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A Comparison of Bupivacaine Instillation and Ultrasound Guided Field Block for Post-Operative Pain Relief in Inguinal Hernia Repair

Author: Iyad Abbas Salman* , Ali Moayed Jwad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 248-251
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Postoperative pain is a common problem after inguinal hernia repair. Postoperative pain may delay the return to normal activity and delay hospital discharge. Various techniques have been employed to provide postoperative analgesia, by the use of regional anesthetic technique, local anesthesia or traditional analgesic technique: opiates, non-steroidal anti-inflammatory drugs (NSAIDs) or combinations.OBJECTIVE: To compare the postoperative pain relief provided by simple bupivacaine wound instillation and ultrasound guided inguinal hernia field block.PATIENT AND METHOD: A single blind, prospective, randomized controlled clinical trial for 72 male patients who were undergoing elective unilateral inguinal hernia repair. In 37 of them 10 ml of 0.5% plain bupivacaine was instilled (irrigated) into the wound by the surgeon for 1 minute. In another 35 patients, ultrasound guided field block performed using 20 ml of 0.25% plain bupivacaine at the end of surgery. Vital signs, numerical pain score and analgesia requirement were recorded at recovery (zero hour), 1st, 2nd, 4th& 8th hours postoperatively.RESULT: By applying null hypothesis, using the t-student test of two independent samples, pain score and request for analgesia show significant difference only at the first two hours with p-value <0.05, otherwise there was no significant differences in the following hours. For vital signs there was no significant difference for both groupsCONCLUSION: Bupivacaine instillation is as effective as ultrasound guided field block for inguinal hernia repair pain. We recommend this technique in places where ultrasound machine is not available especially in many developing countries.


Article
Amyand's Hernia in a 9-Month-Old Infant: Case Report & Review of the Literature

Author: Ali Egab Joda* ,Nawzat Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 2 Pages: 218-223
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: Amyand’s hernia is defined as the presence of an appendix inside the sac of inguinal hernia whether inflamed or not, it is very rare occurring in less than 1% of patients of inguinal hernia surgery. Although it was first described three centuries ago in an 11-year-old boy by Claudius Amyand, it still continues to possess some fuzziness regarding its diagnosis & treatment because of the scarcity of its occurrence. It has variable clinical presentation according to the extent of appendix inflammation & related complications. The diagnosis of an Amyand's hernia is difficult to settled clinically. However, imaging studies are beneficial for both diagnosis and recognition of the associated complications. Here, we report a case of Amyand's hernia in a 9-month-old male infant discovered incidentally during surgery for right sided inguinal hernia in the department of pediatric surgery in the Central Child Teaching Hospital in Baghdad in which we did reduction of a normal appendix into abdominal cavity & herniotomy with high up transfixation of hernia sac.The purpose of presenting this case report is the rare occurrence of Amyand's hernia & the possibility of encountering an unusual content of hernia sac during the repair of inguinal hernia, that is why Amyand's hernia should be taken in consideration while operating on obstructed or strangulated inguinal hernia. The surgeon need to be aware of all clinical presentations with which the Amyand's hernia may present and the suitable, individualized option of surgical treatment applied. In this paper we review the literature on presentation of Amyand's hernia and discuss the diagnostic modalities with the current options of its surgical treatment.

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