New methods of anesthesia for the inguinal canal area

Various pathologies directly related to the inguinal canal remain among the most common conditions in pediatric surgery. Their high incidence encourages the search for new anesthesia methods that consider the individual characteristics of each patient. This review provides an overview on a relatively new method of inguinal canal anesthesia: the spermatic cord block. The authors also propose a modified block technique that expands the applicability of this anesthesia technique.

1. Zabolotskii DV, Koryachkin VA, Ulrikh GE, Ivanov MD, Stepanenko SM, Pogorelchuk VV. Draft of clinical recommendations on the use of neuroaxial anesthesia in children for perioperative analgesia. Regional Anesthesia and Acute Pain Management. 2017;11(4):279–290. (In Russ.). DOI: https://doi.org/10.18821/1993-6508-2017-11-4-279-290.

2. Matinyan NV, Zabolotski DV, Martynov LA, Letyagin IA. Caudal epidural anesthesia in pediatric patients. Regional Anesthesia and Acute Pain Management. 2018;12(1):55–63. (In Russ.). DOI: https://doi.org/10.18821/1993-6508-2018-12-1-55-63.

3. Raux O, Dadue C, Carr J, Rochette A, Capdevila X. Paediatric caudal anaesthesia. Update in Anaesthesia. 2015;30(1):88–92. URL: https://clck.ru/3KVqrX [accessed 3 April 2025].

4. Verghese ST, Hannallah RS, Rice LJ, Belman AB, Patel KM. Caudal anesthesia in children: Effect of volume versus concentration of bupivacaine on blocking spermatic cord traction response during orchidopexy. Anesthesia & Analgesia. 2002;95(5):1219–1223. DOI: https://doi.org/10.1097/00000539-200211000-00019.

5. Struller F, Weinreich FJ, Horvath P, Kokkalis MK, Beckert S, Königsrainer A, et al. Peritoneal innervation: Embryology and functional anatomy. Pleura Peritoneum. 2017;2(4):153–161. DOI: https://doi.org/10.1515/pp-2017-0024.

6. Wang T, Xiang Q, Liu F, Wang G, Liu Y, Zhong L. Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy. Journal of Anesthesia. 2013;27(5):650–656. DOI: https://doi.org/10.1007/s00540-013-1613-9.

7. Larousse E, Asehnoune K, Dartayet B, Albaladejo P, Dubousset AM, Gauthier F, et al. The hemodynamic effects of pediatric caudal anesthesia assessed by esophageal doppler. Anesthesia & Analgesia. 2002;94(5):1165–1168. DOI: https://doi.org/10.1097/00000539-200205000-00020.

8. Belic OV, Peicova MN. Individual variability of the innervation of the inguinal region. Advances of morphology: introduction of new technologies into the educational process and practical medicine. 2022:17- 20. E-LIBRARY: https://elibrary.ru/iyrsoq

9. Amid PK, Chen DC. Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair. Journal of the American College of Surgeons. 2011;213(4):531-536. DOI: https://doi.org/10.1016/j.jamcollsurg.2011.06.424

10. Gordon J, Rifenburg RP. Spermatic Cord Anesthesia Block: An Old Technique Re-imaged. Western Journal of Emergency Medicine. 2016;17(6):811-813. DOI: https://doi.org/10.5811/westjem.2016.8.31017

11. Elemam EM, Abdelbaser I, Elbahrawy K, Alseoudy MM, El Kenany S. Efficacy of combining ultrasound- guided spermatic cord block with ilioinguinal nerve block for analgesia in pediatric inguinal herniotomy: A randomized controlled study. Revista Española de Anestesiología y Reanimación. 2025;72(6):501675. DOI: https://doi.org/10.1016/j.redare.2025.501675

12. Mokini Z, Vitale G, Aletti G, Sacchi V, Mauri T, Colombo V et al. Pain control with ultrasound-guided inguinal field block compared with spinal anesthesia after hernia surgery: a randomized trial. Surgery. 2015;157(2):304-311. DOI: https://doi.org/10.1016/j.surg.2014.09.002

13. Wakefield SE, Elewa AA. Spermatic cord block: A safe technique for intrascrotal surgery. Annals of the Royal College of Surgeons of England. 1994;76(6):401–402. PMID: https://pubmed.gov/7702323.

