A comparative study of two different ultrasound-guided blocks in pediatric inguinal hernia repair using levobupivacaine

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Abstract

Background

Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population worldwide and is a cause of significant pain in the postoperative period. Recently, a transversus abdominis plane (TAP) block has been reported to provide effective analgesia after inguinal hernia repair, but there are few data comparing ultrasound-guided TAP with an ilioinguinal/iliohypogastric nerve (IHN) block, which is the objective of this study.

Patients and methods

Forty-two male patients ranging in age from 6 to 14 years scheduled for elective primary unilateral open inguinal hernia participated in this prospective randomized study. Surgery was performed under combined general anesthesia and ultrasound-guided TAP block (n=22) or IHN block (n=20). After 15 min of general anesthesia blocks were performed using an insulated 22-G needle and 0.2–0.3 mg/kg levobupivacaine as a local anesthetic. Postoperative analgesia comprised intravenous or patient-controlled analgesia morphine. Sonographic data such as the image acquisition time, the needle time under the skin, and image quality were recorded. Time to first analgesic request, faces pain rating score, total analgesic consumption, and adverse effects associated with morphine consumption were recorded for 24 h postoperatively.

Results

In the IHN group, the ultrasound quality was rated as less than excellent in 75% of patients, and needle time under the skin was 77 (20–36) s in the IHN group versus 47 (50–62) s in the TAP group (P<0.001). The median (interquartile range) time to first analgesics request for morphine was 53 (29–229) min in the IHN group versus 19 (5–128) min in the TAP group.

Results

In the IHN block group, there were reduced mean±SD of total morphine requirements in the first 48 postoperative hours (9.8±4.9 vs. 15.61±5.23 mg, P<0.01) compared with the TAP group. Also, postoperative faces pain rating score at rest and movement was reduced in the IHN block compared with the TAP block. Interval morphine consumption was reduced in 6, 12, and 24 h postoperatively in the IHN group. There were no differences between the groups in the incidence of sedation or nausea and vomiting. There were no complications attributable to the block or side effects with analgesics.

Conclusion

After pediatric inguinal repair, TAP block offers good visualization of nerves and the surrounding structure but IHN block offers good analgesia.

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