REDUCING PAIN AFTER INGUINAL-HERNIA REPAIR IN CHILDREN - CAUDAL ANESTHESIA VERSUS KETOROLAC TROMETHAMINE

Background: The optimal method to achieve analgesia after inguinal her nia repair In children is unknown. This study compared the analgesic e fficacy, adverse events, and the costs associated with supplementation of local anesthesia (infiltration of the wound) with either intraveno us ketorolac or caudal analgesia in children having inguinal hernia re pair. Methods: With parental consent and institutional review board ap proval, children aged 2-6 yr having elective, outpatient inguinal hern ia repair were studied in this randomized, single-blinded investigatio n. Anesthesia was induced by inhalation with nitrous oxide and halotha ne or intravenously with propofol. Anesthesia was maintained with nitr ous oxide and halothane. Patients were randomly assigned to receive ca udal analgesia (1 ml/kg 0.20% bupivacaine with 1/200,000 epinephrine) or intravenous ketorolac (1 mg/kg) immediately after induction of anes thesia. Both groups received field blocks with 0.25% bupivacaine admin istered by the surgeon under direct vision during operation. Patients were assessed for 24 h. In-hospital pain was assessed using a behavior -based pain score. Parents assessed pain with a visual linear analog p ain scale with anchors of 0 (no pain) and 100 (worst pain imaginable). Results: The authors studied 164 children, with 84 patients in the ke torolac group. The groups had similar demographic data. In-hospital an algesic requirements and pain scores were almost identical in both gro ups. Pain at home was significantly less in the ketorolac group, with visual linear analog pain scale scores of 10 (0-80) compared with 20 ( 0-80) (median [range]) for ketorolac versus caudal (P = 0.002 by the M ann-Whitney U test). The ketorolac group also had a lower incidence of vomiting, ambulated more rapidly, and micturated earlier (P < 0.05). Conclusion: The use of intravenous ketorolac to supplement local anest hesia infiltrated by the surgeon during pediatric inguinal hernia repa ir is superior to supplementation with caudal analgesia.