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Caudal block versus abdominal wall nerve blocks for inguinal procedures in children - a retrospective analysis at a Reference Childrens’ Hospital in the ultrasound era

Ana Rita Vieira1, António Moniz2, Teresa Rocha3

1 - Interno de Anestesiologia, Centro Hospitalar de Lisboa Ocidental
2 - Assistente Hospitalar Graduado, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central
3 - Chefe de Serviço, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central

-  34th annual ESRA congresso 2015 – Ljubljana, Eslovénia

Background: Caudal block and abdominal wall nerve blocks are effective anesthetic techniques for pediatric inguinal surgery, which can cause a significant degree of discomfort postoperatively.
Aims: The present study has been carried out to assess whether blind caudal block is still preferred to ultrasound-guided abdominal wall nerve blocks in children undergoing inguinal surgery, at a reference childrens’ hospital where the ultrasound techniques have been gaining a wider application in the last few years.
Methods: Retrospective data collection from a clinical logbook on children that were submitted to inguinal hernia repair, orchidopexy or hydrocele repair, between March 2014 and March 2015.
Results: 161 children were enrolled. 146 male and 15 female, from 2 months to 7 years. 83 caudal blocks, 50 ilioinguinal/iliohypogastric nerve blocks and 28 TAP blocks were performed, with 0.2%, 0.375% ropivacaine or 0.125%, 0.25% levobupivacaine in 0.1-0.5mL/Kg single-shot boluses. 65 orchidopexys, 63 hernia and 33 hydrocele repairs were performed. Caudal block was the technique of choice for orquidopexy (54%) and hernia repair (57%); represented 71.6% of all techniques in children under 2 years and 80.8% for the 26 bilateral procedures. Ultrasound-guided abdominal wall blocks were preferred for unilateral procedures (54%) and for hydrocele repairs (45.5%).
Conclusions: Our study showed that a larger number of ultrasound-guided abdominal wall nerve blocks have been performed to pediatric inguinal surgery. However, landmark-based caudal anaesthesia stills the single most important regional technique in children, despite our conviction that ultrasound-guided techniques will be the future.

Palavras Chave: Caudal block ultrasound guided