الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In recent years, awareness of the value of adequate postoperative pain relief has been increased and several methods have been introduced. An effective pain therapy to block or modify the physiologic responses to stress has become an essential component of modern pediatric anaesthesia.
Numerous studies in vitro and in vivo have found a detrimental effect of local infiltrate with LA on the first and second stages of wound healing. The magnitude of this effect on mature wound strength has yet to be determined. Studies of analgesic efficacy have not included adequate assessment of wound healing complications, such as late incisional hernias. Future trials of postoperative LA administered into the wound should include measures of wound strength and healing both at the end of the second stage (3 to 4 weeks), as well as at the end of the third stage (6 to 12 months) of wound healing.
This study was carried out to evaluate effect of local wound infiltration in comparison with caudal block by bupivacaine 0.25% after inguinal herniotomy in pediatrics on: Wound infection, wound healing and postoperative analgesia.
This study was carried out in Paediatric Surgery Department in El-Shatby Hospital on 50 child of both sex aged (2-12 months) evaluated as American Society of Anesthesiologists (ASA) I or II physical status undergoing elective inguinal hernia repair.
Patients were randomly assigned via closed envelope technique into two equal groups 25 children each:
group L: Patients received bupivacaine 0.25 % (0.5 ml/kg) subcutaneous at the surgical site after the repair.
group C: Patients received post-operative caudal block with bupivacaine 0.25 % (1 ml/kg).
All the patients were assessed pre-operatively by detailed history taking, complete clinical examination and routine laboratory investigations. On arrival to the operating room, patients were monitored using an electrocardiograph, a non-invasive arterial blood pressure monitor and pulse oximeter.
They were all subjected to the same anaesthetic protocol, all patients received a standardized general anaesthetic technique using fentanyl (1 µg/kg) IV, followed by laryngeal mask airway (LMA) inserted and anaesthesia maintained with oxygen and sevoflurane 2-3% delivered via an Ayre’s T-piece with spontaneous ventilation.
Postoperative vital signs every hour for 4 hours, postoperative pain using FLACC, duration of analgesia, and total dose of supplementary analgesic in 15 min., 1 hour and 3 hours postoperatively, side effects, white blood cells count day 0 and day 7 postoperative and observational wound healing assessment were done using Southampton scoring system were recorded and statistically analyzed.
The results of the present study showed:
As regard the age, weight and gender distribution of the patients in the present study, there were no statistically significant differences between the two groups.
As regard Postoperative vital signs every hour for 4 hours: heart rates, temperature & respiratory rates at 1st hour postoperative, heart rates and temperature at 2, 3 & 4 hours postoperative, no statistical significance. comparison between two groups shows statistical significance as regard respiratory rates 2, 3&4 hours postoperative.
Postoperative pain was assessed using a FLACC Behavioral Pain Assessment Scale, assessments of analgesia was at 15min, 60 min, 3 hours postoperative. There was statistically significant decreased in pain score scale in group C compared to group L at 15min, 60min, 3 hours postoperatively.
In group L At 15min postoperative the FLACC score ranges from 0-4 with mean value of 1.84±1.03, with 1 case with FLACC score =4. At 60 min the FLACC score ranges from 0-6 with mean value of 2.24±1.92, with was 4 cases with FLACC score ≥ 4. At 3hours postoperative FLACC score ranges from 0-4 with mean value of 1.36±1.58, with3 cases with FLACC score=4.
In group C At 15min postoperative the FLACC score ranges from 0-2 with mean value of 1.16±0.85, with 0 cases with FLACC score more than 3. At 60 min postoperative the FLACC score ranges from 0-4 with mean value of 0.88±1.24, with 1 case with FLACC score more than 3. At 3 hours postoperative the FLACC score ranges from 0-4 with mean value of 0.64±1.25, with 1 case with FLACC score=4.
As regard wound healing There was statistically significant using Southampton scoring system between the 2 studied groups with higher number of patients with higher scores in group L. (noting that all patients lied in the normal healing scores)
In group L: 7 cases (28.0%) scored 0, 9 cases (36.0%) scored IA, and 9 cases (36.0%) scored IC.
In group C: 18 cases (72.0%) scored 0, 4 cases (16.0%) scored IA, and 3 cases (12.0%) scored IC.
According to preoperative and postoperative white blood cells counts showed statistically significant increase in group C at day 7 postoperative.
As regard to analgesic requirement showed statistically significant increase in group L at 15min. & 60 mi