Effects of levobupivacaine infiltration on postoperative analgesia and stress response in children following inguinal hernia repair

Background and objective The present study compared the postoperative analgesic effects of preincisional and postincisional wound infiltration with levobupivacaine and postoperative cortisol and prolactin levels in children following inguinal hernia repair. Methods Ninety-six children aged 2-10 years who were undergoing elective inguinal hernia repair were randomly enrolled in this study. In group A (n = 32), 0.25 ml kg(-1) levobupivacaine (5 mg ml(-1)) was infiltrated after induction of general anaesthesia. In group B (n = 32), 0.25 ml kg(-1) levobupivacaine (5 mg ml(-1)) was infiltrated before the end of the surgery. Group C (n = 32) did not receive levobupivacaine infiltration at any time. Mean arterial pressure, heart rate, objective pain score, adverse effects and the number of rescue analgesics were recorded for 24 h. Blood samples were withdrawn following induction of anaesthesia and at 40 min after the end of surgery for measurement of blood cortisol and prolactin levels. Results The rescue analgesic administration, objective pain scores, heart rate, postoperative plasma cortisol and prolactin levels were higher in group C than in either group A or group B (P < 0.05). There were no differences in these parameters between the two treatment groups (P > 0.05). Postoperative plasma cortisol and prolactin levels were significantly higher in all three groups than preoperative plasma cortisol and prolactin levels (P < 0.001). Conclusions Wound infiltration with levobupivacaine after induction of general anaesthesia and before the end of the surgery both provide postoperative pain relief following hernia repair, and decrease the stress response to postoperative pain. Eur J Anaesthesiol 26:430-434 (c) 2009 European Society of Anaesthesiology.