Contribution of ultrasound-guided ilioinguinal/iliohypogastric block to intraoperative anesthesia in children - Randomized controlled study

Objectives: The aim of this study was to investigate the effect of ilioinguinal/iliohypogastric nerve block (II/IH) only supported by ketamine sedation on intraoperative anesthesia and analgesia. Methods: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided into three groups: 1) the II/IH block and ketamine group, 2) the II/IH block by inserting the laryngeal mask (LMA) and sevoflurane group, and 3) the LMA and sevoflurane group. Peroperative heart rate (HR), mean arterial pressure (MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, and time required for the first analgesia were recorded. Results: The patients, consisting of 34 males and 26 females had an average age of 4 ± 1.3 years. There was no difference in terms of HR and MAP between the ketamine + block applied group and LMA + block applied group; however, HRs were higher and MAPs were lower in the group in which no block was added but only sevoflurane maintenance was provided and the amount of sevoflurane used significantly decreased in the group supported by (II/IH) block (P < 005). In the postoperative period, the HR, MAP and pain scores were higher in the group with no added block but this difference was significant in the first 6 hours (P < 0.05). Rescue analgesia was applied to a fewer of patients in the groups with added blocks and nausea-vomiting occurred only in the group without block. It was observed that analgesia was needed in average for 6.1 hours in the block group to which ketamine was applied; 4.7 hours in average in the block group to which LMA was applied; and for 2.1 hours in average in the group not supported by block (P < 0.05). Conclusion: In this study, it was determined that II/IH block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration, and shorter analgesia need in the postoperative period. © 2018, Iranian Journal of Pediatrics.