A combination of Tramal with Bupivacine versus Bupivacaine alone in wound infiltration and ilioinguinal blocks in herniotomy

Objective: To evaluate the analgesic efficacy and tolerability of tramadol with bupivacaine, in comparison with bupivacaine alone. Methodology: This was a double-blind randomized study on 300 Paediatric patients undergoing inguinal hernia repair under general aneasethsia with local infiltration anesthesia and ilioinguinal blockade at Queen Rania Paediatric Hospital, Jordan. Post operative pain at 1,2,3,6, 12 and 24 hours and analgesic requirements (paracetamol and Ibuprofen) were assessed. Results: Two hundred ninety patients were admitted for twenty four hours for evaluation, four patients were discharged because parents refuse admission. The median intra-operative VAS score was 10 (IR 15) in group I, receiving the combination of 2 drugs vs. 12 (IR 16) in group II, receiving bupivacaine alone, (P = 0.02). There was no difference in pain scores or analgesic requirements at 12 hour post-operatively). Distribution of intra-operative VAS scores showed a greater number (P 0.05) of patients having a VAS score 30 post-operatively in patients receiving the combination of both drugs vs. bupivacaine alone. Conclusion: The use of combination of Tramal and Bupivacaine infiltration with ilioinguinal blocks is more effective than the bupivacaine group alone and can produce rapid onset of block and also stays for longer duration. We recommend this technique for groin hernia repair to reduce post-operative pain