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PEDIATRIC ANESTHESIA

Ultrasonographic-Guided Ilioinguinal/Iliohypogastric Nerve Block in Pediatric Anesthesia: What is the Optimal Volume?

H. Willschke, MD^*, A. Bösenberg, MBChB, FFA(SA), P. Marhofer, MD^*, S. Johnston, MBChB, FCA(SA), S. Kettner, MD^*, U. Eichenberger, MD, O. Wanzel, MD, and S. Kapral, MD^*

*Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna; Division of Anesthesia and Intensive Care Medicine, Orthopedic Hospital Gersthof, Vienna, Austria; Department of Anesthesia, Red Cross Children's War Memorial Hospital, University Cape Town, South Africa; and Department of Anaesthesia, Inselspital Bern, Switzerland

Address correspondence and reprint requests to Harald Willschke, MD, Medical University of Vienna, Department of Anaesthesia and Intensive Care Medicine, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to harald.willschke{at}meduniwien.ac.at.

Recently, our study group demonstrated the usefulness of ultrasonographic guidance in ilioinguinal/iliohypogastric nerve blocks in children. As a consequence, we designed a follow-up study to evaluate the optimal volume of local anesthetic for this regional anesthetic technique. Using a modified step-up-step-down approach, with 10 children in each study group, a starting dose of 0.2 mL/kg of 0.25% levobupivacaine was administered to perform an ilioinguinal/iliohypogastric nerve block under ultrasonographic guidance. After each group of 10 patients, the results were analyzed, and if all blocks were successful, the volume of local anesthetic was decreased by 50%, and a further 10 patients were enrolled into the study. Failure to achieve a 100% success rate within a group subjected patients to an automatic increase of half the previous volume reduction to be used in the subsequent group. Using 0.2 and 0.1 mL/kg of 0.25% levobupivacaine, the success rate was 100%. With a volume of 0.05 mL/kg of 0.25% levobupivacaine, 4 of 10 children received additional analgesia because of an inadequate block. Therefore, according to the protocol, the amount was increased to 0.075 mL/kg of 0.25% levobupivacaine, where the success rate was again 100%. We conclude that ultrasonographic guidance for ilioinguinal/iliohypogastric nerve blocks in children allowed a reduction of the volume of local anesthetic to 0.075 mL/kg.

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