Ultrasonography-guided ilioinguinal-iliohypogastric nerve block for inguinal herniotomies in ex-premature neonates

The ilioinguinal-iliohypogastric (IG-IH) nerve block provides effective opioid-sparing analgesia for inguinal surgeries. The technique is especially useful in apnoea-prone premature neonates with sacral anomalies and coagulopathy. A recent retrospective review of 82 ex-premature neonates who underwent inguinal herniotomy at KK Women's and Children's Hospital, Singapore, reported a success rate of 89% for landmark-guided IG-IH blocks. All blocks in that study were performed by senior paediatric anaesthetists using the landmark-based technique, which relies on fascial clicks. The IG-IH block is expected to be technically more difficult in neonates. There is also a stronger need to ensure success in these patients in order to avoid the use of opioids and reduce the risk of postoperative apnoea. Ultrasonographic guidance has been reported to improve the success of IG-IH blocks in older children to up to 94%. Herein, we report a series of six ex-premature neonates in whom ultrasonography-guided IG-IH blocks were successfully performed using reduced volumes of local anaesthetics (mean volume 0.17 mL/kg) for inguinal herniotomy.