Inguinal Herniorraphy Research Articles

Single-incision laparoscopic inguinal herniorraphy with telescopic extraperitoneal dissection: technical aspects and potential benefits.

Our recent prospective randomized controlled trial (NCT01660048) comparing single-incision laparoscopic (SIL) totally extraperitoneal (TEP) and multi-incision inguinal herniorraphy confirmed safety, efficacy and benefits of single-incision approach. This study (NCT01883115) aimed to assess safety, efficacy and cost effectiveness of telescopic extraperitoneal dissection. Patients with inguinal/femoral hernias from February 2013 to February 2014 undergoing SILTEP herniorraphy with telescopic dissection were compared with patients who had previously undergone SILTEP herniorraphy with balloon dissection. Costs of different ports/trocars were analysed. There were 102 patients in telescopic compared to 51 in balloon dissection group; these had no significant differences in age, sex, body mass index, American Society of Anesthesiologists and pre-op visual analogue scores. Telescopic vs. balloon showed: post-operative pain-day one 2.5 vs. 2.5; p = 0.90, day seven 0 vs. 0; p = 0.02 (0 vs. 1; p < 0.01 for bilateral hernias); operation times-unilateral 48.0 vs. 48.0 min; p = 0.88 and bilateral 70.0 vs. 65.0 min; p = 0.66, length of hospital stay 1.0 vs. 1.0 day, analgesic intake (dextropropoxyphene) 6.0 vs. 6.0 tablets; p = 0.95, return to work/normal physical activities 7.0 vs. 7.0 days; p = 0.46 and cosmetic scar scores 24.0 vs. 24.0, respectively. There was no conversion to open surgery/need for additional ports in either group. Median scar length for telescopic group was 13.0 mm. Costs of disposable ports/trocars for telescopic and balloon groups were US$480 and $720, respectively. There were no morbidities/recurrences with follow-up of 2-36 months. Telescopic extraperitoneal dissection during SILTEP inguinal herniorraphy represents a safe and efficient alternative with potential cost savings compared to balloon dissection.

Comparison of postoperative analgesia of ultrasound-guided ilioinguinal/iliohypogastric nerve block versus ultrasound-guided TAP block for pediatric inguinal hernia repair

Background Providing efficient postoperative analgesia for pediatric herinorrraphy is essential for surgical success. Different ultrasound (US)-guided techniques have been developed for pediatric nerve blocks. Aim This study aimed to compare US-guided ilioinguinal/iliohypogastric (II/IH) nerve block and US-guided transversus abdominis plane (TAP) block for pediatric unilateral inguinal herniorraphy with respect to postoperative analgesic efficacy by considering the time to first rescue analgesic as the primary outcome. Secondary outcomes included average pain scores, assessment of analgesic drug requirement, and incidence of postoperative vomiting. Patient and methods Fifty children scheduled to undergo unilateral herniorraphy were included in the study. After induction of general anesthesia patients were randomly allocated to one of two groups: group A or group B. Group A received US-guided II/IH nerve block with 0.2 ml/kg of 0.25% levobupivacaine and group B received US-guided TAP block with 0.2 ml/kg of 0.25% levobupivacaine. Fentanyl was given intravenously in case of failed block; failure was seen in one child (4%) in group A and in two children (8%) in group B and their postoperative data were not included in the statistical analysis. Time to first rescue analgesic, pain scores (FLACC score), the number of children who required postoperative analgesics, and incidence of vomiting were recorded. Results Time to first rescue analgesic was longer and the duration of analgesia was more stable in group A (273 ± 41.7 min) as compared with group B (209.6 ± 98.4 min) (P Conclusion US-guided II/IH nerve block provides longer and more efficient postoperative analgesia compared with TAP block for pediatric inguinal herniorraphy.

