Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children

Analgesia strategy for inguinal hernia repair in children: a systematic review and network meta-analysis of randomized clinical trials based on regional blocks

Background and objective

Despite its acknowledged benefits, the selection of an optimal regional block for analgesia pediatric hernia surgery remains a subject of debate. This study endeavored to conduct a network meta-analysis and systematic review of randomized clinical trials, aiming to amalgamate insights from both direct and indirect comparisons concerning the analgesic effectiveness and safety of various regional blocks post-inguinal hernia repair in children.

Method

A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to 12 November 2022 by two independent reviewers, employing a standardized protocol. The inclusion criteria encompassed randomized trials focusing on children undergoing inguinal hernia repair utilizing either local infiltration analgesia or regional analgesia. The primary outcomes assessed were pain scores at 2, 6, and 24 h post-operation.

Results

The initial search yielded 281 records relating to 1,137 patients. The analysis of ranking probability indicated that Paravertebral Block (PVB) holds the highest likelihood (88% and 48%) of being the most effective in alleviating pain at 2 h and 6 h post-surgery. Trans vs. Abdominis Plane Block (TAPB) emerged as the superior choice for mitigating pain (83%) and decreasing morphine consumption (93%) at 24 h following the operation. Local Anesthetic Infiltration (LAI) was identified as the most effective in shortening the hospital stay, with a 90% probability.

Conclusions

Regional anesthesia significantly enhances postoperative pain management in pediatric inguinal hernia repair surgery. For short-term postoperative pain relief, PVB emerges as the most effective technique. Meanwhile, TAPB provides more prolonged analgesia. Although TAPB does not exhibit a pronounced advantage in short-term analgesia, its simplicity and the absence of a need for a special position render it a viable option. However, the interpretation of these results should be approached with caution due to the presence of limited data and heterogeneity.

Systematic Review Registration

PROSPERO (CRD42022376435; www.crd.york.ac.uk/prospero).

Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Various regional analgesic techniques have been used in pediatric inguinal surgery to facilitate postoperative recovery. However, each technique's relative performance was undetermined owing to the lack of quantitative analysis.

METHODS

We systematically searched MEDLINE, Cochrane Library, EMBASE, and Web of Science for randomized controlled trials that compared regional analgesia in pediatric inguinal surgeries. After critical study screening and selection, a random-effects network meta-analysis was performed. The primary outcome was the time to the first rescue analgesic after surgery, and the secondary outcomes were the number of patients requiring rescue analgesics after surgery, postoperative pain scores, incidence of postoperative nausea and vomiting, and other adverse events.

RESULTS

This network meta-analysis included 69 randomized controlled trials (4636 patients) that compared 10 regional analgesic techniques. Our study revealed that the quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic after pediatric inguinal surgeries, by 7.7 hours (95% confidence interval [CI], 5.0-10.3) and 6.0 hours (95% CI, 3.9-8.2) when compared with the control group, respectively. In the subgroup involving only inguinal hernia repair, the quadratus lumborum block significantly prolonged the time to the first rescue analgesic than all other regional analgesics. In contrast, in the subgroup involving orchidopexies, only the caudal block significantly prolonged the time to the first rescue analgesic when compared with the control group (4.1 hours; 95% CI, 0.7-7.5). Wound infiltration and landmark-based ilioinguinal-iliohypogastric block had relatively poor analgesic effects than other regional analgesics. No serious adverse effects related to the regional analgesic techniques were reported in any of the included studies.

CONCLUSIONS

The quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic and the least rescue analgesic requirement for pediatric inguinal surgeries. Specifically, the quadratus lumborum block had the longest analgesic duration in inguinal hernia repair, and the caudal block was found to be the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. Most included randomized controlled trials had some concern or a high risk of bias, and future studies should focus on providing high-quality evidence to further clarify the analgesic effects of regional analgesia for pediatric inguinal surgeries.

Analgesic efficacy of ultrasound guided quadratus lumborum block versus ilioinguinal/iliohypogastric nerve block following pediatric open inguinal hernia repair: A prospective randomized controlled trial

Background and Aims

Inguinal hernia repair is a common surgical procedure. We compared the analgesic efficacy of ultrasound-guided anterior quadratus lumborum (QL) block versus ilioinguinal/iliohypogastric (II/IH) nerve block in pediatric patients undergoing open inguinal hernia repair.

