Caudal Block For Open Repair Of Pediatric Inguinal Hernias

Objective Many studies have assessed the postoperative analgesic effects of preoperative caudal block in children undergoing open repair of indirect inguinal hernias, but all of them did not report the outcome domains of physical recovery or economic factors. Our study assessed the two outcome domains by performing a historical cohort study, aiming to provide additional evidence for the using of caudal block in children.Methods We conducted a historical cohort study. According to the diagnostic criteria, inclusion criteria and exclusion criteria, we screened the cases undergoing open repair of indirect inguinal hernias in the First Hospital of Lanzhou University from June.2011to June.2013, and divided them into two groups by the anesthesia techniques they used:intravenous anesthesia alone or combined intravenous-caudal anesthesia. Between the two groups, we compared respectively about postoperative hospital stay, postoperative complications, hospitalization costs, intraoperative and postoperative drug use, as well as duration of operation and anesthesia. SPSS19.0software was used to analyze data.Results A total of113children were included, of whom53children underwent intravenous anesthesia, and60underwent intravenous-caudal anesthesia. The two groups presented no significant differences in terms of patient characteristics, including age, weight and type of indirect inguinal hernia. There were no significant statistically differences between the two groups in postoperative hospital stay, operation duration, anesthesia duration as well as the incidents of scrotum edema, infection, bleeding and recurrent hernia. As for the hospitalization costs, there were no significant statistically differences between the two groups in ward bed fees, surgical fees and total costs. Intravenous-caudal anesthesia increased the anesthesia fees, but decreased the costs of drugs, care, inspection and treatment. There were no significant statistically differences between the two groups in the use of intraoperative ketamine, as well as postoperative hemostatic, antibiotics, antiviral drugs, analgesics, and antiemetic drugs, but intravenous-caudal anesthesia reduced the use of intraoperative fentanyl and propofol.Conclusions Compared with intravenous anesthesia, intravenous-caudal anesthesia reduced the use of intraoperative narcotics in children undergoing open repair of indirect inguinal hernias, but had no effects on the physical recovery. As for the hospitalization costs, intravenous-caudal anesthesia increased the costs of anesthesia, but did no increase the total costs. As the study used a historical cohort approach, and may lead to biased conclusions, prospective studies are still needed to explore these issues clearly.