Efficacy of combining ultrasound-guided spermatic cord block with ilioinguinal nerve block for analgesia in pediatric inguinal herniotomy: A randomized controlled study.

Introduction and objectives: 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.

Patients and methods: 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.

Results: 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.

Conclusions: Adding SCB to IINB can provide better quality of postoperative analgesia and more stable intraoperative hemodynamics in pediatric patients undergoing inguinal hernia repair.