Twenty five infants and children developed an inguinal hernia on the contralateral side 2-76 months after herniotomy. Follow-up period was one to thirteen years. Six hundred and seventy one were boys and sixty one girls (M:F = 11:1). Right side presentation was seen in two-thirds of the children. Subsequent contralateral hernia occurrence was more common in girls (4.9%) and slightly higher in children above 12 months of age (3.5%) but these comparisons were not significant (p values were 0.45 and 0.89 and R.R. values were 0.97 and 0.67 respectively). Subsequent development of contra lateral hernia in children with left-sided hernia was high (6.7%) and this was statistically significant (p = 0.002, R.R. = 3.38).The risk of occurrence of contra-lateral inguinal hernia following unilateral inguinal herniotomy is not significantly excessive when compared by age or sex implying that routine exploration on the contralateral side in infants and children clinically presenting with unilateral inguinal hernia is not justified and we recommend herniotomy only when there is adequate clinical evidence of an inguinal hernia. Despite the significant risk of developing a contralateral hernia in children with left-sided hernia, the authors do not recommend routine right-sided exploration as the frequency is not high.
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The aim of the study was to investigate the stability of labour pain recall 14-21 months after delivery, and to relate it to events during labour.One hundred and fifteen primipara completed a visual analogue scale (VAS) on the second day after delivery, and a similar VAS 14-21 months later. Women who were delivered before completing 37 gestational weeks, had a multiple pregnancy, needed epidural analgesia, or whose infant was transferred to the neonatal care unit were excluded. Data were analysed by three different methods to minimise bias. By method 1, the proportion of VAS 2 > VAS 1 was calculated. By method 2, the accuracy of recall was defined from the equation -1 < or = VAS 2--VAS 1 < or = 1. By method 3, the VAS used was regarded as an unlimited scale, but with all observations shortened to the interval, 0 to 10 cm. Pain scores were related to obstetrical data: instrument delivery, fetal weight, duration of second stage of labour, use of pethidine and use of pudendal analgesia.Thirteen of 20 women (65%) who had received pethidine during labour reported a higher VAS 2 than VAS 1, compared to 27 of 95 (28%) women who had not received pethidine (p = 0.003). According to method 2, 35% of the pethidine-treated women overestimated labour pain on recall, compared to 13% in the non-pethidine-treated group (p < 0.05). According to method 3, women who were not treated with pethidine showed a decrease of 0.81 cm on the recalled VAS, compared to an increase of 1.13 cm in the pethidine-treated group (p < 0.01). None of the other investigated events during labour were related to pain recall.In general, labour pain recall fades over time or tends to be stable, but to a significantly higher number of women receiving pethidine, pain seems to intensify on recall. If further investigations show that this is an effect of pethidine itself, opioids should be used with caution during labour.
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Systematic review of the risk of developing a metachronous contralateral inguinal hernia in children
Abstract Background This study aims to establish the risk of developing a metachronous contralateral inguinal hernia (MCIH) following open repair of a unilateral inguinal hernia in children. Methods A systematic review was performed using a defined search strategy. Studies in which children undergoing open repair of a unilateral inguinal hernia without contralateral exploration and who were followed up for MCIH development were included. Results Of 5937 titles and abstracts screened, 154 full-text articles were identified for review; 49 papers were analysed with data on 22 846 children. The incidence of MCIH was 7·2 per cent overall, 6·9 per cent in boys and 7·3 per cent in girls (P = 0·381). Children with a left-sided inguinal hernia had a significantly higher risk of developing a MCIH than those with a right-sided hernia (10·2 versus 6·3 per cent respectively; P < 0·001). Conclusion Overall, in both boys and girls, 14 contralateral explorations are required to prevent one metachronous hernia. The risk of developing a MCIH appears unchanged in early childhood, with a slight reduction after 12 years of age. Children with a left-sided hernia have the greatest risk of developing a contralateral hernia, but ten explorations are still required to prevent one metachronous hernia. Most MCIHs occur in the first 5 years after unilateral inguinal hernia repair.
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ObjectiveTo analyze the proportion of incarcerated direct inguinal hernia(IDIH) to inguinal hernia and toshow the significance of herniography in diagnosis. MethodsOne case of bilateral IDIH was reported and the literatureswere reviewed to analyze the proportion of IDIH to incarcerated inguinal hernia, direct inguinal hernia and inguinal hernia.The herniography showed the significance in diagnosis of diverticular direct inguinal hernia(DDIH) , which was the mostcommon cause of IDIH.ResultsIn recent years, the proportion of IDIH to incarcerated inguinal hernia, direct inguinalhernia and inguinal hernia increased in elderly group in China. An evaluative herniography preoperative could demonstrate theDDIH and the ipsilateral multiple hernia.ConclusionsIts very important to confirm IDIH and DDIH. The proportion ofIDIH to inguinal hernia increases in elder. An evaluative herniography is of great value to the diagnosis of DDIH, which is themain cause of IDIH.
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