REGIONAL ANESTHESIA FOR HERNIA REPAIR IN CHILDREN - LOCAL VS CAUDAL ANESTHESIA

The purpose of this study was to compare the effect of local anaesthes ia (LA) with that of caudal anaesthesia (CA) on postoperative care of children undergoing inguinal hernia repair. This was a randomized, sin gle-blind investigation of 202 children aged 1-13 yr. Anaesthesia was induced with N2O/O-2 and halothane or propofol and maintained with N2O /O-2/halothane. Local anaesthesia included ilioinguinal and iliohypoga stric nerve block plus subcutaneous injection by the surgeon of up to 0.3 ml.kg(-1) bupivacaine 0.25% with 5 mu g.kg(-1) adrenaline. The dos e for caudal anaesthesia was 1 ml.kg(-1) up to 20 ml bupivacaine 0.2% with 5 mu g.kg(-1) adrenaline. Post-operative pain was assessed with m CHEOPS in the anaesthesia recovery room, with postoperative usage of o pioid and acetaminophen in the hospital and with parental assessment o f pain with a VAS. Vomiting, time to first ambulation and first urinat ion were recorded. The postoperative pain scores and opioid usage were similar; however, the LA-group required more acetaminophen in the Day Care Surgical Unit. The incidence of vomiting and the rimes to first ambulation and first urination were similar. The LA-patients had a sho rter recovery room stay (40 +/- 9 vs 45 +/- 15 min, P < 0.02). The pos toperative stay was prolonged in the CA group (176 +/- 32 vs 165 +/- 2 6 min, P = 0.02). We conclude that LA and CA have similar effects on p ostoperative care with only slight differences.