The following is a summary of “An Objective Evaluation of Intraoperative and postoperative pain in infants undergoing open inguinal herniotomy and Laparoscopic Inguinal Hernia Repair using the Newborn Infant Parasympathetic Evaluation (NIPE™) Monitor,” published in the July 2024 issue of Pediatrics by Sakhtivel et al.

The Newborn Infant Parasympathetic Evaluation (NIPE) monitor, which utilizes heart rate variability to assess pain objectively, has been employed to compare pain levels in infants undergoing open versus laparoscopic inguinal hernia repair. This prospective observational study aimed to evaluate pain objectively in neonates and infants under 2 years of age undergoing elective surgeries, including open inguinal herniotomy and laparoscopic inguinal hernia repair, both performed under general anesthesia with caudal block. The NIPE monitor was continuously connected to the electrocardiogram system to record pain levels during the intraoperative and early postoperative periods in the Post Anesthesia Care Unit. 

The NIPE index, which ranges from 0 to 100, with lower values indicating greater pain, was assessed at various stages of the procedure. The median NIPE index (NIPEm) was computed for the duration of the surgery and recovery. A p-value of <0.05 was considered statistically significant. The study involved 40 infants, with 27 undergoing open herniotomy and 13 undergoing laparoscopic repair. Intraoperatively, the NIPEm was significantly lower in the laparoscopic group compared to the open herniotomy group (59.00 vs. 77.00, p=0.0018). Postoperatively, the NIPEm remained significantly lower in the laparoscopic group (49.00 vs. 57.50, p=0.0001). 

This study is the first to provide objective evidence that laparoscopic inguinal hernia repair results in greater pain during and after the procedure than open herniotomy. The increased pain associated with laparoscopic repair may be attributed to painful stimuli in areas not covered by the caudal block. These findings underscore the need for tailored pain management strategies to address pain effectively in infants undergoing laparoscopic procedures.

Source: sciencedirect.com/science/article/pii/S002234682400472X