Comparison of post-operative pain control and stress response from rectal diclofenac and pre-incisional wound infiltration with bupivacaine in paediatric herniotomy

Abstract

Herniotomy is one of the most common procedures performed by the paeiatric surgeon. Its most common complication is post-operative pain. Furthermore, is the known stress response associated with surgery, which may also have deleterious effects. Analgesics are effective in reducing both these effects. This study compares the effectiveness of two analgesic options- rectal diclofenac and wound-infiltrated bupivacaine, on post-operative pain and stress response. Methods: This was a prospective, double blinded clinical study. Seventy two children undergoing herniotomy were randomized into group 1 (Bupivacaine group) and group 2 (Diclofenac group). The children were similar in all other aspects except for the treatment they received. Pain was evaluated by a blinded assessor on arrival of the patient in the recovery room using the FLACC scale. Blood samples were taken following induction of anaesthesia and at the end of surgery for Cortisol and glucose estimations. Results: The mean pain scores were similar in both groups post-operatively and it remained below a score of 4 throughout the study period. There was no significant difference between the pre- and post operative serum Cortisol and glucose levels in both groups (p >0.05). Conclusion: Rectal diclofenac provides a comparative effectiveness of analgesia to wound-infiltrated bupivacaine in children undergoing herniotomy.