Ultrasound-guided erector spinae versus ilioinguinal/iliohypogastric block for postoperative analgesia in children undergoing inguinal surgeries

Abstract

Context: Erector spinae plane (ESP) block is a promising technique in the field of pediatric postoperative analgesia considering its safety and simplicity. Objective: The objective of the study is to compare the efficacy of ultrasound (US)-guided ilioinguinal/iliohypogastric nerve (IIN) block and ESP block for postoperative analgesia after pediatric unilateral inguinal hernia repair. Patients and Methods: Sixty patients randomized into two equal groups. ESP group received US-guided ESP block, and IIN group received US-guided IIN block. Block in both groups was done with 0.5 mL/kg 0.125 bupivacaine + fentanyl 1 μg/mL injectate. Primary outcome is to compare both groups regarding time to first analgesic request. Secondary outcomes include evaluation of postoperative FLACC score, number of patients requiring rescue analgesic, number of rescue analgesic doses, parental satisfaction, incidence of postoperative vomiting, and motor weakness. Results: IIN group showed a significantly higher FLACC score at 4 and 6 h, significantly higher number of rescue medication doses and number of patients needed rescue analgesia. The ESP group carries a significantly higher parental satisfaction and a significantly longer time to first rescue analgesic compared to IIN group. Conclusion: The findings suggest that US guided ESP block resulted in a more effective and longer duration of postoperative analgesia following a pediatric unilateral inguinal hernia repair compared to IIN block.

Comparison of the analgesic efficacy of the ultrasound-guided transversalis fascia plane block and erector spinae plane block in patients undergoing open inguinal hernia repair under spinal anesthesia

“…Previous studies have shown the efficacy of ESPB after OIHR surgery in both adult and pediatric patients [ 27 , 28 ]. El-Emam and El Motlb [ 27 ] administered ESPB to children at a volume of 0.5 ml/kg from the L1 transverse process and found a lower rescue analgesic requirement, lower FLACC scores, and a longer time to first analgesic request compared to the II-IH block in OIHR.…”

“…Previous studies have shown the efficacy of ESPB after OIHR surgery in both adult and pediatric patients [ 27 , 28 ]. El-Emam and El Motlb [ 27 ] administered ESPB to children at a volume of 0.5 ml/kg from the L1 transverse process and found a lower rescue analgesic requirement, lower FLACC scores, and a longer time to first analgesic request compared to the II-IH block in OIHR. Sakae et al [ 28 ] performed ESPB at T8 level with 20 ml ropivacaine (0.5%) LA, determined that it did not reduce the rescue analgesic requirement, and reported that it was ineffective for OIHR.…”

Ultrasound‐guided peripheral trunk block technique: A new approach gradually stepping onto the stage of clinical anesthesia

“…However, with the technological progress and the emergence of various new trunk block techniques, II/IHNB has entered a controversial era. Some kinds of literature have confirmed that ESPB is superior to II/ IHNB in inguinal surgery analgesia (El-Emam, et al, 2019). Nevertheless, compared with TAPB, II/IHNB alsohas some advantages in inguinal analgesia (Faiz, et al, 2019).…”

Analgesia para cirugía pediátrica ambulatoria

“…-bloqueo del erector espinal: Descrito en 2016 por Forero, ha ganado amplia popularidad desde entonces. Al compararlo con el bloqueo IL/IH en cirugías inguinales, mejoró el manejo del dolor disminuyendo la necesidad de analgesia de rescate, y aumentó el tiempo de duración de la analgesia y la satisfacción parental, sin diferencias en efectos adversos [23]. Si bien faltan estudios randomizados que lo avalen y el mecanismo de acción no está del todo claro, constituye una buena alternativa analgésica en este tipo de cirugías, por su posible efecto en dolor visceral junto con proveer analgesia de pared abdominal [23].…”

“…Al compararlo con el bloqueo IL/IH en cirugías inguinales, mejoró el manejo del dolor disminuyendo la necesidad de analgesia de rescate, y aumentó el tiempo de duración de la analgesia y la satisfacción parental, sin diferencias en efectos adversos [23]. Si bien faltan estudios randomizados que lo avalen y el mecanismo de acción no está del todo claro, constituye una buena alternativa analgésica en este tipo de cirugías, por su posible efecto en dolor visceral junto con proveer analgesia de pared abdominal [23]. -bloqueo de nervio pudendo: En estudios observacionales de niños sometidos a circuncisión, reparación de hipospadia y otras cirugías peneanas, demostró no inferioridad comparado con BC en cuanto a analgesia posoperatoria.…”