Postoperative pain management with combined local infiltration and oral analgesia in herniotmy wound in children

Abstract

Introduction: Post operative pain management in children is one of the most challenging job to anaesthetic as well as to surgeon. Adequate analgesia in children is necessary to reduce parent’s distress after any surgery. This study was carried out to assess the subjective adequacy of combined approach local anaesthesia and oral analgesia after inguinal herniotomy surgery in children.

Methods: It was a prospective study done in a very remote district of Ruccum in Nepal. Adequacy of postoperative pain management was observed after wound infiltration at the local site in inguinal herniotomy cases.subsequently after surgery in 80 children. Wound infiltration at the local site was made with 0.5% bupivacaine. subsequently a combination of syrup of oral analgesic ibuprofen and paracetamol was given 4 hours after surgery when child became fully awake. Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) was used to access the adequacy of pain management.

Results: out of 80 children, pain score< 6 was observed in 95.5% children . Among behavioralscore the commonest neutral bevavior in torso was found in 75 chidren. Likewise, no cry in 73, smiling in 70%, positive in 70%, not touching in 74%, neutral behavior in 74% were observed in cry, facial, child verbal, torso, touch and legs respectively.

Conclusion: Local wound infiltration with 0.5% Bupivacaine is a simple and effective method in pain management in herniotomy cases which givessatisfaction to the children as well astheir parents