Analgesic Efficacy of Ultrasound Guided Transversus Abdominis Plane Block Versus Caudal Block in Inguinal Hernia Repair Surgery in Pediatrics
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Background: caudal epidural block (CEB) is the most preferred modality for pediatric regional analgesia because of its effective somatic and visceral pain control, though transversus abdominis plane (TAP) block is an evolving regional anesthetic technique for abdominal wall.Our study aims to compare the analgesic effect of (CEB) versus (TAP) block in pediatrics undergoing inguinal hernia repair surgeries.Patient and Methods: The study enrolled 44 children, aged 3 to 7 years, scheduled for unilateral inguinal hernia repair surgery.Children were divided into 2 equal groups.Group A received ultrasound guided (CEB), while group B received ultrasound guided (TAP) block.We used a multimodal approach of pain control including regional block, intraoperative fentanyl when needed, standard postoperative paracetamol, and rescue ibuprofen when needed.Hemodynamic stability, fentanyl needs, time for first analgesic request, pain scores by Children's Hospital of Eastern Ontario Pain Score (CHEOPS), and ibuprofen requirements were recorded.Results: Both (CEB) and (TAP) groups showed hemodynamic stability, meanwhile there was no need for fentanyl among all patients in both groups, and the time for first analgesia in CEB and TAP groups, was (4.59±0.59)and (7.48±1.35)hours respectively.Furthermore, the ibuprofen requirements and pain scores were statistically significantly higher in (CEB) group than (TAP) group (P-value < 0.05).Conclusion: Both TAP block and CEB provide effective analgesia in children undergoing inguinal hernia repair surgery with TAP block superiority over CEB as evidenced by longer time for first analgesic request, decreased analgesics needs, and lower pain scores.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.
Hernia Repair
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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.
Hernia Repair
Abdominal Hernia
Inguinal canal
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Narcotic
Antipyretic
Narcotic analgesics
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This study was aimed to investigate the dermal irritant test and the central analgesic effects of topical application of seven different formulations (A-G) of analgesic gel prepared from locally available raw material in animal model. The results of dermal irritant test revealed that no animal showed any kind of toxic effect i.e. redness, irritation, itching, inflammation, skin infection or any other injurious effects. All animals remained healthy, active, alert showing normal behavior and no mortality was observed during the claimed period. The analgesic activity was performed by tail flick test. The analgesic activity against tail flick test revealed that all samples of test gel had analgesic effect at 15, 30 and 60 minutes after sample application but sample D had highest analgesic effects (193%) followed by sample E (155%), sample C (122%), sample G (85%), sample B (84%),sample F (81%) while sample A exhibited (73%) analgesic activity. Wintogeno was run as standard drug and it showed 168% analgesic activity.
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Objectives: To elucidate the dynamics of analgesic consumption regarding intravenous patient controlled analgesia (IVPCA) during postoperative period is rather complex partly due to between-patient variation and partly due to within-patient variation. A statistical method was proposed to classify serial analgesic consumption into different classifications that were further taken as the multiple outcomes on which to explore the associated predictors. Methods: We retrospectively included 3284 patients administrated by IVPCA for 3 days after surgery. A repeated measurement design corresponding to serial analgesic consumption variables defined as six-hour total analgesic consumptions was adopted. After determining the numbers of clusters, serial analgesic consumptions were classified into several homogeneous subgroups. Factors associated with new classifications were identified and quantified with a multinominal logistic regression model. Results: Three distinct analgesic classifications were aggregated, including “high”, ”middle” and “low” level of analgesic consumption of IVPCA. The mean analgesic consumptions on 12 successive analgesic consumptions at 6-hour interval of each classification consistently revealed a decreasing trend. As the trends were almost parallel with time, this suggests the time-invariant proportionality of analgesic consumption between the levels of analgesic consumption of IVPCA. Patient’s characteristics, like age, gender, weight, height, and cancer status, were significant factors associated with analgesic classifications. Surgical sites had great impacts on analgesic classifications. Discussion: The serial analgesic consumptions were simplified into 3 analgesic consumptions classifications. The identified predictors are useful to recognize patient’s analgesic classifications before using IVPCA. This study explored a new approach to analysing dynamic changes of postoperative analgesic consumptions.
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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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Analgesic agents
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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.
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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