English

BACKGROUND: Inguinal herniorraphy is commonly performed on an outpatient basis under nerve blocks, local, spinal or general anesthesia (GA). We have selected inguinal herniorraphy under general anesthesia and spinal anesthesia (SA). OBJECTIVE: To compare the recovery time, postoperative pain and patient satisfaction in the Post Anesthetic Care Unit (PACU). METHODS: A prospective, single blinded, controlled study involved total 60 patients belonging to American Society of Anesthesiologists (ASA) I/II scheduled for elective repair of unilateral inguinal hernia. Randomization was done using computer generated random numbers. GA group received intravenous (IV) propofol (2mg/kg), butorphanol (40µg/kg) and skeletal muscle relaxation was achieved with vecuronium bromide (0.1 mg/kg). Patient was maintained with nitrous oxide and oxygen (66:33) and sevoflurane. SA group received 2ml of 0.5% of hyperbaric bupivacaine intrathecal in lateral decubitus position with 0.04mg/kg midazolam injection IV for sedation. Modified Aldrete scoring system, Visual Analogue Scale (VAS) and modified Bromage score were employed to assess recovery time. When pain score was more than 5, rescue analgesia was given with IV injection ketorolac 30mg. All data were analyzed statistically. RESULTS: Patients in GA group (136.23 ±17.82 minutes) showed a statistically significant (p< 0.05) recovery time to get shifted from PACU compared with patients in the SA group (176.00 ± 11.92 minutes). But patients in the SA group had significantly less VAS score pain (1.30±1.76 vs. 3.23±2.88), less number of patient received rescue analgesia (16.7% vs. 50%) and satisfaction was higher than GA group. CONCLUSIONS: We conclude that GA group resulted in faster recovery time from PACU but SA group had less post- operative pain and better satisfied.

Neonatal laparoscopic inguinal hernia repair: a 3-year experience.

To retrospectively analyze the feasibility, safety and complication rate of laparoscopic inguinal herniorraphy in babies weighing 5kg or less. Thirty infants weighing 5kg or less underwent laparoscopic inguinal hernia repair during a 3-year period. Twenty-eight infants were born preterm and the mean body weight at surgery was 3,800kg. Internal inguinal ring was closed with a non-absorbable purse-string suture. Contralateral processus vaginalis was closed if patent. Feeding was started on the same day and the patient discharged the following day. Follow-up consisted of physical examination at 1week, 6 and 12months post-operatively. Of the 30 patients (27 males, 3 females), 11 had bilateral and 19 monolateral hernia (16 right, 3 left). At laparoscopy, 23 infants needed to have bilateral herniorraphies. The mean corrected gestational age at surgery was 49.1weeks. The mean operative time for repair was 30min for unilateral and 41min for bilateral hernia. There were not intra- or post-operative complications as well as conversions or recurrences. Laparoscopic inguinal hernia repair in newborns and in ex-preterm infants is a safe and effective procedure to perform and, perhaps, even less technically demanding than open herniotomy.

Low-Dose Low-Concentration Spinal Anesthesia for Inguinal Herniorraphy in a Patient with Claustrophobia

Low-Dose Low-Concentration Spinal Anesthesia for Inguinal Herniorraphy in a Patient with Claustrophobia

Impact of a bladder scan protocol on discharge efficiency within a care pathway for ambulatory inguinal herniorraphy

Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38%, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR. As part of a perioperative care pathway, a protocol was implemented to standardize decision making after elective inguinal hernia repair (February 2012). Patients were assessed with a bladder scan, and those with <600 mL of urine were discharged home, whereas those with more than 600 mL of urine had an in-and-out catheterization before discharge. The patients received written information about urinary symptoms and instructions to present to the emergency department if they were unable to void at home. An audit of scheduled outpatient inguinal hernia repairs between October 2011 and July 2012 was performed. Comparisons were made using the t test, Fisher's exact test, and Wilcoxon rank sum test where appropriate. Statistical significance was defined a priori as a p value lower than 0.05. During the study period, 124 patients underwent hernia repair: 60 before and 64 after implementation of the protocol. The findings showed no significant differences in patient characteristics, laparoscopic approach (35 vs. 33%; p = 0.80), proportion receiving general anesthesia (70 vs. 73%; p = 0.67), or amount of intravenous fluids given (793 vs. 663 mL; p = 0.07). The proportion of patients voiding before discharge was higher after protocol implementation (73 vs. 89%; p = 0.02). The protocol had no impact on median time to discharge (190 vs. 205 min; p = 0.60). Only one patient in each group presented to the emergency department with POUR (2%). After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.

