Efficacy of Local Infiltration of Tramadol and Bupivacaine for Postoperative Analgesia in Children Following Herniotomy.

Background: Inguinal herniotomy is a common surgical procedure in children. Wound infiltration of local anesthetics during the procedure is a standard technique for post-operative analgesia. Recently, tramadol is shown to be effective analgesic if used locally also. This study was conducted to compare the post-operative pain after local infiltration of bupivacaine and tramadol. Methods: This study was a double blinded randomized controlled trial conducted at pediatric surgery unit of Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal. A total of 76 children were operated for inguinal hernia during the study period and sixteen children were excluded. Remaining 60 children were randomized into 2 groups: tramadol (T group) and bupivacaine (B group). T group received tramadol and B group received bupivacaine as local wound infiltration at the time of herniotomy. Post - operative pain was evaluated by ‘Modified pain score for children’. Pain score and other variables were compared between the groups. Results: A total of 60 children were randomized into T and B group. Demographic data was comparable. Pain free interval in T group was 7.43 ± 4.41 hours and B group was 6.70 ± 2.46 hours. It was statistical not significant (P=0.42). Pain score at 1, 4, 8, 12 and 24 hours was also similar in the two groups. Conclusion: Local infiltration of Tramadol is as effective as Bupivacaine for postoperative analgesia in children undergoing herniotomy. Tramadol can be used as local infiltration for effective post - operative analgesia

Managerial experiences on Pediatric surgical tumors in Tribhuvan University Teaching Hospital

Introduction: Pediatric tumors are least prioritized but serious problems. Multidisciplinary management improves survival. Incidences, types and follow up results on Nepalese pediatric tumors have not yet been studied. To highlight our center’s experiences on pediatric tumors management and follow up is aimed. Methods: All pediatric surgical tumors admitted in pediatric surgery unit from 2065-2070 BS werer studied. Patients evaluated with or without chemo / radiotherapy pre or post surgery. Total of 22 cases from age four months to 13 years were studied. Results: Tumor detection shown highest in age group below 3 years, followed by 5-10 years. Mean age was 54 months. Most common problem (22.7 %) was Saccrococcygeal teratoma (histologically matured). 13% Nephroblastoma, 9% ovarian tumor, 9% Neuroblastoma and various others each were 4.45 %. Majority underwent surgical excision of tumors. Three cases pre surgery and 5 post-surgery, received chemotherapy. Rest had only excision of tumor mass.Follow up were from three weeks to five years period. During this period, two patients expired (one due to complication of second cycle of chemotherapy and second one died with severe aspiration after second laparotomy for intestinal obstruction one year after initial Nephroblastoma excision.) One patient lost for follow up after excision of stage V Nephroblastoma and first cycle of chemotherapy. Conclusions: Management of pediatric tumors is complicated. Thus it needs better multidisciplinary centre of excellence for satisfactory results. Management is directed according to incidence, types, standard management protocol, which is not studied yet in Nepal. Research on pediatric tumors is virgin area. Large scale studies need to conduct in detail and a center of excellence is essential to provide better services.  Keywords: follow ups; management; Nepalese population; pediatric tumors; types.