Comparison of the Analgesic Effects of Ultrasound-Guided Caudal Versus Ilioinguinal/Iliohypogastric Nerve Block Techniques for Pediatric Inguinal Surgeries: An Exploratory Randomized Controlled Study

TL;DR

This study compared two nerve block techniques for pain management in children after inguinal surgery and found they were equally effective.

Contribution

The study provides initial evidence comparing analgesic effects of caudal and ILIH blocks in pediatric patients.

Findings

Pain scores were similar between caudal and ILIH block groups at multiple time points post-surgery.

Rescue analgesia use was higher in the caudal group but not statistically significant.

Both techniques had comparable block duration until ward discharge.

Abstract

Background: Caudal nerve blocks are commonly used for inguinal surgeries in children but can lead to complications, such as prolonged weakness. The ilioinguinal/iliohypogastric (ILIH) nerve block is an alternative that is used less frequently. This study aimed to compare the effectiveness of these techniques in pediatric patients (ages six months to 12 years) undergoing inguinal surgery.

Methods: A double-blinded, randomized controlled trial was conducted with 20 pediatric patients undergoing inguinal surgery under general anesthesia. Group 1 (n = 8) received a caudal block, while Group 2 (n = 12) received an ILIH block. Pain was assessed using the Face, Legs, Activity, Cry and Consolability (FLACC) and Numeric Rating score (NRS). The primary outcomes included pain reduction and the use of rescue analgesia.

Results: The mean age of Group 1 was 2.13 years (SD=1.356), while that of Group 2 was 3.67 years (SD=1.303). The pain scores were 1.75 (SD=2.235) and 1.25 (SD=1.658) (p=0.792) at 30 minutes post-surgery in the Post Anesthesia Care Unit (PACU), 0.50 (SD=0.756) versus 0.08 (SD=0.289) (p=0.792) at PACU discharge, a score of zero versus 0.58 (SD=0.900) (p=0.792) at two hours post-operation for Group 1 and Group 2 respectively. Pain scores were similar at three hours, six hours, and at ward discharge. On day two at home, Group 1 reported a score of 0.25 (SD=0.707) compared to 0.33 (SD=0.778) in Group 2 (p=0.792). The use of rescue analgesia was higher in the caudal group, but the difference was statistically insignificant (p=0.7055). The block to ward discharge time was similar: 283 (SD=102.182) minutes versus 309.83 (SD=79.409) minutes for Group 1 and Group 2, respectively (p=0.746).

Conclusion: Both caudal and ILIH blocks provided similar analgesic effects for pediatric inguinal surgery. More extensive studies are needed to confirm this conclusion.

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