Material and Methods

It was a prospective randomized study in which 90 patients of 1-8 years of age were randomly assigned into control (general anesthesia only), QL block, and II/IH nerve block groups. Children's Hospital Eastern Ontario Pain Scale (CHEOPS), perioperative analgesic consumptions, and time to first analgesic request were recorded. The normally distributed quantitative parameters were analyzed by one-way ANOVA with post-hoc Tukey's HSD test while parameters that did not follow a normal distribution and the CHEOPS score were analyzed using the Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferonni correction for post-hoc analysis.

Results

In the 1st 6h postoperative, the median (IQR) CHEOPS score was higher in the control group than II/IH group (P = 0.000) and QL group (P = 0.000) while comparable between the latter two groups. CHEOPS scores were significantly lower in the QL block group than the control group and II/IH nerve block group at 12 and 18h. The intraoperative fentanyl and postoperative paracetamol consumptions in the control group were higher than II/IH and QL groups while lower in QL than II/IH group.

Conclusion

Ultrasound-guided QL and II/IH nerve blocks provided effective postoperative analgesia in pediatric patients undergoing inguinal hernia repair with lower pain scores and less perioperative analgesic consumptions in the QL block group compared to II/IH group.

Management of Groin Pain Using an Iliohypogastric Nerve Block in a Patient with Inguinal Hernia due to Persistent Müllerian Duct Syndrome

Persistent Müllerian duct syndrome can cause an inguinal hernia, although this is a rare occurrence; recurrent inguinal hernias can, in turn, cause ongoing groin pain. Management of groin pain plays an important role in patients' quality of life. We present our experience with a 43-year-old man who had a 2-week history of left-sided groin pain. The patient underwent laparoscopic surgery for a left inguinal hernia via the transabdominal preperitoneal approach. Right-sided cryptorchidism was noted during surgery, with a solid structure-thought to be a uterus-extending into the left inguinal canal. The diagnosis was persistent Müllerian duct syndrome, and the groin pain was relieved after a laparoscopic right orchiectomy with a bilateral preperitoneal hernia repair using a mesh. Four years later, magnetic resonance imaging performed for new-onset left groin pain showed a left inguinal hernia caused by the uterine structure. We diagnosed the recurrent hernia as the cause of his pain. Prior to performing any invasive surgical procedures, an iliohypogastric nerve block was performed using 1% lidocaine. Short-term analgesia was provided by the block, improving his quality of life. He has been followed since then and has declined surgical neurectomy. An iliohypogastric nerve block can be an effective method of controlling groin pain caused by an inguinal hernia resulting from persistent Müllerian duct syndrome; the effectiveness of the nerve block will help determine whether surgical neurectomy is indicated for permanent pain control.

Ultrasound-guided retrolaminar block versus ilioinguinal nerve block for postoperative analgesia in children undergoing inguinal herniotomy: A randomized controlled trial

STUDY OBJECTIVE

Ultrasound-guided retrolaminar block (RLB) is a new, safe and technically easy nerve block. To our knowledge, no studies have evaluated its analgesic efficacy in pediatric patients. This study aimed to compare the postoperative analgesic efficacy of RLB and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy.

DESIGN

Superiority, prospective, randomized, double-blinded, controlled study.

SETTING

Operating rooms and wards of Mansoura University Children's Hospital, Egypt.

PATIENTS

Sixty-five patients aged 2 to 6 years undergoing unilateral inguinal herniotomy were enrolled.

INTERVENTIONS

In the ultrasound-guided RLB group (n = 30), we injected 0.5 mL/kg bupivacaine 0.25% into the retrolaminar space between the lamina of T12 and the paraspinal muscles and in ultrasound-guided INB group (n = 30), 0.5 mL/kg bupivacaine 0.25% was injected for INB.

MEASUREMENTS

The primary outcome measure was the number of patients requiring ibuprofen as rescue analgesia and the secondary outcome measures were intraoperative hemodynamic changes and the postoperative FLACC (Face, Legs, Activity, Cry, Consolability) score.

MAIN RESULTS

The number of patients who needed rescue analgesia in the first postoperative 24 h was significantly lower (P = 0.023) in the RLB group [5 (16%)] than the INB group [13 (43%)]. The mean (SD) arterial blood pressure and heart rate were significantly higher (P < 0.001) during sac traction in the INB group [74.07 (2.99), 97.33 (6.98)] than the RLB group [67.73 (3.55), 90.79 (5.13)]. The postoperative FLACC scores at 4, 6, 12, and 24 h were significantly lower (P < 0.05) in the RLB group than in the INB group.

CONCLUSION

Retrolaminar block is superior to ilioinguinal nerve block in providing postoperative analgesia in pediatric patients undergoing unilateral inguinal herniotomy.

