Comparison of postoperative analgesia of ultrasound-guidedilioinguinal/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.AimThis 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 methodsFifty 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.ResultsTime 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 0.001). The average FLACC pain score for group A was 2 (1–2) compared with 3 (2.25–3.5) in group B, with statistically significant difference between the two groups (P 0.001). The total number of patients who required paracetamol as a rescue analgesic in group A was 8 (33.3%) compared with 14 (60.9%) in group B (P 0.001). Two patients in group B required morphine and both suffered from vomiting.ConclusionUS-guided II/IH nerve block provides longer and more efficient postoperative analgesiacompared with TAP block for pediatric inguinal herniorraphy.