Bispectral index monitoring of propofol sedation during ultrasound guided nerve block for inguinal herniorraphy: A randomized prospective study.

Background:Patient's awareness can be reduced during ultrasound guided nerve block for inguinal herniorraphy with propofol sedation. The study was aimed to evaluate the clinical efficacy of direct visualization of anatomy of inguinal region by ultrasound and benefits of bispectral index (BIS) monitoring.Materials and Methods:After approval, 40 adult male consented patients of ASA grade I-III of 18-58 years with body mass index <25 were randomized into two groups of 20 patients each. A high frequency (8-13 MHz) linear transducer was used to perform the ilioinguinal and iliohypogastric nerves (ILHN and ILIN) block between the internal oblique and transversus abdominis muscles with 20 mL of 0.75% ropivacaine. The propofol infusion rate for sedation in patients of group I (non-BIS) was managed clinically and in patients of group II (BIS) was managed with BIS index of 65-75. Any surgical or anesthetic complications were recorded. The two groups were compared by evaluating the propofol consumption during surgery.Results:Ultrasonographic visualization of the ILHN and ILIN was possible in all patients and inguinal herniorraphy was performed uneventfully. The mean dose of propofol required for sedation was 5.45 mg/kg/h in patients of group I (non-BIS) while 4.92 mg/kg/h in patients of group II (BIS). The mean propofol consumption was not statistically significant (P = 0.12). All patients were hemodynamically stable and there was no respiratory depression during propofol sedation.Conclusion:Ultrasonography has facilitated the clinically effective nerve block for inguinal herniorraphy and BIS monitoring has ensured amnesia and faster emergence.

An Unusual Presentation of Crossed Testicular Ectopia as an Incarcerated Inguinal Hernia

Crossed testicular ectopia (CTE) is generally defined as both testes located in the same hemiscrotum and contralateral hydrocele with the absence of a testis. However, the initial presentation of CTE in an infant as an incarcerated inguinal hernia is extremely rare. We report on a 10-month-old infant with CTE, who visited the emergency room presenting with a left incarcerated inguinal hernia. After manual reduction for an incarcerated hernia and left inguinal herniorraphy, the left testis was fixed into the left hemiscrotum and right transseptal orchiopexy was performed.

New Approach of Ultrasound-Guided Genitofemoral Nerve Block in Addition to Ilioinguinal/Iliohypogastric Nerve Block for Surgical Anesthesia in Two High Risk Patients: Case Report

We report two high risk patients undergoing inguinal herniorraphy and testicular biopsy under ultrasound-guided ilioinguinal/iliohypogastric and genitofemoral nerve blocks. The addition of the genitofemoral nerve block may enhance the ilioinguinal/iliohypogastric block to achieve complete anesthesia and thus avoid general and neuraxial anesthesia related hypotension that may be detrimental in patients with low cardiac reserve.