Preemptive analgesic efficacy of ultrasound-guided transversalis fascia plane block in children undergoing inguinal herniorrhaphy: a randomized, double-blind, controlled study

Background

Surgical repair of congenital inguinal hernia results in significant postoperative discomfort and pain. The aim of the current study was to evaluate the pre-emptive analgesic efficacy of a transversalis fascia plane (TFP) block after pediatric inguinal herniorrhaphy.

Methods

Forty-four patients aged 12 to 60 months who underwent unilateral inguinal herniorrhaphy were enrolled. Four patients were excluded, and the remaining were allocated to the control group and the TFP block group. In the TFP block group, 0.4 ml/kg bupivacaine 0.25% was instilled in the plane between the transversus abdominis and transversalis fascia, while in the control group 0.9% saline was used instead of bupivacaine. The collected data were the total dose of paracetamol consumed during the first 12 h postoperatively, the postoperative Face, Leg, Activity, Cry, Consolability (FLACC) pain score, time to first use of rescue analgesia, number of patients required additional postoperative analgesics, and parents' satisfaction.

Results

The median paracetamol consumption was significantly lower in the TFP block group than in the control group, and FLACC pain scores were significantly lower for all study times in the TFP block group with higher parental satisfaction scores than those for the control group. The number of patients who required additional analgesics was significantly lower in the TFP block group than in the control group.

Conclusions

The use of a TFP block decreases postoperative analgesic consumption and postoperative pain intensity after pediatric inguinal herniorrhaphy. Future studies with larger sample size are required to evaluate the actual complications rate of TFP block.

Evaluation of Ultrasound-guided Genitofemoral Nerve Block Combined with Ilioinguinal/iliohypogastric Nerve Block during Inguinal Hernia Repair in the Elderly

To evaluate the anesthetic effect of ultrasound-guided (USG) ilioinguinal/iliohypogastric nerve (II/IHN) block combined with genital branch of genitofemoral nerve (GFN) block in the elderly undergoing inguinal hernia repair, 54 old patients (aged 60-96years, ASA I-III) with indirect hernia were enrolled and scheduled for unilateral tension-free herniorrhaphy. Patients were grouped randomly to receive either USG II/IHN plus GFN block (Group G) or USG II/IHN block alone (Group I). The intraoperative visual analogue scale (VAS) scores were recorded at skin incision, at spermatic cord/round ligament traction and at sac ligation. The resting and dynamic VAS scores were recorded postoperatively. The requirements of extra sedatives and analgesics for intra- and postoperative analgesia were assessed. Occurrence of complications of the block, postoperative nausea and vomiting and femoral nerve palsy was also reported. Both groups showed similar sensory block. When stretching spermatic cord/round ligament, the patients in group G had significantly lower VAS scores than in group I. And group G used much fewer adjuvant sedatives and analgesics to achieve adequate anaesthesia. In addition, group G was presented with better intraoperative anaesthesia and lower postoperative dynamic VAS scores at all time points tested. No significant difference was found in the postoperative requirement of rescue medication. Both groups showed no complications related to the block and group G reported no femoral nerve palsy. The addition of GFN block to II/IHN block improves the quality of perioperative anesthesia and analgesia in the elderly and reduces the consumption of extra sedatives and analgesics during the surgery.

Use of genitofemoral and ilioinguinal and iliohypogastric nerve block during orchiectomy in a post-lung transplant patient. A case report

The case is presented of a post-lung transplant patient, ASA III, proposed for orchiectomy due to testicular cancer. A combination of iliohypogastric (ILH), ilioinguinal (ILI) and genitofemoral (GF) nerve block together with sedation was used as anaesthetic technique. The inguinal area received sensory innervation mainly from ILI, ILH and GF nerves. The genital branch of the GF nerve supplies innervation to skin of the anterosuperior portion of the scrotum. When performing the echo-guided block of GF nerve, it is necessary to identify the spermatic cord, and administer the local anaesthetic on the inside and periphery of the cord. Peripheral nerve blocks are a valid option for complex patients. Its main advantage is the anaesthesia and analgesia level that it provides without the haemodynamic instability associated with general or neuraxial anaesthesia. GF nerve block provides hemi-scrotal anaesthesia, allowing manipulation and intervention in the inguinal-scrotal area, complementing the anaesthesia provided by ILI and ILH nerve blocks.

Transversus Abdominis Plane Block versus Ilioinguinal/Iliohypogastric Nerve Block with Wound Infiltration for Postoperative Analgesia in Inguinal Hernia Surgery: A Randomized Clinical Trial

Background:

Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair.

Aim:

The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery.

Settings and Design:

This was a randomized clinical trial performed in a tertiary care hospital.

