Abstract
BackgroundIlioinguinal-iliohypogastric block (ILIHB) is a well-established procedure for postoperative analgesia after open inguinal surgery in children. This procedure is effective and safe, especially when ultrasound is used. Data availability for comparing ultrasound-guided blocks versus wound infiltration is still weak. The study was designed to determine the efficacy of ultrasound-guided ILIHB (US-ILIHB) on postoperative pain control in pediatric patients following a inguinal daycase surgery, compared with perifocal wound infiltration (PWI) by the surgeon.MethodsThis randomized, double-blinded trail was conducted in pediatric patients aged from 6 months to 4 years. The total number of children included in the study was 103. Patients were allocated at random in two groups by sealed envelopes. The ILIHB group recieved 0,2% ropivacain for US-ILIHB after anesthesia induction. The PWI group recieved 0,2% ropivacain for PWI performed by a surgeon before wound closure. Parameters recorded included the postoperative pain score, pain frequency, time to first analgesics and consumption of analgesics.Results: US-ILIHB significantly reduced the occurrence of pain within the first 24 h after surgery (7.7%, p = 0.01). Moreover, the pain-free interval until administration of the first dose of opioids was 21 min longer, on average (p = 0.003), following US-ILIHB compared to perifocal wound infiltration. 72% of children who received US-ILIHB did not require additional opioids, as compared to 56% of those who received PWI.ConclusionThus our study demonstrates that US-ILIHB ensures better postoperative analgesia in children and should be prioritized over postoperative PWI.Trail registrationUIHBOPWIIC, DRKS00020987. Registered 20 March 2020 – Retrospectivley registered.
Highlights
Ilioinguinal-iliohypogastric block (ILIHB) is a well-established procedure for postoperative analgesia after open inguinal surgery in children
Local anaesthetic procedures allow for a reduction of the opioid dose which in turn reduces the rate of systemic side effects caused by opioids [6, 7]
A multicentre study by the “Pediatric Regional Anesthesia Network” based on 15,000 cases has demonstrated that the risk of side effects from local anaesthesia in children is low with no observable long-term damage [8]
Summary
Ilioinguinal-iliohypogastric block (ILIHB) is a well-established procedure for postoperative analgesia after open inguinal surgery in children. This procedure is effective and safe, especially when ultrasound is used. The latest Cochrane Review demonstrate that ultrasound-guided regional anaesthetic procedures allow for more targeted blocks using lower doses of local anaesthetics in children, which further reduces the incidence of side effects [10]. Even though ILIHB is an established regional anaesthesia procedure, data availability for comparing ultrasound-guided blocks versus wound infiltration is still weak due to the lack of evidence [13,14,15,16,17,18]. Unequivocal data demonstrating that either method provides a high quality of analgesia, in children or in adults, is not yet available making the choice of the right anaesthetic procedure to ensure optimal analgesia difficult
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