Assessment Postoperative Analgesic Efficacy of Ilioinguinal-Iliohypogastric Block as Compared to Caudal Block in Children Undergoing Inguinal Herniotomy: A Randomised Clinical Study

Introduction: An Inguinal herniotomy is most frequently performed surgery in children under general anaesthesia along with various regional anaesthesia techniques such as ilioinguinal-iliohypogastric block (hernia block) or caudal block. Aim: To compare postoperative analgesic efficacy of hernia block (anatomical landmark guided ilioinguinal-iliohypogastric block) versus caudal block using bupivacaine as a local anaesthetic in children undergoing inguinal herniotomy. Materials and Methods: This single-centre, randomised clinical study was conducted at tertiary medical college and hospital (Lokmanya Tilak Municipal Medical College and General Hospital), Mumbai, Maharashtra, India, from December 2016 to December 2018. The study included 100 children from age 6 months to 6 years with American Society of Anesthesiologists (ASA) grade I and II, posted for elective inguinal herniotomy (unilateral). All children were given either hernia block or caudal block, based on computerized randomisation method. Total 55 patients received hernia block (Group H) with 0.3 mL/kg of 0.25% concentration of bupivacaine and another 45 patients received caudal block (Group C) with 0.75 mL/kg of 0.25% bupivacaine. In the postoperative period, mean pain free period and total duration of rescue analgesia were recorded in both the groups. Chi-square test and Fisher's-exact test. The p-value <0.05 was indicated as statistically significant. Results: Demographic data was comparable in two groups. The mean drug volume (bupivacaine 0.25%) used in group C was 8.44 +/- 3.46 mL and in group H was 4.24 +/- 1.6 mL. The mean pain free period, with in the first 24 hours, in group C was 8.80 +/- 6.43 hours and in group H, it was 11.77 +/- 8 hours. Rescue analgesia and FLACC score (the Face, Legs, Activity, Cry, Consolability scale) at 0 min, 15 min, 30 min and every hour upto 4 hours was comparable in both the groups. Mean time of discharge of patients receiving either of blocks, FLACC score at the time of discharge were comparable in both the groups. Conclusion: Hernia block was more effective than caudal block based on duration of postoperative analgesia. There was higher margin of safety with lower volume of local anaesthetic used.