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BJA Advance Access published online on May 27, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei157
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
Accepted March 24, 2005

Clinical Investigation

Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children{dagger}

H. Willschke 1, P. Marhofer 1*, A. Bösenberg 2, S. Johnston 2, O. Wanzel 3, S. G. Cox 2, C. Sitzwohl 1, and S. Kapral 1

1 Department of Anaesthesia and Intensive Care Medicine, Medical University of Vienna, A-1090 Vienna, Austria
2 Department of Anaesthesia, University Cape Town, Red Cross Children Hospital, Klipfontein Rd, Rondebosch 7700, South Africa
3 Division of Anaesthesia and Intensive Care Medicine, Orthopaedic Hospital Gersthof, A-1180 Vienna, Austria

* To whom correspondence should be addressed.
P. Marhofer, E-mail: peter.marhofer{at}meduniwien.ac.at


  Abstract

Background. The ilioinguinal/iliohypogastric nerve block is a popular regional anaesthetic technique for children undergoing inguinal surgery. The success rate is only 70-80% and complications may occur. A prospective randomized double-blinded study was designed to compare the use of ultrasonography with the conventional ilioinguinal/iliohypogastric nerve block technique.

Methods. One hundred children (age range, 1 month-8 years) scheduled for inguinal hernia repair, orchidopexy or hydrocele repair were included in the study. Following induction of general anaesthesia, the children received an ilioinguinal/iliohypogastric block performed either under ultrasound guidance using levobupivacaine 0.25% until both nerves were surrounded by the local anaesthetic or by the conventional ‘fascial click’ method using levobupivacaine 0.25% (0.3 ml kg-1). Additional intra- and postoperative analgesic requirements were recorded.

Results. Ultrasonographic visualization of the ilioinguinal/iliohypogastric nerves was possible in all cases. The amount of local anaesthetic used in the ultrasound group was significantly lower than in the ‘fascial click’ group (0.19 (SD 0.05) ml kg-1 vs 0.3 ml kg-1, P<0.0001). During the intraoperative period 4% of the children in the ultrasound group received additional analgesics compared with 26% in the fascial click group (P=0.004). Only three children (6%) in the ultrasound-guided group needed postoperative rectal acetaminophen compared with 20 children (40%) in the fascial click group (P<0.0001).

Conclusions. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks can be achieved with significantly smaller volumes of local anaesthetics. The intra- and postoperative requirements for additional analgesia are significantly lower than with the conventional method.

Keywords: anaesthesia, paediatric; monitoring, ultrasonography; nerve block, ilioinguinal/iliohypogastric.
{dagger} This study was performed at the Red Cross Children Hospital, Klipfontein Road, Rondebosch 7700, Cape Town, South Africa.
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