Is ilioinguinal/iliohypogastric nerve block always totally safe in children?

Abstract

We report a case of accidental puncture of the small bowel during an ilioinguinal/iliohypogastric nerve block procedure for hernia repair. The diagnosis was made a few days later during a laparoscopic exploration owing to the progressive onset of clinical and radiological intestinal obstruction. A large, obstructing subserosal haematoma was found without any apparent perforation of the mucosa, and the damaged loop was resected. Such a complication has already been reported once in the literature after use of a long bevel needle for the puncture. This case is the first reported using an atraumatic short bevel needle. We discuss the technical aspects of the procedure and underline the fact that regional anaesthesia in children is never totally risk free.

Ultrasound guidance for ilioinguinal/iliohypogastric nerve block: a pilot study

“…However uncommon complications of ilioinguinal and iliohypogastric nerve block in the inguinal region do exist and include bowel perforation of both colon and small bowel [8,9]. Other complications include femoral nerve blocks, intravascular injection, intraperitoneal block, parasthesia of lower limb and even tibial fracture [12,14].…”

“…Case reports, particularly in children, indicate the possibility of colonic puncture and associated morbidity with blind ilioinguinal and iliohypogastric blockade [8,9]. Reported complications in adults include limb dysaesthsia, femoral nerve block and pelvic haematoma [10][11][12].…”

Application of Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block in Pediatric Same-Day Surgery

“…Therefore, this method was used in the present study for IINB in group T. Although the traditional anatomic landmark-guided (fascial click) IINB techniques have the advantage of simplicity, the success rate of these blocks has only been about 70 %. These techniques also involve greater risk of perforation of the colon and small intestine [9] and pelvic hematoma [10]. Furthermore, the IIN and IHN often exhibit anatomic variations in the inguinal region.…”

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“…The AL technique for ILIH block, without USG, has a reported failure rate up to 45% [3]. It is associated with incorrect local anesthetic placement in 14% of cases, inadvertent femoral nerve block, and the rare, but serious, complication of small bowel puncture [11,16,17].…”