Incidence of Complications and Parental Satisfaction Following Pain Relief Methods in Paediatric Herniotomy: Caudal Block Versus Pre-incisional Field Block and Diclofenac Suppository Approach

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Abstract Introduction: Acute post-operative pain is one of the most common adverse effects of surgery experienced by children following herniotomy. Methods of managing this adverse effect include the use of caudal block, pre-incisional field block, and parenteral analgesics. We therefore sought to determine the incidence of complications and parental satisfaction following caudal block versus combination of pre-incisional field block and rectal diclofenac suppository for post-herniotomy analgesia. Materials and Methods: This was a randomised single-blind controlled clinical trial carried out in the Modular theatre of the Jos University Teaching Hospital. Fifty-eight children aged 1–6 years scheduled for elective day case open unilateral inguinal herniotomy with an American society of anesthesiologists of I and II were recruited and randomised into groups A and B; 1 mL/kg of 0.25% plain bupivacaine was administered caudally to group A, while 1 mL/kg of 0.25% plain bupivacaine and 1 mg/kg of diclofenac suppository were administered via pre-incisional field block to group B. Presence of complications such as nausea, vomiting, and pain was noted. Parental satisfaction with post-operative analgesia was assessed using a 5-point Likert item. Data collected were analysed using the SPSS. Results: Patients in the two study groups were comparable with respect to the measured parameters. Two (6.9%) patients in the caudal block group experienced vomiting, while three (10.3%) patients in both study groups had hypotension. Twenty-six (89.7%) and 19 (65.5%) parents in the caudal block group and field block with diclofenac suppository group were, respectively, “very satisfied” ( P = 0.0001). No parent was either dissatisfied or extremely dissatisfied. Conclusion: Both caudal block with plain bupivacaine and pre-incisional field block with plain bupivacaine plus diclofenac suppository showed comparable efficacy in the incidence of minimal complications. No parent was either dissatisfied or extremely dissatisfied with the techniques.

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