Comparison of the Effects of Laparoscopic and Open Repair Techniques on Postoperative Pain and Analgesic Consumption in Pediatric Unilateral Inguinal Hernia

Abstract

Aim: Although laparoscopic inguinal hernia (IH) repair in adults is widely accepted, its advantages in pediatric age group are questionable. We aimed to compare the effects of open inguinal hernia repair and laparoscopic inguinal hernia repair on length of anaesthesia, postoperative pain and analgesic consumption in boys who underwent unilateral inguinal hernia repair. Methods: Forty patients aged between 7 and 14 years who underwent open and laparoscopic inguinal hernia repair were included in this study. The patients were randomly divided into two groups: unilateral open inguinal hernia repair group (OR) n=20 and unilateral laparoscopic inguinal hernia repair group (LR) n=20. All patients underwent general anesthesia. The duration of anaesthesia and the duration of surgery were recorded. The Patient Controlled Analgesia (PCA) device was set at a 0.01 mg/kg bolus dose, 10 minutes lockout interval and 4 hour limit of 4 mg morphine. The patients, who received morphine PCA for 24 hours postoperatively, were monitored with continuous oximetry. The Visual Analogue Scale (VAS) was used to measure pain (0 cm: no pain, 10 cm: worst possible pain). We recorded the side effects of morphine, such as respiratory depression, nausea, vomiting, urinary retention, pruritus. SpO2 level and Ramsay Sedation Scale (RSS), Numerical Rating Scale (NRS), and Visual Analogue Scale (VAS) scores at intervals 1, 2, 4, 12, 24 hours as well as amount of analgesics consumed and number of requests within 24 hours postoperatively were recorded. Time to first walking was recorded. Results: In group OR, the mean duration of anaesthesia and surgery were 39.85 minutes and 28.85 minutes, respectively. In group LR, the mean duration of anaesthesia and surgery were 26.11 and 20.53 minutes, respectively. VAS scores and time to first walking were similar in both groups. There was no significant difference in amount of analgesics consumed and number of request between the two groups. In group OR, the number of unsuccessful requests was higher than in group LR. There was not any side effects except for a higher NRS score of higher than 2 in one patient. Peripheral oxygen saturation was never less than 95%. RSS scores were never higher than 2. Conclusion: Higher number of unsuccessful request implies that children who undergo an open inguinal hernia repair feel more pain, thus, it can be thought that laparoscopic hernia repair is an alternative technique although the duration of anaesthesia and surgery was significantly longer in unilateral laparoscopic inguinal hernia repair technique. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 84-8)

Keywords

• Boys
• unilateral open and laparoscopic inguinal hernia repair
• postoperative pain
• PCA