Evaluation of Caudal Block and Ilioinguinal/Iliohypogastric Nerve Block Efficacy With Perfusion Index in Pediatric Inguinal Hernia Operations under General Anesthesia: A Randomized Controlled Trial.

PURPOSE: This study aimed to evaluate the analgesic efficacy of caudal and ilioinguinal/iliohypogastric (II/IH) nerve blocks using perfusion index (PI) and pleth variability index (PVI) in pediatric inguinal hernia surgeries.

DESIGN

This study was a prospective, randomized, double-blind, controlled, three-arm trial.

METHODS

Ninety-six children (2 to 8 years; ASA I-II) undergoing unilateral inguinal hernia repair under general anesthesia were randomized into Group I (control), Group II (caudal), or Group III (II/IH). Analgesia success was defined a priori as a greater than or equal to 100% increase in PI at incision versus baseline. Outcomes included demographics; PI/PVI and hemodynamics; anesthesia/surgery durations; intra-/postoperative rescue analgesia; FLACC scores (0, 2, 6 hours); discharge time; and complications.

FINDINGS: Demographics, anesthesia/surgery durations, and complications were similar among groups. Group II showed a significantly higher prevalence of successful analgesia than Group I (P = .010). PI values at 0, 5th, and 15th minutes after incision were lower in Group I than in Group II-III (P = .001, P = .041, P = .047, respectively). Cutoff values for PI were greater than 4.6 for the control, greater than 5.3 for the caudal, and greater than 4.5 for the II/IH groups. In Group I, intraoperative/postoperative opioid requirements (P = .045, P < .001), FLACC scores (P < .001), and discharge duration (P = .026) were significantly higher than in the other groups.

CONCLUSIONS

This is the first prospective study using PI to assess the success of caudal and II/IH blocks in pediatric inguinal hernia surgeries. Both blocks effectively reduced postoperative pain, analgesic use, and discharge times. We recommend PI for evaluating intraoperative analgesia efficacy in pediatric patients. Further studies with larger samples and broader age ranges are warranted.