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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims The ilioinguinal/iliohypogastric nerve block (IINB) is a well practiced regional anesthesia (RA) technique for inguinal surgeries in children. IINB is considered as effective as caudal block for peri-operative analgesia. Ultrasound guidance (USG) of IINB offers advantage of direct visualization of nerves, helps decreasing the volume of local anaesthetics (LA) used and thus, increases safety. This study aimed at proving efficacy of USG IINB, using low volume of LA, defining the surrounding anatomical structures in children.
Methods We studied various scientific papers, meta-analysis and review articles published between 2005-2023 related to IINB in paediatric unilateral inguinal surgeries like orchidopexy and inguinal hernia repair. The conventional fascial pop techniques using large volume of LA are replaced with precise visualization of nerve and needle during USG IINB, enabling use of ultra low volume of drugs to achieve high quality block.
Results ‘RA always works provided you put the right dose of the right drug in the right place.’ This adage reflects the true reality of RA. Accurate placement of LA around IIN in children is seldom possible using landmark technique. USG ensures the right place between internal oblique and transversus abdominus, avoiding injury to adjacent structures. The distance between skin-IIN is 5-10mm, and between IIN-peritoneum is around 3-5mm in children. Using USG IINB, an effective block can be achieved using volume of 0.25% Levobupivacaine as low as 0.075ml/kg.
Anatomy of ilioinguinal iliohypogastric nerves
USG probe position and right place to block ilioinguinal nerve in children
Conclusions The use of USG IINB enables the administration of ultra low volume of LA at correct fascial plane with maximum efficacy in children undergoing inguinal surgeries.