Elemam E M, Abdelbaser I, Elbahrawy K, Alseoudy M M, El Kenany S
Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Rev Esp Anestesiol Reanim (Engl Ed). 2025 Jun;72(6):501675. doi: 10.1016/j.redare.2025.501675. Epub 2025 Mar 20.
US-guided ilioinguinal nerve block (IINB) is a common analgesic regional technique in pediatric inguinal herniotomy, However, alone it could not provide complete analgesia for such surgery due to spare of the genital branch of the genitofemoral nerve (GFN) and some sympathetic fibers. Spermatic cord block (SCB) can block both of them. This study aimed to assess the analgesic effects of combining US-guided spermatic SCB and IINB in pediatric patients subjected to elective open inguinal herniotomies.
A total of 50 male pediatric patients who underwent inguinal herniotomy were included in the current prospective, randomized, controlled study. Patients were randomly allocated to two groups: one group received IINB and the other received combined IINB and SCB. The number of patients who required rescue analgesia after surgery was the primary outcome parameter, whereas assessment of the intraoperative hemodynamic parameters (MAP: mean arterial pressure; HR: heart rate), total consumption of paracetamol, postoperative pain score, and occurrence of adverse events were the secondary outcome measures.
The number of patients who needed rescue analgesia was significantly lower in IINB/SCB group (12%), than IINB group (41 %), P = 0.025. The median (interquartile range) total dose of paracetamol consumption was significantly lower in the IINB/SCB group [0 (0-0)] mg/kg than in the IINB group [0 (0-10)], P = 0.020. Pain score was significantly (P < 0.05) lower in the IINB/SCB group than in the IINB group at all-time points. Both MAP and HR were significantly higher in the IINB group than in the IINB/SCB group during traction on hernial sac, P < 0.05. Occurrence of adverse events was comparable in both groups.
Adding SCB to IINB can provide better quality of postoperative analgesia and more stable intraoperative hemodynamics in pediatric patients undergoing inguinal hernia repair.
超声引导下髂腹股沟神经阻滞（IINB）是小儿腹股沟疝修补术中常用的一种区域镇痛技术。然而，由于生殖股神经（GFN）生殖支和一些交感神经纤维未被阻滞，单独使用该技术无法为这类手术提供完全的镇痛效果。精索阻滞（SCB）可同时阻滞上述神经。本研究旨在评估超声引导下精索SCB与IINB联合应用于择期开放性小儿腹股沟疝修补术患者的镇痛效果。
本前瞻性、随机、对照研究共纳入50例接受腹股沟疝修补术的男性小儿患者。患者被随机分为两组：一组接受IINB，另一组接受IINB联合SCB。术后需要补救性镇痛的患者数量是主要观察指标，而术中血流动力学参数（MAP：平均动脉压；HR：心率）、对乙酰氨基酚的总消耗量、术后疼痛评分及不良事件的发生情况为次要观察指标。
IINB/SCB组需要补救性镇痛的患者数量（12%）显著低于IINB组（41%），P = 0.025。IINB/SCB组对乙酰氨基酚的中位（四分位间距）总消耗量[0（0 - 0）]mg/kg显著低于IINB组[0（0 - 10）]，P = 0.020。在所有时间点，IINB/SCB组的疼痛评分均显著低于IINB组（P < 0.05）。在牵拉疝囊时，IINB组的MAP和HR均显著高于IINB/SCB组，P < 0.05。两组不良事件的发生率相当。
在小儿腹股沟疝修补术中，IINB联合SCB可提供更好的术后镇痛质量及更稳定的术中血流动力学。
