Comparative study between ultrasound-guided ilioinguinal/iliohypogastric nerve blocks and caudal epidural anaesthesia in lower abdominal surgery in children

Nabil M Abd El Moati, Hany M El Zahaby, Emad El din M Abd El Aziz, Noha E. Hussien, Azza M. Lotfy
Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
Hany M El Zahaby
MD, Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.7123/01.ASJA.0000416585.13899.b4

The failure rate of the blind technique of ilioinguinal/iliohypogastric nerve blocks is about 20–30%. The use of ultrasound can greatly improve the efficacy of this block by: allowing real-time visualization of both nerves; showing the spread of local anaesthetic injected around the nerve; reducing the dose of local anaesthetics used in children; and decreasing the rate of complications. The current study aimed at comparing ultrasound-guided ilioinguinal/iliohypogastric nerve blocks with the commonly performed caudal epidural block for inguinal operations in children.

One hundred children (class I–II ASA) aged 1–8 years of both sexes, scheduled for elective inguinal hernial repair, orchidopexy, or hydrocele repair, were included. Patients were divided into two equal groups. Group A received general anaesthesia with a caudal epidural block in the form of 1 ml/kg of bupivacaine 0.25%, and group B received general anaesthesia with an ultrasound-guided ilioinguinal/iliohypogastric nerve block using bupivacaine 0.25%.

The ultrasound group (group B) showed rapid onset of action and longer duration of postoperative analgesia compared with the caudal analgesia group (group A) (P<0.05). The dose of local anaesthetics was lower in group B compared with group A (P<0.05). These doses of local anaesthetics used in group B were not correlated with either age or weight of the patients. There were no recorded complications in the ultrasound group, whereas in the caudal group intravascular puncture occurred in 4%, intrathecal puncture in 2%, and subcutaneous injections occurred in 6% of cases.

The present study showed that an ultrasound-guided ilioinguinal/iliohypogastric nerve block was as effective as a caudal epidural block in children for controlling pain intraoperatively and during the early postoperative period. The use of ultrasound showed the advantage of earlier onset of action, decreased dose of local anaesthetic without affecting the quality of analgesia and increased duration of postoperative analgesia when compared with caudal epidural analgesia.