ABSTRACT
Context:
Pediatric inguinal surgeries sometimes cause considerable post-operative pain that requires effective analgesics. Caudal and abdominal nerve blocks may help this population with pain. It is uncertain how successful they are compared.
Methods:
A randomized controlled trial included 70 pediatric inguinal surgery patients. An abdominal (ANB) or caudal nerve block (CNB) was randomly assigned to participants in addition to usual analgesic treatment. Post-operative pain was measured at various times using a standardized scale. The initial rescue analgesia time and dose were recorded. Statistics were used to compare CNB and ANB results.
Results:
The CNB and ANB groups were demographically similar. At every time point, the two groups’ analgesic usage and post-operative pain were similar. No serious adverse events occurred in either group.
Conclusion:
CNB and ANB provide equivalent analgesia for pediatric inguinal surgeries. Both approaches alleviate pain well and have similar post-operative effects. Individual nerve block approaches must be chosen based on patient features and clinical considerations. More research is needed to determine each procedure’s long-term safety and results.
KEYWORDS: Abdominal nerve block, analgesia, caudal nerve block, inguinal procedures, pediatric surgery
INTRODUCTION
Discomfort management solutions may face difficulties when it comes to pediatric inguinal operations, which are often performed procedures linked to considerable post-operative discomfort. Sufficient pain management is essential for minimizing suffering, encouraging early ambulation, and lowering the possibility of surgical complications. Pediatric surgery patients can now get tailored analgesia thanks to the development of regional anesthesia procedures including caudal (CNB) and abdominal nerve block (ANB).[1,2,3]
By injecting a local anesthetic into the caudal epidural space, CNB can block nociceptive transmission from the sacral nerve roots and provide analgesia to the the lower limbs, lower abdomen, and perineum. Similar to this, ANBs work by infusing local anesthetics at the surgical site to target the nerves supplying the abdominal wall, such as the ilioinguinal and iliohypogastric nerves. These methods have the benefit of lowering the risk of opioid-related side effects in children and minimizing systemic opioid consumption.[4,5,6]
Even though CNB and ANB are becoming more and more common, further study is still required to determine how effective and safe they are in comparison to other methods for pediatric inguinal operations.
MATERIALS AND METHODS
Enrolling pediatric patients aged 1 to 10 years who were having elective inguinal operations at a tertiary care hospital between January 1, 2020, and December 31, 2021 was the goal of this randomized controlled study. In addition to receiving routine analgesic therapy, participants were randomly allocated to undergo either an ANB or a CNB.
Under ultrasound guidance, CNBs were carried out by injecting 0.25% bupivacaine into the caudal epidural space at a dose of 1 mg/kg. Targeting the ilioinguinal and iliohypogastric nerves with 0.5% ropivacaine at a dose of 0.3 ml/kg infiltration at the surgery site, ANBs were carried out via a landmark-based method.
A standardized pain scale was used to measure post-operative discomfort at 1, 2, 4, 6, and 24 hours. The time to first rescue analgesia and amount of analgesics used were noted. T-tests were used for statistical analysis, and a P-value of less than 0.05 was deemed statistically significant.
RESULTS
Table 1 lists the research participants’ demographic details according to the kind of nerve block they had. The study found no statistically significant changes in age (P = 0.42), sex distribution (P = 0.68), weight (P = 0.59), or ASA physical status classification (P = 0.36) between the CNB and ANB groups. This suggests that the baseline features of the two groups were similar.
Table 1.
Demographic characteristics of study participants
| Characteristic | CNB | ANB | P |
|---|---|---|---|
| Age (years) | Mean±SD: 6.8±1.5 | Mean±SD: 6.6±1.3 | 0.42 |
| Sex (Male/Female) | 20/15 | 18/17 | 0.68 |
| Weight (kg) | Mean±SD: 22.5±3.2 | Mean±SD: 22.8±3.5 | 0.59 |
| ASA Physical Status | |||
| I | 25 | 23 | |
| II | 10 | 12 | 0.36 |
The post-operative pain ratings for the CNB and ANB groups are shown in Table 2 at different time intervals. Between the two groups, there were no statistically significant differences in pain levels at any of the time intervals that were evaluated (1, 2, 4, 6, and 24 hours post-operatively). Throughout the monitoring period, the mean pain scores for both groups stayed consistently low, indicating that both CNB and ANB effectively controlled pain. These results suggest that for pediatric patients having inguinal operations, CNB and ANB procedures have similar analgesic effectiveness.
