Regional Block, Wound Infiltration, and Caudal Block For Post Operative Pain Management in Children Undergoing Inguinal Herniotomy: A Randomized Controlled Trial

Background: Pain management postoperatively for such a common condition plays an important role, as unmanaged pain may cause behavioral and sleep changes, and parental distress. Objective: To compare regional block, caudal block, and wound infiltration for post-operative pain management in pediatric inguinal herniotomy. Methods A randomized, controlled trial (NCT 05969613) was carried out in pediatric surgery department, KEMU from January till December 2019, and 300 patients undergoing inguinal herniotomy were enrolled after informed consent. They were randomly allocated in 3 groups and underwent regional block in Group A, wound infiltration in Group B, and caudal block in Group C using Bupivacaine. Rescue analgesia was given if pain scores were ≥4. Postoperative pain scores, duration of analgesia and complications like urinary retention and wound infection were compared. Results: Postoperative FLACC scores revealed need of rescue analgesia in 9(9%) patients at 2nd hour in Group C (p value <0.001), and at 8th hour, 12(12%) in Group A, 19(19%) in Group B, and 30(30%) in Group C had score ≥4 (p value 0.000). Wong Baker Score also revealed higher scores and need of rescue analgesia in Group C than Group A or B after 4 hours postoperatively (p value <0.001). Duration of analgesia was 288.16±23.7 min in Group A, 338.55±19.79 min in Group B, and 262.43±15.4 min in Group C (p value <0.001). Urinary retention was present in 9 (9%) children in Group C (p value <0.001). Six (6%) children had wound infection in Group A, three (3%) in Group B, and 15 (15%) in Group C (p value 0.005). Conclusion: Regional block and wound infiltration were more effective as compared to caudal block in terms of pain control. Caudal block also had more complication rates.