A Users' Guide to Interpreting Observational Studies of Pediatric Anesthetic Neurotoxicity

At a meeting of the Royal Society of Medicine in 1965, Sir Bradford Hill proposed to answer the question he himself posed to the assembled audience: “How do we determine what are physical, chemical and psychologic hazards of occupation and in particular those that are rare and not easily recognized?”1 Although the question Hill proposed was directed at problems of occupational medicine, the article subsequently published from this lecture has become the sentinel guide for the assessment of causation in epidemiologic research. Since the publication of the paper, more than a decade ago, in Science by Ikonomidou,2 there has been a steady stream of work convincingly demonstrating that anesthetic agents and other drugs that act as N-methyl-D-aspartate agonists and γ-aminobutyric acid antagonists can produce widespread apoptotic neurodegeneration, with associated cognitive and behavioral decrements in a variety of animal species, including nonhuman primates. Predictably, these studies have prompted a great deal of concern. They have also generated a series of observational studies seeking evidence for similar effects in children, with varying results.3– 8 The study by Block et al. in this month’s issue of Anesthesiology9 is yet another examination of the association between exposure to anesthesia in young children and outcome, in this case performance on a test of academic achievement. The central concern of those who provide anesthesia to children is that of causation: Does anesthetic exposure at a young age cause neurodevelopmental problems? In the hierarchy of study designs, the randomized control trial reigns as the gold standard. Unfortunately, such studies are expensive, time-consuming, and, in this area, may be ethically impossible. An ongoing randomized clinical trial comparing regional and general anesthesia for infants receiving inguinal herniorraphy will be valuable, but in the meantime, the anesthesia community is left to make judgments regarding the potential applicability of animal findings to children based on a growing number of retrospective observational studies. These studies provide insight, but how should they be interpreted? For example, in studies that find an association between anesthesia and subsequent neurodevelopmental problems, is anesthesia merely a marker for another causative factor (e.g., the stress of a surgical procedure, or the underlying condition which makes surgery necessary)? We here present a “users’ guide” of several questions that should be considered when interpreting observational studies of the association between anesthetic exposure and neurodevelopmental or other outcomes. This discussion is by no means exhaustive, but is meant to alert consumers of literature in this area regarding some of the potential strengths and weaknesses of available and to-be-published studies. This guide should not be seen as criticism of Block et al. or others authors who have contributed to this body of work. Indeed, as nicely typified by Block et al., most authors spend a great deal of time injecting caution into the discourse and highlighting study limitations.

A case of appendicocele

A 58-year-old woman with an unconfirmed diagnosis of uterine fibroids, and a past medical history of uterine polyps, two cesarean sections and a right inguinal herniorraphy presented to the emergency department with 1 month of sharp right lower quadrant pain that had become debilitating 24 h prior to presentation. She also complained of vaginal discharge and bleeding while denying nausea, vomiting and fever. Physical examination revealed a mass in the right inguinal area that was exquisitely tender to palpation and irreducible at the bedside. Her symptoms were exacerbated with a valsalva maneuver. Bowel sounds were present in all four quadrants. Laboratory findings were all within normal limits. She remained afebrile. The patient had an abdominal/ pelvic MRI earlier that day at an outlying facility ordered by her gynecologist. Unfortunately, the results were not available at the time the patient presented. On further consultation, recommendations were made for outpatient follow up. Given the patient’s presentation, undifferentiated gynecologic pathology and history of multiple abdominal surgeries, further evaluation was warranted to solidify the diagnosis, and to confirm the need for surgical intervention for the most likely diagnosis of an incarcerated inguinal hernia. Computed tomography (CT) of the abdomen revealed a fibroid uterus, focal lesions in the urinary bladder and right indirect inguinal hernia containing the appendix with mild stranding and thickening of the hernia sac wall concerning for acute appendicitis (Figs. 1, 2 and 3). The appendix measured 7.0 cm in length and 0.7 cm in diameter on pathologic evaluation.

