Elective orchidopexy in the paediatric population: a trial of intra-operative spermatic cord block

Abstract

It is well established that pre-emptive and multimodal analgesia improve pain control and decrease narcotic use as well as the length of stay. Whilst some form of local anaesthetic (LA) block is almost routine for most inguinal procedures in children, the best modality is uncertain for orchidopexy. We sought to explore as to whether the addition of spermatic cord block (SCB) to our standard ilio-inguinal block (IIB) in this situation had any impact on analgesic requirements post-operatively. A retrospective review of a single surgeon and single centre experience of LA block for elective orchidopexy is described for a 9-year period. In the first half of the study, the LA technique was an IIB. An SCB was added to the IIB in the second half using the same total dose of 0.8 ml/kg bupivacaine. In the entire group, 35% of the SCB + IIB boys required narcotics as compared to 56% with IIB alone (p > 0.05). On subgroup analysis of a "medium risk" procedure (i.e. inguinal approach for a superficial pouch testis) only 35% required narcotics in the SCB + IIB group as compared to 70% in the IIB (p < 0.05). Use of a SCB + IIB in elective orchidopexy in a paediatric population has additional benefit to IIB alone.

Resolution of post-traumatic chronic testicular pain in a pediatric patient after microsurgical denervation of the spermatic cord: a case report

“…Although the spermatic cord block has also been described in the pediatric population for analgesia in elective orchidopexy, there is no description of this block being used in a chronic pain setting or as a tool for determining eligibility for microsurgical denervation. 16 The incidence of chronic pain in pediatrics is substantial. King et al quote 11%-38%.…”