Table 2.
Pain scores at various time points postoperatively
| Time Point (hours) | CNB (Mean±SD) | ANB (Mean±SD) | P |
|---|---|---|---|
| 1 | 2.1±0.8 | 2.3±0.7 | 0.32 |
| 2 | 1.8±0.6 | 2.0±0.5 | 0.21 |
| 4 | 1.5±0.4 | 1.6±0.4 | 0.45 |
| 6 | 1.4±0.3 | 1.5±0.3 | 0.39 |
| 24 | 1.2±0.2 | 1.3±0.2 | 0.28 |
SD=Standard Deviation. P values calculated using independent t-tests. Significant P (P<0.05)
DISCUSSION
This study illuminates the efficacy of ANB and CNB for young inguinal patients. Current data show identical post-operative pain ratings and analgesic consumption for the two techniques. These findings inform pain treatment in this population and add to the literature on regional anesthesia in pediatric surgery.
Both ANB and CNB groups had similar pain levels following inguinal surgeries, showing that both techniques relieve discomfort. This is similar with past study that showed CNB and ANB equivalent for pediatric surgical procedures such as orchidopexy and inguinal hernia repair.[1,2] Both nerve blocks reduce analgesic requirements and pain perception by blocking nociceptive transmission from the surgical site.[3] Current findings suggest that CNB or ANB can provide peri-operative analgesia for pediatric inguinal surgeries.
Previous studies revealed one strategy was more successful at managing pain than the other. The study’s findings support this. Conroy et al.[4] found lower pain ratings and less analgesic consumption with CNB than ANB in pediatric hernia surgery. Remember that patient demographics, study techniques, and outcome measurements might create inconsistent results between studies. The local anesthetic agent, dosage, and manner of administration of nerve block operations can significantly alter findings and should be considered when interpreting data.[5]
ANB and CNB may have had similar analgesic effects in current study due to the abdominal–caudal innervation overlap. CNB inhibits the same nerves as ANB, which innervate the lower abdomen with sensory nerves. The two approaches target separate nerves, yet this anatomical redundancy may explain similar pain relief levels. Anatomical variations in nerve distribution and sensitivity to local anesthetics may also affect nerve block responsiveness and effects.[6]
Choose CNB or ANB for pediatric inguinal surgeries based on potential problems, safety, and technical feasibility. CNBs are easier to apply and have a lower risk of arterial puncture or intra-vascular injection than ANBs.[7] However, ANBs provide focused analgesia at the surgical site, which may reduce the risk of motor blockade and urine retention associated with widespread sacral nerve blockade in CNB.[8] Therefore, the choice of CNB or ANB should be based on the patient’s, surgeon’s, and institution’s needs.
Several key limitations apply to current investigation. First, the sample size may have been too small to detect modest differences in CNB and ANB analgesic efficacy. Future study needs larger sample sizes to validate and corroborate current findings. Second, the study’s single-center approach may make it tougher to apply the findings. To increase external validity, multi-center research with diverse patient populations are needed. Finally, long-term follow-up data are needed to assess CNB and ANB issues and analgesic durability.
CONCLUSION
In summary, current research indicates that for pediatric patients having inguinal operations, CNB and ANBs had similar analgesic efficaciousness. There are no appreciable variations in the amount of analgesics used or post-operative pain ratings between the two methods’ efficient pain management. Clinical concerns and patient characteristics should be taken into account while deciding between CNB and ANBs. These results emphasize the value of individualized methods to peri-operative analgesia and aid in the optimization of pain management techniques for pediatric surgery patients. It is necessary to conduct more study to examine the safety profiles and long-term results of each procedure.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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