Intraoperative Bupivacaine Irrigation for Analgesia after Inguinoscrotal Surgery in Children

Paik, Soon Ho; Song, Young Jun; Yang, Dae Yulk; Kim, Sung Yong; Kim, Ha young

Abstract

Postoperative pain is a major problem that may restrict early mobilization and hospital discharge of surgical patients and it may cause psychologic trauma in pediatric patients, so effective postoperative analgesia is important especially in pediatric surgery. A study was undertaken to test the effect of intraoperative wound irrigation with bupivacaine for postoperative analgesia in pediatric inguinoscrotal surgery and the analgesic effect was measured with postoperative analgesics requirement and pain score. A total of 149 patients of 5 months to 13 years old were enrolled in our study. In comparison of analgesics requirement a total of 69 patients were enrolled and assigned to 2 groups. Group 1 was treated with wound irrigation with 0.21 ml/kg 0.25 % bupivacaine solution before closure of the inguinal canal and before suturing the subcutaneous layer. Group 2 was treated with normal saline instead of bupivacaine. Postoperatively 3 mg/kg phenobarbital was administered intramuscularly on complaint of pain. And the total number of doses of phenobarbital administered during first 24 hours of postoperative period was recorded. Drug administration and patient evaluation were double-blinded. In comparison of pain score a total of 80 patients were enrolled and assigned to 2 groups as same method as above and score according to the Oucher pain scale was recorded by nursing staff to assess the efficacy of intraoperative bupivacaine irrigation. The children in the bupivacaine group required significantly less postoperative medication for analgesia than those in the control group. The average number of doses of phenobarbital in the bupivacaine group was 0.189 +/- 0.065 compared to 0.594 +/- 0.109 in the control group (p=0.002). On the Oucher pain scale the bupivacaine group reported less pain than the control group (score 27.69 +/- 6.04 versus 37.56 +/- 5.18, respectively, p=0.01). We concluded that bupivacaine irrigation effectively decreases postoperative pain and narcotic drug requirement, and the irrigation of wounds with bupivacaine should be a routine procedure in elective inguinoscrotal surgery in children.