Caudal Epidural Block versus Combined Ilioinguinal and Iliohypogastric Nerve Block for Post-Operative Analgesia in Pediatric Surgeries Below the Umbilicus

Abstract

Objective: To compare the duration and effectiveness of postoperative analgesia provided by caudal block versus combined Ilioinguinal and Iliohypogastric nerve block in pediatric infra-umbilical surgeries.
Study Design: Quasi-experimental.
Place and Duration of Study: The study was carried out at the Anesthesia Department of Pak Emirates Military Hospital (PEMH) Rawalpindi, Pakistan, from June 2021 to December 2021.
Materials and Methods: Sample size was calculated from the WHO sample size calculator using the population size received in 6 months. The sample size was filtered down by purposive sampling to 80 (children aged 5-10 years) using a pre-defined inclusion/exclusion criterion scheduled for below umbilicus surgeries. They were alternatively divided into two equal groups (n=40) where Group-C received a caudal block and Group-I received ultrasound-guided Ilioinguinal and Iliohypogastric nerve block. Both groups underwent the same general anesthesia technique with I-gel and similar medications at inductions. Our primary outcome measure was the duration of analgesia using the Revised Faces Pain Scale, where p-value <0.05 was considered significant. The secondary outcomes measured were motor block and urinary retention.
Results: Median revised Faces Pain Score (FPS-R) immediately after surgery was 1.50(1) for Group-C and 0.00(1) for Group I, respectively. At 4 hours postoperatively, the median FPS-R in Group-C was 4.00(2), and in Group I, it was 2.00(0). After 8 hours, Group-C had a median FPS-R of 6.50(1) and Group-I had pain scores of 3.00(1).  Median pain scores of Group-C and Group-I at 12 hours postoperatively were 8.00(1) and 5.00(1), respectively. The demographic characteristics of the patients were comparable in both groups with similar duration of surgery. Group-C reported some cases of side effects, such as motor block and urinary retention, while Group-I did not have any of these effects. All anesthetic procedures did not otherwise have any adverse events.
Conclusion: Our study demonstrated that combined Ilioinguinal and Iliohypogastric nerve block furnished efficient post-operative analgesia while requiring smaller amounts of local anesthetics and avoiding the adverse effects of the caudal block. It is an ideal regional block technique for infra-umbilical surgeries in pediatric populations at busy centres.