A Comparative Study of Diclofenac and Wound Infiltration to Additional Ilioinguinal/iliohypogastric Nerve Block With 0.25% Plain Bupivacaine for Pain Relief in Children Undergoing Groin Surgery – University Teaching Hospital (UTH), Lusaka

Abstract

Surgery in the groin region is commonly performed in paediatric patients at the University Teaching Hospital (UTH).Intramuscular (IM) Diclofenac and wound infiltration, with lignocaine, are the commonest analgesics administered intraoperatively. This study aimed at determining whether an additional ilioinguinal/iliohypogastric nerve block with 0.25% plain bupivacaine, done using the landmark technique,would improve postoperative analgesia in children undergoing groin surgery at the UTH when compared to IM diclofenac and wound infiltration with 1% lidocaine (with adrenaline 1:200,000). A non-randomized intervention study of 36 children undergoing unilateral inguinal herniotomy, hydrocelectomy and orchidopexy was conducted at UTH. The children were allocated to two groups – Group 1 (control) received IM diclofenac and wound infiltration (UTH usual care), while Group 2 (intervention group) received medication as in control plus an ilioinguinal/ iliohypogastric nerve block performed by landmark technique. The Mann-Whitney U test was used to compare the pain scores between the two groups and any result yielding a p-value of less than 5 percent was statistically significant. The operations done were unilateral inguinal herniotomy, hydrocelectomy and orchidopexy. Half of the participants were between 2-5 years old and the other half between 5-7 years. Post-operatively, the pain scores measured at times 0 and 1 hour were statistically non-significant in both groups (p-values 0.181 and 0.355 respectively). At the 6 hour post-operative, all of the participants had pain scores of 0. Oral Paracetamol (15 - 20 mg/kg) was the only post-operative analgesic received by the patients in the study. This study showed that the addition of ilioinguinal/iliohypogastric nerve block, done with the landmark technique, does not offer superior pain relief during the post-operative period in children undergoing unilateral groin surgery at UTH.