title: Ultrasound-guided ilioinguinal/iliohypogastric block did not reduce emergence delirium after ambulatory pediatric inguinal hernia repair: a prospective randomized double-blind study.
abstract: OBJECTIVE
  Emergence delirium (ED) is a common postoperative complication of ambulatory pediatric surgery done under general anesthesia with sevoflurane. However, perioperative analgesic techniques have been shown to reduce sevoflurane-induced ED. The primary objective of this investigation was to examine whether an ultrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve block for ambulatory pediatric inguinal hernia repair could reduce the incidence of sevoflurane-induced ED.
  
  
  METHODS
  The subjects of this prospective randomized double-blind study were 40 boys ranging in age from 1 to 6 years, who were scheduled to undergo ambulatory inguinal hernia repair. The patients were randomized to either receive or not to receive an ultrasound-guided II/IH nerve block (Group B and Group NB, respectively). General anesthesia was maintained with sevoflurane and nitrous oxide. The primary outcome assessed was ED, evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scale 30 min after emergence from general anesthesia. The secondary outcomes assessed were postoperative pain, evaluated using the Behavioral Observational Pain Scale (BOPS), and the amount of intra-operative sevoflurane given.
  
  
  RESULTS
  The median PAED scale scores did not differ between Groups B and NB at 30 min (P = 0.41). BOPS scores also did not differ significantly between the groups, but the mean amount of intraoperative sevoflurane given was significantly lower in Group B than in Group NB (P < 0.01).
  
  
  CONCLUSIONS
  Ultrasound-guided II/IH nerve block for ambulatory pediatric inguinal hernia repair did not reduce ED, but it did decrease the amount of intra-operative sevoflurane needed.
  
  
  BACKGROUND
  UMIN000008586.
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata-City, Niigata, 951-8510, Japan. ww81854@sa2.so-net.ne.jp.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Ohashi
authors.affiliation: Department of Anesthesiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Sadahei
authors.initials: S
authors.lastname: Denda
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata-City, Niigata, 951-8510, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Furutani
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata-City, Niigata, 951-8510, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata-City, Niigata, 951-8510, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kamiya
authors.affiliation: Department of Anesthesiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Komura
authors.affiliation: Department of Anesthesiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Nishimaki
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iinuma
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirayama
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Naitou
authors.affiliation: Department of Pediatric Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata-City, Niigata, 950-1197, Japan.
authors.forename: Koju
authors.initials: K
authors.lastname: Nitta
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata-City, Niigata, 951-8510, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Baba
mesh_terms: D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D000071257:Emergence Delirium / Q000209:etiology / Q000517:prevention & control; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D007223:Infant; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D009407:Nerve Block / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D000077149:Sevoflurane; D014463:Ultrasonography
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: Emergence delirium; Pediatric patient; Postoperative pain; Ultrasound-guided nerve block