الفهرس 
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Abstract
Regional anesthesia plays an important role in the perioperative anesthetic management of children and particularly of babies and neonates undergoing surgery. Perfect block techniques are required for an improved perioperative outcome. With performing blocks using blind techniques, there is a significant high failure rates and possible serious complications. Also although all the blocks used in adult practice are possible in children many blocks are underused or avoided. This is largely from fear of complications and failure, and limited experience with complicated techniques.
The scope of ultrasound imaging guidance for regional anesthesia is growing rapidly suggesting that ultrasound can improve block success rate and decrease complications.
Classical caudal epidural block is the most frequently used regional technique in children; accounting for almost 50% of all regional technique, its popularity is due its simplicity and high success rate, but with blind technique, higher failure rates and more serious complications such as intravascular, intrathecal injections are much more likely. The use of ultrasound imaging for caudal epidural block provides higher success rates and render these serious complications less likely.
The ilioinguinal/iliohypogastric nerve block is also a popular regional anaesthetic technique for surgical procedures in the sensory area of the ilioinguinal and iliohypogastric nerves for inguinal surgery (inguinal hernia repair or orchidopexy, but the failure rate with this ‘blind’ technique is a disappointing (20–30%) , even in experienced hands. In addition, complications such as colonic or small bowel punctures and pelvic hematoma have been described.
The present study was conducted on 45 children aged from one to six years old of both sex, ASA physical status I and II ,scheduled for elective inguinal hernia repair, orchidopexy and hydrocele repair, aiming to evaluate the use of ultrasound-guided ilioinguinal/iliohypogastric nerve block in pediatric patients regarding the efficacy of the block, the dose of local anesthetic administered and the incidence of complication in comparison with caudal epidural anesthesia and also the classic anesthetic – Opioid technique.
In the present study all patients received general anesthesia then they were randomized into three groups:
group A received ultrasound guided caudal epidural block,
group B received ultrasound-guided ilioinguinal/ iliohypogastric nerve block.
group C received general anesthesia with IV morphine (0.1mg/kg).
The present study demonstrated that U/S-guided ilioinguinal/ iliohypogastric nerve block technique is effective in controlling intraoperative and postoperative pain and has many advantages over the use of ultrasound guided caudal epidural block and the use of intravenous opioids and the caudal blocks.
These advantages include rapid onset of action, decreasing the dose of local anesthetic used without affecting the quality of the block, this is particularly important in infant and preterm as it decrease the incidence of local anesthetic toxicity, increasing the success rate of ilioinguinal/ iliohypogastric nerve block as ultrasound allow direct visualization of the nerve and under real time image, precise injection of local anesthetic around nerve regardless the anatomical variation in the children, increase the safety as there were no complications recorded with the use of ultrasound-guided ilioinguinal/ iliohypogastric nerve block, and increase the duration of postoperative analgesia.