Preemptive ilioinguinal-iliohypogastric nerve block versus intravenous morphine for postoperative pain control after unilateral inguinal herniotomy in children: a comparative study

ABSTRACT

Inguinal hernia repair in children is one of the commonest surgical procedures. As a day-case procedure, it requires adequate post-operative pain control. A prospective randomized double-blinded study was designed to compare the effectiveness of postoperative pain control and incidence of complications between combined ilioinguinal/iliohypogastric nerve block and intravenous morphine. Sixty patients aged 2-12 years were randomly allocated to two groups of thirty. One group received intravenous morphine 100 microgram/kg before skin incision and the other had an ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine [0.25 ml/kg] also before skin incision. All patients have received standardized anaesthesia. Pain was assessed using 0-10 scale at 0.30 minutes and 1, 2, 3 and 4 hours postoperative. Time to first analgesia, number of paracetamol doses and the incidence of respiratory depression, vomiting and itching were assessed during the first 24 hours. During the first four postoperative hours, the two groups had identical pain scores. Time to first analgesia and number of doses of the rescue drug for residual pain during the first 24 postoperative hours was equal for the two groups. None of the 60 patients had respiratory depression but the morphine group patients were found to have more episodes of vomiting [P<0.05], no significant differences in itching [p=NS]. We concluded that both intravenous morphine [100 microgram/kg] and ilioinguinal-iliohypogastric nerve block have the same analgesic effect for postherniorrhaphy pain in children with higher incidence of vomiting in morphine treated patients