Male form of persistent Mullerian duct syndrome type I (hernia uteri inguinalis) presenting as an obstructed inguinal hernia: a case report

IntroductionPersistent Mullerian duct syndrome is a rare form of male pseudo-hermaphroditism characterized by the presence of Mullerian duct structures in an otherwise phenotypically, as well as genotypically, normal man; only a few cases have been reported in the worldwide literature. We report the case of a 30-year-old man with unilateral cryptorchidism on the right side and a left-sided obstructed inguinal hernia containing a uterus and fallopian tube (that is, hernia uteri inguinalis; type I male form of persistent Mullerian duct syndrome) coincidentally detected during an operation for an obstructed left inguinal hernia.Case presentationA 30-year-old South Indian man was admitted to our facility with a left-sided obstructed inguinal hernia of one day's duration. He had a 12-year history of inguinal swelling and an absence of the right testis since birth. Our patient had well developed masculine features. Local physical examination revealed a left-sided obstructed inguinal hernia with an absence of the right testis in the scrotum. Exploration of the inguinal canal revealed an indirect inguinal hernia containing omentum, the left corner of the uterus and a left fallopian tube. Extension of the incision revealed a well formed uterus, cervix and upper part of the vagina attached to the prostate by a thick fibrosed band. Total excision of the uterus, bilateral fallopian tubes and right testis was performed. A biopsy was taken from the left testis. The operation was completed by left inguinal herniorraphy. Histopathological examination of the hernial contents was consistent with that of a uterus and fallopian tubes without ovaries. Both testes were atrophied, with complete arrest of spermatogenesis. Post-operative karyotype analyses were negative for 46,XY and Barr bodies on buccal smear. A semen examination revealed azoospermia with a low serum testosterone level.ConclusionsIn cases of unilateral or bilateral cryptorchidism associated with inguinal hernia, as in our patient's case, the possibility of persistent Mullerian duct syndrome should be kept in mind in order to prevent further complications such as infertility and malignant change. Hernia uteri inguinalis is the type I male form of persistent Mullerian duct syndrome, characterized by one descended testis and herniation of the ipsilateral corner of the uterus and fallopian tube into the inguinal canal.

Determinants of a short convalescence after laparoscopic transabdominal preperitoneal inguinal hernia repair

Evidence-based recommendations for the expected duration of convalescence after laparoscopic groin hernia repair are not available, and objective reasons for prolonged convalescence are not clear. Our main aim was to establish the expected duration of convalescence using preoperative recommendations to the patient and to identify the limiting factors for early (postoperative) resumption of normal activities after laparoscopic transabdominal preperitoneal inguinal herniorraphy (TAPP). This was a single-center prospective study. The intervention (the recommendation to the patient) was 1 day for convalescence. Several predefined factors were investigated for their influence on the duration of convalescence and the risk of early postoperative pain. Predefined, clinically justified reasons for not resuming normal activities within the first 3 postoperative days were also registered. Between August 2009 and August 2010, 185 consecutive male patients with groin hernia were enrolled prospectively, and 162 patients were available for analysis. Convalescences from work and leisure activities were a median of 5 days (range, 1-40) and 3 days (range, 1-49), respectively (P = .34). Preoperative expectations of convalescence from work (the number of days) was the only factor to explain prolonged convalescence from work (P < .001). Postoperative, self-registered planned sick leave, and complaints of pain and fatigue were the dominant reasons for not resuming normal activities within the first 3 days after operation. Younger age was the only factor found to explain the intensity of postoperative pain (P < .001). Postoperative convalescence (return to work or normal activities) was between 3 and 5 days after TAPP in patients who were counseled about a 1-day expected convalescence. The expectation of convalescence from work was an important reason for delayed convalescence beyond 1 day.

Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial

BackgroundProlonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.MethodsSeventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.ResultsThere were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).ConclusionsShortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.Trial registrationClinicalTrail.gov NCT01354249

Evaluation of Prophylactic Antibiotic Prescription in Post-Operative Infection in Patients Undergone Inguinal Herniorraphy Surgery with Prolene Mesh: A Randomized Double Blind Study

Evaluation of Prophylactic Antibiotic Prescription in Post-Operative Infection in Patients Undergone Inguinal Herniorraphy Surgery with Prolene Mesh: A Randomized Double Blind Study

Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases

We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified.

Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP) approach using Polypropylene Mesh (Mesh) and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

Clinical and radiographic findings of a sliding inguinoscrotal hernia containing the urinary bladder

Large sliding inguinal hernias involving the urinary bladder are rare. We present the relevant clinical data, radiographic images, and the intraoperative findings of a sliding inguinoscrotal herniation of the urinary bladder. A 67-year-old male presented with a scrotal mass and the need to manually compress his scrotum in order to void. Diagnosed with a large sliding inguinal hernia with significant bladder involvement (scrotal cystocele), the patient underwent an inguinal herniorraphy and replacement of the bladder in the retroperitoneal space. Surgery proved to be successful in the management of the inguinal hernia and voiding dysfunction.

How do pediatric anesthesiologists define intraoperative hypotension?

Although blood pressure (BP) monitoring is a recommended standard of care by the ASA, and pediatric anesthesiologists routinely monitor the BP of their patients and when appropriate treat deviations from 'normal', there is no robust definition of hypotension in any of the pediatric anesthesia texts or journals. Consequently, what constitutes hypotension in pediatric anesthesia is currently unknown. We designed a questionnaire-based survey of pediatric anesthesiologists to determine the BP ranges and thresholds used to define intraoperative hypotension (IOH). Members of the Society of Pediatric Anesthesia (SPA) and the Association of Paediatric Anaesthetists (APA) of Great Britain and Ireland were contacted through e-mail to participate in this survey. We asked a few demographic questions and five questions about specific definitions of hypotension for different age groups of patients undergoing inguinal herniorraphy, a common pediatric surgical procedure. The overall response rate was 56% (483/860), of which 76% were SPA members. Majority of the respondents (72%) work in academic institutions, while 8.9% work in institutions with fewer than 1000 annual pediatric surgical caseload. About 76% of respondents indicated that a 20-30% reduction in baseline systolic blood pressure (SBP) indicates significant hypotension in children under anesthesia. Most responders (86.7%) indicated that they use mean arterial pressure or SBP (72%) to define IOH. The mean SBP values for hypotension quoted by SPA members was about 5-7% lower across all pediatric age groups compared to values quoted by APA members (P = 0.001 for all age groups). There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20-30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have implications for patient care as well as future clinical research.

Three concentrations of levobupivacaine for ilioinguinal/iliohypogastric nerve block in ambulatory pediatric surgery

Study Objective To compare the postoperative analgesia of three different concentrations of levobupivacaine for ilioinguinal/iliohypogastric (II/IH) block in children undergoing inguinal hernia repair. Design Double-blind, prospective, randomized, controlled trial. Setting Operating room and postoperative recovery area of a university hospital. Patients 73 ASA physical status I and II children, aged one to 6 years, scheduled for outpatient inguinal hernia repair. Interventions Patients were randomized to receive one of three levobupivacaine concentrations: 0.125% (L0.125), 0.25% (L0.25), or 0.375% (L0.375). All patients received standard anesthesia with sevoflurane and II/IH nerve block. Measurements Heart rate (HR), non invasive blood pressure (NIBP), respiratory rate, end-tidal carbon dioxide concentration (ETCO 2), and oxygen saturation via pulse oximetry (SpO 2) were monitored during surgery. Postoperative pain scores with CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) and need for rescue analgesia postoperatively were measured and recorded. Main Results 60 patients entered the postoperative observational period. The number of patients who received rescue analgesia was comparable in the three groups. In Group L0.125, mean CHEOPS score was significantly higher, and time to first administration of rescue analgesia was shorter, than in the other two groups ( P < 0.05). Pain scores and time to first administration of rescue analgesia were comparable between Groups L0.25 and L0.375. Conclusions II/IH nerve block using 0.4 mL kg -1 of 0.25% levobupivacaine provided satisfactory postoperative pain relief after inguinal herniorraphy.