Interest of Caudal Anesthesia in Inguinal Hernia Surgery in Children, About 20 Cases

Case Report

Austin J Clin Case Rep. 2020; 7(4): 1176.

Interest of Caudal Anesthesia in Inguinal Hernia Surgery in Children, About 20 Cases

Ed-dafali Larbi, Yassine Smiti*, Aziza Bentalha, Salma Ech-cherif Kettani and Alae El Koraichi

Department of Anesthesia and Resuscitation, Rabat Children’s Hospital, Moracco

*Corresponding author: Yassine Smiti, Department of Anesthesia and Resuscitation, Rabat Children’s Hospital, Moracco

Received: October 19, 2020; Accepted: October 30, 2020; Published: November 06, 2020


Introduction: Locoregional anesthesia occupies a major place in pediatric anesthesia because, combined with general anesthesia, it allows reducing the anesthetics doses, and it provides effective prolonged analgesia and allows reducing the use of opioids postoperatively. The main objective of our study is to show the interest of the caudal anesthesia in inguinal hernia surgery in children.

Materials and Methods: This is a prospective study, spread over a period of 9 months, involving 20 children operated for inguinal hernia.

Results: The FLACC score was less than 3 in all patients during the first 6 hours postoperatively. The incidence of PONV was 20% and the bladder was 10%.

Conclusion: Our study shows the benefit of caudal anesthesia in inguinal hernia surgery.

Keywords: Inguinal Hernia; Caudal Anesthesia; Children


Locoregional Anesthesia (LRA) has become essential in pediatric anesthesia. Combined with general anesthesia, it reduces the dose of inhaled anesthetics. Also, it provides a prolonged per and postoperative analgesia and allows saving of morphine. All this allows early postoperative rehabilitation.

The caudal anesthesia was introduced in 1933. Since then, it has become the gold standard for inguinal hernia surgery. However, and due to the rich vascularization of the sacral space, the risk of systemic passage toxicity. Also, the caudal anesthesia is difficult to achieve in several situations such as spinal malformations or coagulation disorders.

The aim of our study is to evaluate the effectiveness of this block in the anesthesia of the treatment of Inguinal Hernia (IH) in terms of intra and postoperative analgesia and perioperative complications.

Material and Methods

This is a prospective study conducted in the Children’s hospital of the Rabat, over 5 months.

A ultrasound-guided caudal anesthesia CB with 0.5 ml / kg of 0.25% Bupivacaine using a 20 G spinal needle.

The operations are carried out under general anesthesia. The anesthetic protocol is standardized. Intraoperative monitoring consists of a continuous electrocardiogram, a pulse oximeter, noninvasive blood pressure monitoring and capnography.

Induction with sevoflurane and then supplemented by administration of propofol at a dosage of 2.-mg / kg. A laryngeal mask is then inserted and the patient is then positioned for the performance of the block. The time to complete the block is noted and the surgical incision is made after a minimum of 15 minutes. Hemodynamic parameters are noted during the surgical procedure. Any increase in hemodynamic parameters of more than 20% means an insufficient analgesia and failure of the block. The treatment involves injection of 0.1 μg/kg of Sufentanyl.

The patients are transferred to SSPI after removal of the laryngeal mask where the hemodynamic parameters and the FLACC score are noted at H0, H1/2, H1, H2, H3, H6.


The average age of the patients was 4 years with extremes ranging from 12 months to 9 years. The sex ratio was 4/1 and all patients were ASA I.

The average weight of our patients was 19 Kg, with extremes of 10 and 38 Kg. The blocks were performed on the first attempt in 90% of patients, and on the second attempt in 10% of patients. The average duration of the realization was 4.3 minutes.

The mean duration of the operative procedure was 38 minutes with extremes of 25 and 60 minutes. The median theoretical MAC was 2.5.

The variations in Heart Rate (HR), Mean Arterial Pressure (MAP) and halogenated requirements relative to the theoretical MAC intraoperatively are described in Table 1.

Citation: Ed-dafali Larbi, Smiti Y, Bentalha A, Ech-cherif Kettani S and El Koraichi A. Interest of Caudal Anesthesia in Inguinal Hernia Surgery in Children, About 20 Cases. Austin J Clin Case Rep. 2020; 7(4): 1176.