A COMPARATIVE STUDY OF LOCAL INFILTRATION OF WOUNDS WITH BUPIVACAINE AND INTRAVENOUS PARACETAMOL AT THE TIME OF INDUCTION FOR POST-OPERATIVE PAIN RELIEF IN PEDIATRIC INGUINAL HERNIOTOMY SURGERIES

Abstract

Background and Objective:

Effective postoperative pain control in children is essential to reduce distress, enhance recovery, and prevent complications. We aim to compare the efficacy of local wound infiltration with bupivacaine versus intravenous (IV) paracetamol for early postoperative pain management in children undergoing inguinal herniotomy.

Methods:

This double-blind randomized controlled trial included 98 children aged 5–12 years undergoing elective inguinal herniotomy. Participants were randomly assigned into two groups (n=49 each). In the bupivacaine group, 0.25% bupivacaine (prepared by diluting 0.5% solution) was infiltrated into the surgical wound at induction. In the paracetamol group, IV paracetamol was administered at induction. Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 30 minutes and hourly for 6 hours. Rescue analgesia was administered for FLACC scores ≥4. Data were analyzed using appropriate statistical tests, with p≤0.05 considered significant.

Results:

Of the 98 children, 69.4% were male and 30.6% female, with a mean age of 7.19±1.63 years. The bupivacaine group demonstrated significantly lower FLACC scores at 2, 3, 4, 5, and 6 hours postoperatively (p<0.05). Additional analgesia was required in 6.1% of patients in the bupivacaine group compared to 22.4% in the paracetamol group (p=0.021).

Conclusion:

Local wound infiltration with bupivacaine provides superior and prolonged postoperative analgesia compared to IV paracetamol in pediatric inguinal herniotomy, with reduced need for rescue analgesia.