Use of a Modified Spermatic Cord Block in Children During Inguinal Canal Surgery

Introduction. Caudal anesthesia does not always provide satisfactory blockade and has contraindications, which sets goal of searching for new methods of inguinal canal zone blockades.

The aim of the study to assess effect of spermatic cord blockade on central hemodynamics, serum cortisol levels; to evaluate intraoperative and postoperative analgesia in children operated for orchidopexy.

Materials and methods. Prospective non-randomized study was conducted, which included 26 children aged 1 to 17 years, who underwent unilateral orchidopexy. Modified spermatic cord block was performed. Acid-base balance, serum cortisol, central hemodynamic parameters using bioimpedance rheography method, qNOX index using Conox monitor were examined. Postoperative pain syndrome was assessed by FLACC, Wong-Baker, and visual analogue scale depending on age.

Results. Significant decrease in cortisol levels was detected at the time of testicular traction (p < 0.050); according to acid-base balance analyses no significant changes were found. At each stage of surgical intervention statistically significant decreases were detected in mean arterial pressure, stroke volume, total peripheral vascular resistance, and oxygen delivery index (p < 0.050). qNOX index did not increase in response to pain stimulation. Score on postoperative analgesia scales did not exceed 2 [2; 4] points in patients after 1 hr., after 3 hr.— 2 [0; 4], after 6 hr.— 2 [0; 3]; after 12 and 24 hr. — 0 [0; 4] and 0 [0; 0].

Conclusion. Use of a modified spermatic cord block provides effective intraoperative analgesia, reduces body’s stress response to surgery and causes a moderate decrease in central hemodynamic parameters in patients.

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