Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery

Abualhassan A Abdellatif, Abualhassan A Abdellatif

Abstract

Context: Ultrasound (US) guidance is strongly recommended when performing peripheral nerve blocks in infants and children.

Aims: To assess whether US-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks with local anesthetic (LA) would provide comparable postoperative analgesia to blind technique caudal block with LA following pediatric unilateral groin surgery. Secondary endpoints included analgesic consumption, parental satisfaction, and postoperative complications.

Settings and design: Prospective, crossover randomized controlled trial performed on children undergoing unilateral groin surgery.

Methods: Fifty children aged 1-6 years scheduled for unilateral groin surgery were included in the study. After induction of general anesthesia and prior to surgical incision, patients were prospectively randomized into one of two groups: Group B received US-guided II/IH nerve blocks with 0.1 ml.kg(-1) of 0.25% bupivacaine and Group C received a caudal blockade with 0.7 ml.kg(-1) of 0.25% bupivacaine. Patients were assessed in the recovery room, the day-stay unit and for 24 h at home for pain score, analgesic consumption, and parental satisfaction.

Statistical analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test or Fisher exact test for non-continuous variables. P<0.05 was considered significant.

Results: The average pain scores during hospital stay were 1.82±1.71and 1.52±1.41 for group C and group B respectively (P>0.05). The average time to first rescue analgesia was longer in group B 253±102.6 min as compared to 219.6±48.4 min in group C. In recovery room, four patients in group C required pain rescue medication compared to five patients in group B (P>0.05). Similarly eight patients in the group C and six patients in group B required pain rescue medication at day-stay unit or at home (P>0.05). Group C received 0.74 pain rescue medication doses (range 0-8), while group B received 0.65 pain rescue medication doses (range 0-6) at hospital and at home (P>0.05).

Conclusions: US-guided II/IH nerve blocks is an ideal postoperative analgesic for unilateral groin surgery in children, particularly hernia repairs and is as effective as caudal block, with a lower volume of local anesthetics.

Keywords: Analgesia; caudal block; children; ilioinguinal/iliohypogastric nerve block (II/IH); local anesthetic hernia repair; ultrasound guidance.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
US image of the II/IH nerve in the plane between the internal oblique and the transversus abdominis muscle. Arrows illustrate the position of the needle adjacent to the nerves. ASIS – Anterior superior iliac spine; EO – External oblique muscle; IO – Internal oblique muscle; TA – Transversus abdominis muscle; N – Needle 1: Ilioinguinal nerve 2: Iliohypogastric nerve

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