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We examine the efficacy and complications of general anesthesia with ilioinguinal-iliohypogastric nerve block performed on ex-premature neonates undergoing inguinal herniotomy. The ex-premature neonate has many co-morbidities and is at risk of postoperative apnea and bradycardia. Anesthesia techniques aimed to provide good surgical conditions include general anesthesia and central neuroaxial techniques. There are still significant complications after these techniques and none is superior.A retrospective search of our department's computer database was conducted on ex-premature neonates, post-menstrual age of 48 weeks and under, who received general anesthesia and ilioinguinal-iliohypogastric nerve block for bilateral inguinal herniotomy from 1997 to 2009.Eighty-two neonates were selected. All medical notes were traced and information including the demographics, co-morbidities and perioperative data were obtained. The mean gestational age was 30.3 weeks (sd ± 3.2) and the mean post-conception age was 40.0 weeks (sd ± 3.1). Mean birth weight was 1284 g (sd ± 518) and mean weight at the time of surgery was 2795 g (sd ± 958). Thirty-two (39.0%) neonates had apnea of prematurity, which required caffeine treatment. Thirty-five (42.7%) neonates required intubation for ventilatory support preoperatively. There was a good success rate of the ilioinguinal-iliohypogastric nerve block in 73 (89.0%) patients. They were deemed successful clinically by the attending anesthesiologist. No perioperative rescue opioid was required. Four neonates had postoperative apnea requiring intervention.Ilioinguinal-iliohypogastric nerve block has a success rate similar to other techniques and when combined with general anesthesia, provides a viable alternative technique of anesthesia in these high-risk patients.

Background: EMLA cream is the current technique of choice to reduce pain during venous cannulation in most paediatric practice. Its use is limited by logistic arrangements and failure to improve cooperation and allay anxiety. Nitrous oxide (N 2 O) would appear to be an effective alternative. A combination technique may be useful in selected patients. Methods: One hundred and twenty unpremedicated ASA 1 and 2 day surgery patients, aged 8-15 years were randomized into group 1 (EMLA + air/O 2 ), group 2 (50% N 2 O/50% O 2 ) and group 3 (EMLA + 50% N 2 O/50% O 2 ). All patients underwent cannulation on the dorsum of the hand with a 22-G intravenous catheter. Pain behaviour before cannulation was assessed by an observer with Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). Pain during cannulation was evaluated with CHEOPS by an observer and Visual Analogue Scale (VAS) (0-100 mm) by the patient. Satisfaction score (0-100%) for the experience were reported by the patient. Degree of ease of cannulation, time for cannulation were assessed. Heart rate, oxygen saturation were compared before, during and after cannulation. Results: The self-reported VAS for group 3 (10.10 ± 14.99) was significantly lower than group 1 (26.13 ± 27.59) and group 2 (18.35 ± 18.11) (P = 0.003). No significant difference existed between VAS for group 1 and 2. There were also significantly more patients with VAS = 0 in group 3 (23/40) versus group 2 (11/40) versus group 1 (10/40), P = 0.004. The satisfactory score in group 3 (93 ± 9.96) was significantly higher (P = 0.039) than group 1 (81.13 ± 24.61) and group 2 (84 ± 22.02). The increase in CHEOPS from before to during cannulation was significant only in group 1 (P = 0.002). There was no significant difference between frequency of patients with side-effects, ease of cannulation and time taken for cannulation in the three groups. Conclusions: EMLA and 50% N 2 O are equally effective for pain reduction while a combination technique provides superior analgesia and satisfaction. N 2 O has an advantage over EMLA in reduction of pain related behaviour in older children.