Materials and Methods:

Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine – TAP block and Group I received 10 ml of 0.25% ropivacaine – IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain.

Statistical Analysis:

Statistical comparisons were performed using Student's t-test and Chi-square test.

Results:

Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h (P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block.

Conclusion:

As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.

Prospective study of the neurotopographic adequacy of transverse incision in Lichtenstein inguinal hernioplasty

Lichtenstein technique requires identification of the iliohypogastric, ilioinguinal, and genital branch of the genitofemoral nerves.The aim of the study was to verify if the transverse incision is suitable for identification of the iliohypogastric, ilioinguinal, and genital branch of the genitofemoral nerves.This study included 29 patients who underwent hernioplasty, and also 10 dissections of the inguinal regions from 5 cadavers. The anthropometric measurements included: incision size (IS) and topography, pubic angle (PA), body mass index (BMI), and the distance from the pubis to the incision and bi-iliac crest plane. The correlations between variables of interest and the ability to identify the nerves were assessed.Measures of height (P = 0.108), BMI (P = 0.343), and abdominal circumference (AbC) (P = 1.000); the correlations between incision IS and PA (r = -0.17, P = 0.406), IS and BMI (r = 0.56, P = 0.002), IS and AbC (r = 0.56, P = 0.002); incision and pubic heights (r = -0.26, P = 0.174); patient height and PA (r = -0.33, P = 0.092). The associations between these measures were: BMI (P = 0.136), AbC (P = 0.104), PA (P = 0.641), and IS (P = 0.399). The rates of successful nerve identification in patients and corpse were: iliohypogastric-29 (29)/9 (10), 100% (P = 0.147); ilioinguinal-29 (29)/10 (10), 100%; and genital branch of the genitofemoral nerve-26 (29)/9 (10), 89.7/80% (P = 0.488).The transverse incision permitted identification of the nerves for Lichtenstein hernioplasty.

Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy

OBJECTIVES

We hypothesized that preoperative (pre-op) ultrasound (US)-guided posterior transversus abdominis plane block (TAP) and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG) will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately.

METHODS

This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups.

RESULTS

A total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two "block" groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each "block" group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar.

CONCLUSION

Ultrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.).

Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy

PURPOSES

Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy.

METHODS

Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS (n = 31) received levobupivacaine 0.25% 1 ml/kg plus sufentanil 0.5 μg/kg, and group L (n = 31) received levobupivacaine 0.25% 1 ml/kg only. HR or MAP fluctuation >20% or entropy increase >15% during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded.

RESULTS

There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45%) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71%) patients in group L (P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 (P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L (P < 0.001).

CONCLUSION

In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response.

Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions

Proper anesthesia and knowledge of the anatomical location of the iliohypogastric and ilioinguinal nerves is important during hernia repair and other surgical procedures. Surgical complications have also implicated these nerves, emphasizing the importance of the development of a clear topographical map for use in their identification. The aim of this study was to explore anatomical variations in the iliohypogastric and ilioinguinal nerves and relate this information to clinical situations. One hundred adult formalin fixed cadavers were dissected resulting in 200 iliohypogastric and ilioinguinal nerve specimens. Each nerve was analyzed for spinal nerve contribution and classified accordingly. All nerves were documented where they entered the abdominal wall with this point being measured in relation to the anterior superior iliac spine (ASIS). The linear course of each nerve was followed, and its lateral distance from the midline at termination was measured. The ilioinguinal nerve originated from L1 in 130 specimens (65%), from T12 and L1 in 28 (14%), from L1 and L2 in 22 (11%), and from L2 and L3 in 20 (10%). The nerve entered the abdominal wall 2.8 ± 1.1 cm medial and 4 ± 1.2 cm inferior to the ASIS and terminated 3 ± 0.5 cm lateral to the midline. The iliohypogastric nerve originated from T12 on 14 sides (7%), from T12 and L1 in 28 (14%), from L1 in 20 (10%), and from T11 and T12 in 12 (6%). The nerve entered the abdominal wall 2.8 ± 1.3 cm medial and 1.4 ± 1.2 cm inferior to the ASIS and terminated 4 ± 1.3 cm lateral to the midline. For both nerves, the distance between the ASIS and the midline was 12.2 ± 1.1 cm. To reduce nerve damage and provide sufficient anesthetic for nerve block during surgical procedures, the precise anatomical location and spinal nerve contributions of the iliohypogastric and ilioinguinal nerves need to be considered.

