Ultrasound Blocks for the Anterior Abdominal Wall

72 | Ultrasound Blocks for the Anterior Abdominal Wall
Iliohypogastric and Ilioinguinal Nerve Block and
Wound Infiltration
Many studies have compared IIB to LIA. Simple infiltration of
the wound with local anesthetic solution should be encouraged
in pediatric anesthesia as it may become as effective as IIB. IIB
has been shown to be more effective than simple wound
infiltration for postoperative pain and analgesic request in
inguinal surgery (Caetano 2006). Also, IIB associated with LIA
may improve analgesia after inguinal surgery.
Ultrasound-guided IIB is effective in reducing intra- and
postoperative pain in children undergoing inguinal hernia
repair, orchidopexy or hydrocele repair (Willschke 2005).
Ultrasounds reduce the required volume of local anesthetic
(Willschke 2006). The reduction in the dose is also necessary
because of reported higher plasma levels of local anesthetic after
ultrasound-guided blocks (Weintraud 2009).
Iliohypogastric and Ilioinguinal Nerve Block and
Caudal Anesthesia
The IIB for inguinal procedures may provide analgesia
comparable to a caudal injection, possibly with a longer mean
duration (Hannallah 1987, Markham 1986). The adverse effects of
motor block and urinary retention are eliminated. Heart rate,
linear analogues score, total amount of analgesic and time of
first administration of analgesics have been evaluated as criteria
for the efficacy of the analgesic technique.
The IIB compared to a caudal block revealed similar recovery
times and no difference in postoperative pain or discomfort
scores after inguinal hernia repair (Hannallah 1987). Both
procedures have a similar duration of action of at least 6 hours.
No difference in the number of patients without pain for 4 h or
in those requiring analgesics by 24 h has been reported
compared to caudal block (Fisher 1993). Similarly, children