Regional Anaesthetic Techniques in Laparoscopic Inguinal Hernia Repair in Children: A Systematic Review

Regional anaesthetic modalities are employed to mitigate intraoperative and postoperative pain in children undergoing laparoscopic inguinal hernia repair (LIHR), forming an important component of multimodal perioperative analgesia. This review aims to evaluate the literature on regional anaesthetic use in LIHR in children.

A systematic review was conducted (1993-2025) using PRISMA guidelines. Selected studies included randomised controlled trials and cohort studies that evaluated regional anaesthetic techniques in LIHR in patients ≤16 years. The ROBINS-I (Risk of Bias in Non-randomised Studies of Interventions) and RoB 2 (Cochrane Risk-of-Bias tool for randomized trials) tools assessed the quality of included studies. The study was prospectively registered with PROSPERO (CRD420251072969).

6 databases were searched, identifying 3882 articles. 8 studies with 770 patients were included. Utilised regional anaesthetic techniques included: rectus sheath block (RSB), local infiltration (LAI), quadratus lumborum block, transversus abdominis plane block (TAPB), intrathecal block and abdominal wall nerve block (AWNB). Four studies compared regional anaesthesia with controls, finding that RSB, LAI, caudal block, intrathecal anaesthesia, TAPB, and AWNB, resulted in lower pain scores and analgesic consumption than controls. The remaining four studies compared two regional anaesthetic modalities, with mixed results.

Several regional techniques have been described for LIHR, with considerable heterogeneity in the outcomes used to assess perioperative pain. Evidence from this review suggests that regional anaesthetic modalities provide superior analgesia compared to general anaesthesia alone. However, no single technique can presently be recommended as superior. Further research is required to establish standardised approaches to regional anaesthesia in LIHR.