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Effect of Bupivacaine With Epinephrine Wound Instillation for Pain Relief After Pediatric Inguinal Herniorrhaphy and Hydrocelectomy
  1. Suwannee Suraseranivongse, M.D.,
  2. Sumitra Chowvanayotin, M.D.,
  3. Sangsom Pirayavaraporn, M.D.,
  4. Suneerat Kongsayreepong, M.D.,
  5. Panidaporn Gunnaleka, B.Sc.,
  6. Kanitha Kraiprasit, B.Sc.,
  7. Suppat Petcharatana, B.Sc. and
  8. Thunyanit Montapaneewat, B.Sc.
  1. From the Departments of Anaesthesiology (S.S., S.C., S.P., S.K., K.K., S.P., T.M.) and Nursing (P.G.), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
  1. Reprint requests: Suwannee Suraseranivongse, M.D., Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. E-mail: sisur{at}


Background and Objectives To evaluate the effect of a 20- or 60-second instillation period using 0.5% bupivacaine with epinephrine for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy.

Methods In a randomized, double-blind study, 103 children (aged 1 to 12 years, American Society of Anesthesiologists [ASA] physical status I or II) were allocated into 4 groups after induction of anesthesia. Group 1: normal saline 0.25 mL/kg instilled, which remained in the wound for 20 or 60 seconds before wound closure. Group 2: 0.25 mL/kg 0.5% bupivacaine with epinephrine 5 μg/mL instilled, which remained in the wound for 20 seconds. Group 3: the same quantity and dose of drug 2 instilled as group, but remained in the wound for 60 seconds. Group 4: an ilioinguinal and iliohypogastric block performed before operation using 0.5 mL/kg 0.25% bupivacaine with epinephrine. The Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) and Aldrete-Kroulik recovery scores were used to monitor postoperative pain and recovery status. Analgesic was given when the CHEOPS score was ≥ 7 despite other supportive therapy.

Results The number of patients requiring analgesics within 2 hours in group 1 (73.1%) was more than groups 2, 3, and 4 (23.1%, 20.8%, and 16%, respectively, P < .001). The median time to first analgesic in group 1 (50 minutes) was also less than groups 2, 3, and 4 (420, 525, and 425 minutes, respectively, P < .0001).

Conclusion 0.5% Bupivacaine with epinephrine for as short an instillation period as 20 or 60 seconds can provide a good analgesic alternative after herniorrhaphy and hydrocelectomy in pediatric patients. All studied blocks had comparable duration of action. Reg Anesth Pain Med 2003;28:24-28.

  • Bupivacaine
  • Epinephrine
  • Instillation
  • Herniorrhaphy
  • Hydrocelectomy

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  • Supported by Siriraj Research Development Fund and Thailand Research Fund.