Paravertebral block (PVB) has been used for postoperative
analgesia in children since 1992. There are no prospective randomised studies comparing the use of PVB versus caudal block (CB) for outpatient
inguinal hernia repair surgery. The hypothesis of this study is that a single level, single injection PVB can provide a longer duration of
analgesia and less requirement for supplemental
analgesia than single shot CB for children undergoing inguinal surgery. Seventy children, aged three to seven, American Society of Anesthesiologists score I to II, having unilateral inguinal surgery were enrolled in the study. The patients were divided into two randomised groups. In group PVB, a single shot of 0.2 ml/kg
levobupivacaine was administered via the lumbar paravertebral route and in group CB, patients were given 1 ml/kg
levobupivacaine caudally.
Sevoflurane concentration was evaluated after induction and recorded during incision, sac
traction and closure. Face, legs, activity, cry and consolability (FLACC) scores, heart rate, blood pressure and SpO2 were evaluated postoperatively. Only four (11.4%) patients in the PVB group needed rescue
analgesic drugs compared to 12 (34.3%) patients in the CB group (P = 0.044). Patients were given
tramadol as rescue
analgesia in the first four postoperative hours. No other supplemental
analgesic drug was given apart from
tramadol. FLACC scores were the same in the both groups. Parental satisfaction was significantly higher in the PVB group compared to the CB group (74.3 vs 40%, P = 0.01). This study has demonstrated that a single level single injection paravertebral block provides superior intraoperative and postoperative
analgesia when compared to a caudal block for unilateral
inguinal hernia repair.