COMPARISON OF CAUDAL BUPIVACAINE ALONE VERSUS BUPIVACAINE WOUND INFILTRATION PLUS RECTAL DICLOFENAC SUPPOSITORY FOR POSTOPERATIVE ANALGESIA AFTER PEDIATRIC INGUINAL HERNIOTOMY: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Effective postoperative analgesia is an important component of perioperative care in children undergoing inguinal herniotomy. Caudal bupivacaine is commonly used; however, local wound infiltration combined with a non-steroidal anti-inflammatory drug may provide an alternative multimodal strategy without neuraxial block. Objective: To compare the duration of postoperative analgesia between bupivacaine wound infiltration combined with rectal diclofenac suppository and caudal bupivacaine alone in children undergoing elective inguinal herniotomy. Methods: This single-center, parallel-group randomized controlled trial was conducted at the Department of Anesthesiology, Multan Institute of Kidney Diseases, Multan, Pakistan, from 20 January to 19 May 2026. Sixty male children aged 4–8 years, classified as ASA physical status I–II and undergoing elective inguinal herniotomy, were allocated equally to two groups using a draw/sealed-envelope method. Group A received rectal diclofenac 2 mg/kg (dose adjusted to 25 or 37.5 mg) plus preincisional infiltration with 0.25% bupivacaine 0.5 mL/kg. Group B received a caudal block with 0.25% bupivacaine 1 mL/kg, with a maximum dose of 2.5 mg/kg. Pain was assessed at 0, 15, 30, 45, and 60 minutes and every 30 minutes thereafter for up to 8 hours or until rescue analgesia was required. Data were analyzed using SPSS Statistics; continuous variables were compared using an independent samples t test, and stratified analyses were performed. A p value ≤0.05 was considered statistically significant. Results: The mean duration of postoperative analgesia was 149.23±9.61 minutes in Group A and 117.20±5.51 minutes in Group B. The between-group mean difference was 32.03 minutes (95% CI 27.98–36.08 minutes, calculated from the reported summary statistics), with a reported p value of 0.0001. The difference remained statistically significant in the reported stratified analyses by age, residential status, and BMI. Conclusion: In this study population, bupivacaine wound infiltration combined with rectal diclofenac was associated with a longer duration of postoperative analgesia than caudal bupivacaine after pediatric inguinal herniotomy. Larger, prospectively registered trials using standardized pain assessment, explicit allocation and blinding procedures, adverse-event reporting, and clinically relevant secondary outcomes are warranted.