Caudal, ultrasound-guided inguinal field block, ultrasound-guided transversus abdominis plane block as an adjuvant to general anesthesia in unilateral inguinal hernia repair in pediatrics: a comparative study

Abstract

Background Caudal analgesia is the most common method used in the subumbilical region in pediatrics. The inguinal field block and the ultrasound-guided transversus abdominis plane block are other modalities to control postoperative pain in inguinal hernial repair in pediatrics. The aim of this study is to compare the combination of general anesthesia and these techniques on postoperative pain score, first time to rescue analgesia, intraoperative hemodynamics, and postoperative sedation. Methods In all, 120 pediatric patients (3–10 years old) scheduled for inguinal hernia repair under general anesthesia were allocated into three groups: Group I [caudal block (CB)]: in this group, the patients received 0.5 ml/kg of bupivacaine 0.25% caudally. Group II [inguinal field block (IFB)]: received 0.5 ml/kg of bupivacaine 0.25% under ultrasound guidance. Group III [transversus abdominis plane block (TAP)]: received 0.5 ml/kg of bupivacaine 0.25% under ultrasound guidance. The measurement: intraoperative (heart rate and mean arterial blood pressure), modified objective pain score, first time to rescue analgesia, Ramsay sedation score, and postoperative adverse effects. Results The time to first rescue analgesia and the modified objective pain was less with more sedation in IFB and TAP groups compared with the CB group from after 6 till 18 h. Also, the IFB is superior to TAP in pain control at 24 h and in prolongation of the time of analgesia. Conclusion The three techniques are safe and provide good intraoperative hemodynamic stability. Both IFB and TAP provide less pain score and prolonged postoperative analgesia and also more sedation than CB after 6 till 18 h.