الفهرس 
ULTRASOUND GUIDED PERIPHERAL NERVE BLOCKOnly 14 pages are availabe for public view
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Abstract
Abstract
Background: The ilioinguinal/iliohypogastric nerve block is a popular regional anaesthetic technique for children undergoing inguinal surgery. The success rate is only 70–80% and complications may occur. Also caudal epidural anesthesia is a common technique accounting for almost 50% of all regional techniques. Its popularity is due its simplicity and high success rate. Ultrasound represents a new era in regional anesthesia, one of improved anatomical knowledge, enhanced practical techniques and increased predictability and success with reduced complications. Methods: One hundred children aged, 1–8 years scheduled for inguinal hernia repair, orchidopexy or hydrocele repair were included in the study. Following induction of general anaesthesia, the children divided randomly into either group A or group B(n=50,each).group A received caudal epidural anesthesia using 1 ml/Kg of bupivaccine 0.25% ,group B received ultrasound-guided ilioinguinal/iliohypogastric block using bupivacaine 0.25% until both nerves were surrounded by the local anaesthetic. Heart rate, MAP and respiratory rate were recorded intaroperative and postoperative, duration of postoperative analgesia, dose of local anesthetic needed to surround both nerves in ultrasound group were recorded. Results: Ultrasound-guided ilioinguinal/iliohypogastric nerve block had rapid onset of action where there were significant increase in heart rate, respiratory rate and MAP at skin incision in caudal group compared to ultrasound group (P<0.05), the duration of postoperative analgesia was longer in ultrasound group (285 ± 40.55 min) compared to (118 ± 25.5 min) in caudal group, the dose of local anesthetic was (2.54±0.950 ml) in the ultrasound group with the lowest dose being 0.15 ml/Kg, this dose was not correlated with neither the age nor the weight of the patients, there were no recorded complication in ultrasound group while the incidence of complication in caudal group was 12% (4% intravascular puncture,2% intrathecal puncture and 6% subcutaneous injections). Conclusion: Caudal epidural anesthesia in children has a similar effectiveness as ultrasound-guided ilioinguinal/ iliohypogastric nerve block as regard the intraoperative and immediate postoperative analgesia, Ultrasound-guided ilionguinal/iliohypogastric nerve block carried the advantage of faster onset of action, longer duration of postoperative analgesia, the need of lower volume of local anesthetic with no complications recorded with this technique when compared to the caudal epidural block.
Key words: ultrasound- ilioinguinal/iliohypogastric nerve block- caudal epidural block-pediatric.