RESUMEN
BACKGROUND AND AIMS: The purpose of this study was to compare the analgesic efficacy of the ilioinguinal-iliohypogastric nerve block (II/IH) with local wound infiltration in children undergoing herniotomy surgeries. METHODS: After ethics committee approval and informed consent, 100 children aged 6 months-7 years posted for herniotomy surgeries were randomly divided into Group B and Group W. Local wound infiltration was performed in Group W by the surgeon at the time of port placement and the end of the surgery with 0.2 mL.kg-1 of 0.25% bupivacaine. Ipsilateral II/IH was performed in Group B at the end of the surgery, under ultrasonographic guidance with a Sonosite portable ultrasound unit and a linear 5-10 MHz probe with a 22G hypodermic needle, and 0.2 mL.kg-1 of 0.25% bupivacaine was used on each side. The parameters recorded were postoperative hemodynamics, paracetamol and opioid requirements, postoperative pain scores, postoperative nausea vomiting, and the need for rescue analgesia in the first 6 h postoperatively. RESULTS: The median pain scores were significantly lower in the II/IH group than the local wound infiltration group at 10 min (2 [0-2.5] compared to 2 [3-4]; P = 0.011), 30 min (1.5 [0-3] compared to 3 [2-5]; P < 0.001), 1 h (1.5 [0-2] compared to 2 [2-3]; P < 0.001) and 2 h (2 [0-2] compared to 2 [1.5-2.5]; P = 0.010) postoperatively. The need for postoperative opioids and rescue analgesia was also significantly lower in the II/IH group (P < 0.001). CONCLUSION: II/IH is superior to local wound infiltration for postoperative analgesia in pediatric herniotomy surgeries.
RESUMEN
BACKGROUND: Ulnar nerve blockade as a component of wrist block is a promising technique for adequate anesthesia and analgesia for different surgeries of the hand. Due to anatomical variations in the location of ulnar nerve under the flexor carpi ulnaris (FCU) a technique with good results and minimal complications are required. AIM: The aim of the following study is to compare the three techniques (volar, transtendinous volar [TTV] and ulnar) for ulnar nerve block at the wrist in human cadaveric wrists. MATERIALS AND METHODS: Our study was conducted using 40 cadaver wrists. After inserting standard hypodermic needles by three techniques for ulnar nerve blockade at the wrist, a detailed dissection of FCU was done. The mean distance from the tip of the needle to ulnar artery/nerve and number of instances in which the ulnar artery/nerve pierced were observed. RESULTS: Inter-group statistical significance was observed in measurement of the mean distance (mm) from the tip of the needle to the ulnar artery (volar [0.92 ± 0.11], TTV [3.96 ± 0.14] and ulnar [7.14 ± 0.08] approaches) and ulnar nerve (volar/TTV/ulnar approaches were 0.71 ± 0.12/3.61 ± 0.10/6.31 ± 0.49, respectively) (P = 0.001). Inadvertent intra-arterial/intraneural injections was seen with volar approach in 14 (35%) and 16 (40%) of the cadaveric wrists respectively, statistically significant with transtendinous and ulnar techniques of ulnar nerve block. CONCLUSION: TTV approach could be a better technique of choice for ulnar nerve blockade at the wrist because of its ease to practice, safer profile and minimum chances of inadvertent intra-arterial/intraneural injection with adequate anesthesia/analgesia.