A comparative study of diclofenac and wound infiltration to additional landmark technique of ilio-hypogastric nerve block for pain relief in children undergoing groin surgery- the University Teaching Hospital (UTH), Lusaka, Zambia

Background: Surgery in the groin region is commonly performed in paediatric patients at the University Teaching Hospital (UTH). Intramuscular (IM) Diclofenac and wound infiltration, with lignocaine, are the commonest analgesics administered intra-operatively.
The aim of this study was to determine whether an additional ilio-inguinal/ilio-hypogastric nerve block, done using the landmark technique, to IM diclofenac and wound infiltration with 1% lidocaine (with adrenaline 1:200,000), would improve post-operative analgesia in children undergoing groin surgery at the UTH.
Methods: This was a non-randomized intervention study of children (n=36) undergoing unilateral inguinal herniotomy, hydrocelectomy and orchidopexy operations at the UTH. The children were allocated to two groups: control group received IM diclofenac and wound infiltration, while intervention group received medication as in control group plus an ilio-inguinal/ilio-hypogastric nerve block performed by landmark technique. Intra-operative clinical observations and post-operative pain scores were analysed in the two groups of participants.
Results: 50% of the participants were under 60 months. Post-operatively, the pain scores measured at times 0 and 1 hour post operation were statistically non-significant in both groups (p values 0.181 and 0.355 respectively). Oral Paracetamol (15-20 mg/kg) was the only post-operative analgesic required by the patients in the study. At two minutes after skin incision the mean heart rate in the control group was 114/minute (p-value 0.023) while in the intervention group it was 108/minute (p-value 0.035). The mean respiratory rate at two minutes after skin incision in the control group was 31/minute (p-value 0.012) while in the intervention group it was 36/minute (p-value 0.019). When the baseline heart rate and respiratory rate were compared with the readings measured at the end of the operation, no statistically significant difference was noted in both groups (p-values 0.291 and 0.621; 0.792 and 0.32) respectively.
Conclusion: This study showed that that the addition of ilio-inguinal/ilio-hypogastric nerve block, done with the landmark technique, does not offer superior pain relief during the post-operative period in children undergoing unilateral groin surgery at UTH.