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COMPARISON OF THE ONE-PLANE AND TWO-PLANE METHOD OF ULTRASOUND-GUIDED ILIOINGUINAL-ILIOHYPOGASTRIC (II/IH) NERVE BLOCK AS POSTOPERATIVE ANALGESIA IN A PEDIATIRC AMBULATORY HERNIORRHAPHY
Author(s): ,
Miyazawa, N.*
Affiliations:
Tokyo Metropolitan Children's Medical Center, Anesthesia, Tokyo, Japan
,
Minoshima, R.
Affiliations:
Keio University School of Medicine, Anesthesiology, Tokyo, Japan
,
Ishida, S.
Affiliations:
Tokyo Metropolitan Children's Medical Center, Anesthesia, Tokyo, Japan
,
Kitamura, H.
Affiliations:
Tokyo Metropolitan Children's Medical Center, Anesthesia, Tokyo, Japan
Shinto, A.
Affiliations:
Tokyo Metropolitan Children's Medical Center, Anesthesia, Tokyo, Japan
ESRA Academy. Miyazawa N. Sep 15, 2017; 196149
Noriko Miyazawa
Noriko Miyazawa
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Abstract
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Background and Aims:

The II/IH nerve block is normally performed between internal oblique muscle (IOM) and transversus abdominis muscle (TAM). We hypothesized that a two-plane block, i.e. IOM/TAM and external oblique muscle (EOM)/IOM, would be more effective for postoperative analgesia. This study was a randomized, controlled, prospective study comparing the efficacy of one-plane and two-plane block as postoperative analgesia in pediatric ambulatory unilateral inguinal herniorrhaphy.

Methods:

After IRB approval, 263 patients aged 6 months to 8 years were randomly assigned to either one-plane (TAM/IOM) or two-plane (TAM/IOM and EOM/IOM) group. The one-plane group received a 0.2% ropivacaine 0.3ml/kg. The two-plane group received a 0.2ml/kg injection between TAM/IOM followed by a 0.1ml/kg injection between EOM/IOM. The primary outcome was the FLACC scale after 45 minutes evaluated by PACU nurses blinded to the groups. The secondary outcome was additional analgesia within two and 24 hours. Body-movement at incision was interpreted as failed block. Statistical analysis was performed using Mann-Whitney U-test and Pearson’s Chi-squared test.

Results:

242 patients completed this study. No patient moved at incision. The FLACC scale at 45 minutes didn’t differ significantly between the groups (p=0.354). No analgesics were required by 85.1% and 76.5% patients in one-plane group and 78.5% and 64.4% patients in two-plane group at two and 24 hours without significant difference (P=0.182, P=0.068), respectively.

Conclusions:

Both methods achieved sufficient post-operative analgesia. There was no significant difference either in the FLACC scale at 45 minutes after anesthesia or in the requirement for analgesia within 24 hours between the groups.

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