Çocuklarda unilateral inguinal herni operasyonlarında ilioinguinal/iliohipogastrik ve sakral epidural bloğun intraoperatif ve postoperatif analjezik özelliklerinin karşılaştırılması

Amaç: Pediatrik inguinal girişimlerde kaudal, spinal ve sakral epidural gibi santral bloklar sıklıkla kullanılmaktadır. Bu girişimlerde periferik bloklar da kullanılmakta ve başarılı sonuçlar alınmaktadır. Bu çalışmada, genel anestezi altında ilioinguinal/ iliohipogastrik bloğunun intraoperatif ve postoperatif analjezik etkinliğini sakral epidural blok ile karşılaştırmayı amaçladık. Gereç ve Yöntem: Bu çalışma, Gazi Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı’nda, Gazi Üniversitesi Tıp Fakültesi Etik Kurulu’ndan ve Sağlık Bakanlığı İlaç ve Eczacılık Genel Müdürlüğü Merkez Etik Kurulu’ndan B.10.0.İEG.011.00.01 numaralı izin alındıktan sonra gerçekleştirilmiştir. ASA I - II grubunda olup genel anestezi altında elektif tek taraflı inguinal herni ameliyatı olacak, yaşları 1-8 arasında olan 60 hasta randomize olarak iki gruba ayrıldı: Grup S (n=30) sakral epidural blok grubu ve Grup I (n=30) ilioinguinal / iliohipogastrik sinir bloğu grubu. Bulgular: Hemodinamik değerler her iki grupta da kontrol değerlerinden istatistiksel olarak anlamlı derecede düşük bulundu. Sevofluran için MAC değerleri, tüm cerrahi periyotlarda her iki grupta da istatistiksel olarak anlamlı derecede düşüktü. Ek analjezik gereksiniminin Grup I’da, 8. ve 12. saatlerde Grup S’ye göre istatistiksel olarak anlamlı derecede düşük olduğu gözlendi. İlk analjezik alım saatleri açısından iki grup arasında anlamlı fark bulunmadı. Sonuç: Çalışmamızda Grup I ve Grup S’de analjezik etkinlikleri benzer bulundu.

Comparison of intraoperative and postoperative analgesic properties of ilioinguinal/ iliohypogastric and sacral epidural block in pediatric unilateral inguinal hernia operations

Objectives: Central blocks such as caudal, spinal, and sacral epidural are frequently used in pediatric inguinal surgeries. Furthermore, peripheral blocks have been used and successful results have been obtained in pediatric inguinal surgeries. In this study, we aimed to compare the intraoperative and postoperative analgesic efficacy of the ilioinguinal/iliohypogastric (IL/IH) block under general anesthesia with the sacral epidural block. Methods: This study was carried out in Gazi University Faculty of Medicine, Department of Anesthesiology and Reanimation, after obtaining permission from the Ethics Committee of Gazi University Faculty of Medicine and the Central Ethics Committee of the General Directorate of Pharmaceuticals and Pharmacy of the Turkish Ministry of Health, numbered B.10.0.İEG.011.00.01. Sixty patients in the American Society of Anesthesiologists I-II group between the ages of 1 and 8 years who will undergo elective unilateral inguinal hernia operation under general anesthesia were randomly divided into two groups. Group S (n=30) sacral epidural block and group I (n=30) IL/IH nerve block were planned. Results: Hemodynamic values were found to be statistically significantly lower than control values in both groups. The minimum alveolar concentration values for sevoflurane were statistically significantly lower values in both groups at all surgery periods. In terms of additional analgesic requirement, the group I was found to be statistically significantly lower than the group s at the $8^{th}$–$12^{th}$ h. When the first analgesic intake hours were examined, no significant difference was found between the two groups. Conclusion: In our study, group I and group S analgesic efficacy was found to be similar.

