Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair

Purpose: Placement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intrao-perative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambula-tory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia.Design: Randomized controlled trial.Methods: Children aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anes-thesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accord-ingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demo-graphics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery.Findings: A total of 90 children (30 in each group) were included in the analysis. General information, intrao-perative hemodynamic variables, bispectral index score, and duration of surgery were not significantly differ-ent among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] mg/kg/min, 0.33[0.33 to 0.33] mg/kg/min; 0.17[0.17 to 0.20] mg/kg/ min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postop-erative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both).Conclusions: AWNB is associated with a lower intraoperative remifentanil requirement and a lower postoper-ative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.(c) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.