Inguinal hernias become incarcerated in 10% to -15% of children and reduction of the hernia is an urgent painful procedure. No recommendations exist for analgesia during this procedure. We surveyed pediatric emergency physicians (PEP) and pediatric surgeons (PS) for their analgesia and sedation use during the reduction. The survey was mailed to 19 centers in North America. A total of 56% (185/331) surveys were completed by PEP and 56% (68/122) from PS. A total of 96.7% (245/253) of responders reported giving analgesia or sedation during reduction. PS were more likely to use intravenous drugs, try for a longer time, wait longer between trials, and conduct more trials compared to the PEP. Clinically related variables were more important for PEPs than PS for analgesia and sedation. System-related variables were more important by PS for admission.
Perspective: This survey shows significant variability between specialties in the drugs, route, and number of attempts during reduction of a painful incarcerated hernia in children. Development of a sedation and analgesia protocol may be useful in order to unify management of pain and discomfort during hernia reduction.