Ultrasound-guided retrolaminar block versus ilioinguinal nerve block for postoperative analgesia in children undergoing inguinal herniotomy: A randomized controlled trial

Study objective: Ultrasound-guided retrolaminar block (RLB) is a new, safe and technically easy nerve block. To our knowledge, no studies have evaluated its analgesic efficacy in pediatric patients. This study aimed to compare the postoperative analgesic efficacy of RLB and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy. Design: Superiority, prospective, randomized, double-blinded, controlled study. Setting: Operating rooms and wards of Mansoura University Children's Hospital, Egypt. Patients: Sixty-five patients aged 2 to 6 years undergoing unilateral inguinal herniotomy were enrolled. Interventions: In the ultrasound-guided RLB group (n = 30), we injected 0.5 mL/kg bupivacaine 0.25% into the retrolaminar space between the lamina of T12 and the paraspinal muscles and in ultrasound-guided INB group (n = 30), 0.5 mL/kg bupivacaine 0.25% was injected for INB. Measurements: The primary outcome measure was the number of patients requiring ibuprofen as rescue analgesia and the secondary outcome measures were intraoperative hemodynamic changes and the postoperative FLACC (Face, Legs, Activity, Cry, Consolability) score. Main results: The number of patients who needed rescue analgesia in the first postoperative 24 h was significantly lower (P = 0.023) in the RLB group [5 (16%)] than the INB group [13 (43%)]. The mean (SD) arterial blood pressure and heart rate were significantly higher (P < 0.001) during sac traction in the INB group [74.07 (2.99), 97.33 (6.98)] than the RLB group [67.73 (3.55), 90.79 (5.13)]. The postoperative FLACC scores at 4, 6, 12, and 24 h were significantly lower (P < 0.05) in the RLB group than in the INB group. Conclusion: Retrolaminar block is superior to ilioinguinal nerve block in providing postoperative analgesia in pediatric patients undergoing unilateral inguinal herniotomy.

Automated summary

This study aimed to compare the postoperative analgesic efficacy of ultrasound-guided retrolaminar block (RLB) and ilioinguinal nerve block (INB) in pediatric patients undergoing unilateral inguinal herniotomy. The results showed that RLB group had significantly lower number of patients needing rescue analgesia in the first 24 hours postoperatively, lower mean arterial blood pressure and heart rate during sac traction, and lower postoperative FLACC scores compared to the INB group.