Comparison of Two Different Pain Management Techniques in Pediatric Patients Undergoing a Hernia Repair
Condition: Pain; Inguinal Hernia
MeSH terms: Hernia; Hernia, Inguinal
Study type: Interventional

Summary: 
      The purpose of this research study is to find the best way to decrease pain in children right
      after surgery whom have had their hernia fixed. Right now, there are two different ways
      surgeons and anesthesia providers try to decrease pain. It is not clear if one way is better
      than the other. The method used is often chosen by which one the doctor has more experience
      using. The Investigator plans to find out if one of the methods is more effective and/or
      safer than the other method.

      The results of this study will help learn how to best control pain in children having surgery
      for hernia repair.
    

Detailed description: 
      Unilateral inguinal herniorrhaphy is a commonly performed surgical procedure in the pediatric
      population. Multimodal anesthesia consisting of systemic narcotics, surgical wound
      infiltration with local anesthetic and ilioinguinal and/or iliohypogastric nerve blockade has
      traditionally been employed to achieve acceptable analgesia. Recently, ultrasound-based
      studies have demonstrated that blind abdominal wall injections are done with poor accuracy.
      Ultrasound-guided alternatives, such as the transverses abdominis plane (TAP) block, may
      improve analgesic efficacy and patient comfort in the post-operative period when compared to
      blind landmark based nerve blockade. There has been increasing utilization of the TAP block
      in the adult population due to the described ability to provide effective blockade of the
      thoracolumbar spinal nerves innervating the abdominal wall. We propose a randomized
      prospective evaluation of the analgesic efficacy comparing surgeon performed
      ilioinguinal/iliohypogastric block with ultrasound-guided TAP blockade in healthy ASA I and
      II pediatric patients undergoing unilateral herniorrhaphy on an outpatient basis.
    

Intervention name(s): TAP Block; Ilioinguinal/iliohypogastric blockade
Intervention type(s): Procedure; Procedure
Intervention description(s): While the terminal branches of T7 to L1 cannot be visualized under ultrasound as they pass between the internal oblique and the transverse abdominis muscles, they are expected to lie within this plane. The three muscular layers of the abdominal wall, however, can be easily identified under ultrasound guidance. A needle is advanced under ultrasound guidance towards the fascial plane that separates the internal oblique and the transversus abdominis muscles, at which point local anesthetic is deposited under direct visualization.; Ilioinguinal and iliohypogastric blockade is performed as an injection after palpation of the anterior superior iliac spine followed be a perceived loss of resistance with insertion of the needle, or may be infiltrated locally following herniorrhaphy exposure as anatomic landmarks can prove to be difficult to locate in the anesthetized pediatric patient.
Other intervention name(s): transversus abdominis plane block
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pain; Regional Anesthesia; ultrasound; transversus abdominis plane; herniorrhaphy; pediatrics