Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial

Abstract

Ultrasound-guided transversus abdominis plane (TAP) block has shown promise for analgesia after pediatric inguinal surgery. This prospective, randomized study tested the hypothesis that the TAP block would provide comparable analgesia after pediatric inguinal surgery compared with a conventional ultrasound-guided ilioinguinal block. After induction of general anesthesia, infants and children presenting for elective inguinal surgery were randomly assigned to receive an ultrasound-guided TAP block (needle cephalad of the iliac crest at the anterior axillary line) (n = 20) or ilioinguinal block (needle immediately anteromedial to the anterior superior iliac spine) (n = 21). Supplemental analgesia consisted of as-required intraoperative fentanyl, regular acetaminophen, as-required ibuprofen, and rescue morphine. Patients were assessed in the recovery room, the day-stay unit (30 min to 2 h after surgery) and at 24 h for age appropriate numerical pain score, analgesic consumption, and parental satisfaction. In the day-stay unit, pain was more frequent (76% vs 45%, P = 0.040), and ibuprofen use was higher (62% vs 30%, P = 0.037) in the TAP group. Recovery room pain, morphine consumption and postdischarge ibuprofen use, comfort and satisfaction scores were similar between groups. Ultrasound image quality was poorer, and needle time under the skin was longer (median [interquartile range] 81 [66-120] vs 46 [40-51], P < 0.001) for the ilioinguinal group. Following pediatric inguinal surgery, ilioinguinal block provides more effective analgesia than the TAP block.