Current management of hernias and hydroceles

The repair of inguinal hernia and hydrocele is one of the most common operations in a pediatric surgery practice. This work reviews current concepts in the management of the inguinal hernia and hydrocele. The authors describe current concepts of anesthetic management of children undergoing repair of inguinal hernia. The authors also discuss current management of the contralateral hernia, hernias in premature infants, and the management of an incarcerated hernia. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and its application for investigation of the contralateral inguinal canal.

A comparison of nerve stimulator guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children

The aim of this study was to compare the efficacy of nerve stimulator guided paravertebral block with ilio-inguinal nerve block in children undergoing inguinal herniorrhaphy. Eighty children were randomly allocated to receive either paravertebral block or ilio-inguinal nerve block. Each block was evaluated in terms of intra-operative haemodynamic stability, postoperative pain scores at rest, on movement and during activity, requirement for supplemental analgesia and parental satisfaction. Haemodynamic stability was maintained significantly better during sac traction in the paravertebral block group (p < 0.005). Pain scores and analgesic consumption were significantly lower in the paravertebral block group during the postoperative follow-up period (p < 0.05). Parental satisfaction (93%vs 69%) and surgeon satisfaction (93%vs 64%) were significantly higher in the paravertebral block group (p < 0.05). Paravertebral blockade improved and prolonged postoperative analgesia, and was associated with greater parental and surgeon satisfaction when compared to ilio-inguinal nerve block.

Bowel hematoma following an iliohypogastric-ilioinguinal nerve block

We report a case of a subserosal small bowel hematoma following an ilioinguinal-iliohypogastric nerve block for an appendicectomy in a 6-year-old girl. The bowel hematoma was noted in the wall of the terminal ileum after opening the peritoneum. The hematoma was nonobstructing and the child remained asymptomatic. We discuss the technical aspects of this block.

Tramadol for pain relief in children undergoing herniotomy: a comparison with ilioinguinal and iliohypogastric blocks

BACKGROUND

Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Preoperative ilioinguinal and iliohypogastric nerve blocks have been widely used to provide analgesia in children undergoing herniorrhaphy. Tramadol is an analgesic with micro-opioid and nonopioid activity. In this study we compared the usage of intravenous tramadol with ilioinguinal and iliohypogastric nerve blocks for control of post-herniorrhaphy pain in children aged 2-7 years.

METHODS

Sixty patients were randomly allocated to two groups of thirty. One group received tramadol 1.5 mg.kg(-1) i.v. before induction of general anesthesia and the other had an ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine (0.25 ml.kg(-1)) before skin incision. We assessed pain using the Children's Hospital of Eastern Ontario Pain Scale and the Categorical Pain Scale.

RESULTS

At 1, 4 and 24 h after surgery the two groups had identical pain scores. At 2 and 3 h after surgery the tramadol group experienced significantly less pain (P < 0.05). The rescue drug for residual pain, was used equally in the two groups. None of the 60 patients had respiratory depression but the tramadol group patients were found to have more episodes of nausea and vomiting (P < 0.05).

CONCLUSIONS

We concluded that tramadol can have at least the same analgesic effect as that of ilioinguinal and iliohypogastric nerve blocks for post-herniorrhaphy pain in children, with even a superior effect at the time of maximal analgesia. We also highlight the troublesome side-effect of nausea and vomiting which brings into question the benefits of using this opioid that seems to lack respiratory depression.

Comparison of Ilioinguinal-iliohypogastric Nerve Block Versus Spinal Anesthesia for Inguinal Herniorrhaphy

OBJECTIVE

This study was carried out to determine the optimal anesthetic technique for use in elective herniorrhaphy.

METHODS

We retrospectively analyzed 126 inguinal hernia repairs. The patients were allocated to one of two groups: an ilioinguinal-iliohypogastric nerve block group (IHNB group, n = 63) and spinal anesthesia group (SA group, n = 63). We recorded information about perioperative and postoperative parameters.

RESULTS

There were statistically significant decreases in both mean arterial pressure and pulse rate in the SA group (P < 0.001). None of the patients in the IHNB group required recovery room care. Patients in the IHNB group initiated oral intake (0.31 +/- 0.1 h) more quickly than patients in the SA group (5.74 +/- 0.1 h) (P < 0.001). The time-to-home readiness was significantly lower (14.1 +/- 1.5h) in group IHNB, compared with group SA (42.8 +/- 5.3h) (P < 0.001). First rescue analgesic time postoperatively was 3.30 +/- 0.2 hours in group SA and 2.7 +/- 0.13 hours in group IHNB (P < 0.05).

CONCLUSION

The use of IHNB for patients undergoing herniorrhaphy resulted in a shorter time-to-home readiness, quicker oral intake post surgery, and no need for recovery room care, when compared with the use of SA.