Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children

BACKGROUND: This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair. METHOD: A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups. RESULTS: 155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days–14 years) in the laparoscopic group, 6 months (17 days–13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption. CONCLUSIONS: Laparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.