58 Sedation and Analgesia for Incarcerated Inguinal Hernia in the Paediatric Emergency Department

Ten percent of children with inguinal hernia will experience incarceration and a reduction procedure will be required. The procedure involves pain and discomfort in most cases. No recommendations on the level of sedation or analgesia for children exist.

We conducted a formal mail survey among paediatric emergency physicians (131) and paediatric surgeons (45) in eight centers across Canada. The survey consisted of multiple choice questions to determine the use of sedation or analgesia for incarcerated hernia reduction and the length of the trials. Up to 3 surveys were sent. Data was entered into Microsoft Excel software and descriptive statistics were done with the SPSS program.

A total of 118 (67%) of the physicians responded. Eighty four (71%) stated that they would perform the first reduction trial with no sedation or analgesia. If another trial was needed, 74 (62%) would have given sedation or analgesia, mostly through the intravenous route. Fentanyl and Midazolam were the most frequently prescribed medications. The first attempt at reduction would last 5±5 minutes (range 1–30); waiting between trials was suggested to be on average 14±10 minutes long (range 1–45) and the number of attempts the responders would carry out was on average 2±1 trials (range 0–3).

Paediatric emergency physicians and paediatric surgeons do not use a unified protocol for reduction of incarcerated hernia in the paediatric emergency department and significant practice variation exists. Effort should be made to create and disseminate a protocol for sedation and/or analgesia during this urgent procedure.