PDF

___

1. Kundra P, Sivashanmugam T, Ravishankar M. Effect of needle insertion site on ilioinguinal-iliohypogastric nerve block in children. Acta Anesthesiol Scand 2006;50(5):622– 6.
2. Boretsky KR. Regional anesthesia in pediatrics: marching forward. Curr Opin Anaesthesiol 2014;27(5):556–60.
3. Ingelmo P, Locatelli BG, Frawley G, Knottenbelt G, Favarato M, Spotti A, et al. The optimum intitial pediatric epidural bolus: a comparison of four local anesthetic solutions. Paediatr Anaesth 2007;17(12):1166–75.
4. Weintraund M, Marhofer P, Bösenberg A, Kapral S, Willschke H, Felfernig M, et al. Ilioinguinal/Iliohypogastric blocks in children: where do we administrator the local anesthetic without direct visualization? Anesth Analg 2008;106(1):89–93, table of contents.
5. Thibaut D, Cuadra-Fontaine JC, Bravo MP, Fuente R. Ilioinguinal/Iliohypogastric blocks: where is the anesthetic injected? Anesth Analg 2008;107(2):728–9.
6. Kuratani N, Kikuchi H. [Current concepts in perioperative management of children : preface and comments]. Masui 2007;56(5):506–8. (Japanese)
7. Ivani G, Mosetti V. Pediatric regional anesthesia. Minerva Anesthesiol 2009;75(10):577–83.
8. Lönnqvist PA, Ecoffey C, Bosenberg A, Suresh S, Ivani G. The European society of regional anesthesia and pain therapy and the American society of regional anesthesia and pain medicine joint committee practice advisory on controversial topics in pediatric regional anesthesia I and II: what do they tell us? Curr Opin Anaesthesiol 2017;30(5):613–20.
9. Byun S, Pather N. Pediatric regional anesthesia: a review of the relevance of surface anatomy and landmarks used for peripheral nerve blockades in infants and children. Clin Anat 2019;32(6):803–23.
10. Bisconette B, Dalens B. Chapter 26: Regional Anesthesia. In: Hadzic A, editor. Pediatric Anesthesia Principles and Practice. New York: McGraw Hill; 2002. p. 563-5.
11. Weintraund M, Landblad M, Kettner S, Willschke H, Kapral S, Lönnqvist P, et al. Ultrasound versus landmark – based technique for ilioinguinal – iliohypogastric nerve blockade in children: The implcations on plazma levels of ropivacaine. Anesth Analg 2009;108(5):1488–92.
12. Bösenberg A. Pediatric regional anesthesia update. Pediatric Anesth 2004;14(5):389–402.
13. McCann ME, de Graaff JC, Dorris L, Disma N, Withington D, Bell G, et al; GAS Consortium. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet 2019;393(10172):664–77.
14. Bhattarai BK, Rahman TR, Sah BP, Tuladhar UR. Analgesia after inguinal herniotomy in children: combination of simplified (Single Puncture) ilioinguinal and iliohypogastric nerve blocks and wound infiltration vs. caudal block with 0.25% bupivacaine. Kathmandu Univ Med J (KUMJ) 2005;3(3):208–11.
15. Caetano AM, Falbo GH, Lima LC. Comparação entre três técnicas regionais de analgesia pós-operatória em crianças com ropivacaína [Comparison among three techniques of postoperative regional analgesia with ropivacaine in children.]. Rev Bras Anestesiol 2006;56(6):561–70. (Portuguese)
16. İzci Y, Gürkanlar D, Ozan H, Gönül E. The morphological aspects of lumbar plexus and roots an anatomical study. Turk Neurosurg 2005;15(2):87–92.
17. Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner S, Eichenberger U, et al. Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg 2006;102(6):1680–4.
18. Kil HK. Caudal and epidural blocks in infants and small children: historical perspective and ultrasound-guided approaches. Korean J Anesthesiol 2018;71(6):430–9.
19. Kumagai M, Yamashita M. Sacral intervertebral approach for epidural anaesthesia in infants and children: application of “drip and tube” method. Anaesth Intensive Care 1995;23(4):469–71.
20. Quinot JF, Coquelin G. Anesthésie caudale transsacrée en pratique ambulatoire chez l’enfant. Notre expérience [Trans-sacral caudal anesthesia in ambulatory practice in infants. Our experience]. Cah Anesthesiol 1993;41(4):347– 8. (French)
21. Bringuier S, Picot MC, Dadure C, Rochette A, Raux O, Boulhais M, et al. A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations. Pain. 2009 Sep;145(1–2):60–8.
22. McGrath PJ, McAlpine L. Psychologic perspectives on pediatric pain. J Pediatr 1993;122(5 Pt 2):S2–8.
23. Kaminsky O, Fortier MA, Jenkins BN, Stevenson RS, Gold JI, Zuk J, et al. Children and their parents’ assessment of postoperative surgical pain: Agree or disagree? Int J Pediatr Otorhinolaryngol 2019;123:84–92.
24. Samerchua A, Leurcharusmee P, Panichpichate K, Bunchungmongkol N, Wanvoharn M, Tepmalai K, et al. A Prospective, randomized comparative study between ultrasound-guided posterior quadratus lumborum block and ultrasound-guided ilioinguinal/iliohypogastric nerve block for pediatric inguinal herniotomy. Paediatr Anaesth 2020;30(4):498–505.
25. Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Cox SG, et al. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth 2005 Aug; 95(2):226–30.