14. Zhou Y, Gong WY, Zhang JY, Li CG, Xu B, Zhang DQ et al. The effect of combined pudendal nerve and spermatic cord block or caudal epidural block on postoperative analgesia after posterior urethroplasty: a randomized trial. BMC anesthesiology. 2024;24(1):380. DOI: https://doi.org/10.1186/s12871-024-02744-x

15. Birkhäuser FD, Wipfli M, Eichenberger U, Luyet C, Greif R, Thalmann GN. Vasectomy reversal with ultrasonography-guided spermatic cord block. BJU International. 2012;110(11):1796–1800. DOI: https://doi.org/10.1111/j.1464-410X.2012.11099.x.

16. Li Y, Feng X, Chen D, He Y, Fang T, Tai L et al. Single-point ultrasound-guided iliohypogastric- ilioinguinal-genitofemoral nerve block for inguinal hernia surgery in older adult patients: a randomized controlled trial. Quantitative imaging in medicine and surgery. 2024;14(12):8249-8259. DOI: https://doi.org/10.21037/qims-24-787

17. Simon DP, Bajic P, Lynch KM, Levine LA. Spermatic cord block series as a minimally invasive therapy for chronic scrotal content pain. The Journal of Urology. 2021;206(3):725–732. DOI: https://doi.org/10.1097/JU.0000000000001777.

18. Urbanski M, Walker D, Morrison JC, Islam MM. Post-vasectomy Pain Syndrome: A Review of the Literature and Updated Treatment Algorithm. Cureus. 2025;17(2):e79592. DOI: https://doi.org/10.7759/cureus.79592

19. Kaye KW, Lange PH, Fraley EE. Spermatic cord block in urologic surgery. The Journal of Urology. 1982;128(4):720–721. DOI: https://doi.org/10.1016/s0022-5347(17)53154-7.

20. Fuchs EF. Cord block anesthesia for scrotal surgery. The Journal of Urology. 1982;128(4):718–719. DOI: https://doi.org/10.1016/S0022-5347(17)53153-5.

21. Issa MM, Hsiao K, Bassel YS, Bouet R, Young MR, Petros JA. Spermatic cord anesthesia block for scrotal procedures in outpatient clinic setting. The Journal of Urology. 2004;172(6 Pt 1):2358–2361. DOI: https://doi.org/10.1097/01.ju.0000144544.43148.10.

22. Reale C, Corinti R, Galullo B, Borgonuovo P, Borgonuovo P. Infiltrazione anestetica del funicolo spermatico nella chirurgia dell’idrocele voluminoso [Anesthetic infiltration of the spermatic cord in surgery for voluminous hydrocele]. Archivio Italiano di Urologia, Andrologia. 1998;70(3 Suppl):43–46. (In Ital.). PMID: https://pubmed.gov/9707771.

23. Aggarwal H, Chiou RK, Siref LE, Sloan SE. Comparative analysis of pain during anesthesia and no-scalpel vasectomy procedure among three different local anesthetic techniques. Urology. 2009;74(1):77–81. DOI: https://doi.org/10.1016/j.urology.2008.11.023.

24. Kiesling VJ, Schroeder DE, Pauljev P, Hull J. Spermatic cord block and manual reduction: Primary treatment for spermatic cord torsion. The Journal of Urology. 1984;132(5):921–922. DOI: https://doi.org/10.1016/S0022-5347(17)49947-2.

25. Blatt AH, Cassey JG. Elective orchidopexy in the paediatric population: A trial of intra-operative spermatic cord block. Pediatric Surgery International. 2007;23(1):49–55. DOI: https://doi.org/10.1007/s00383-006-1815-4.

26. Wipfli M, Birkhäuser F, Luyet C, Greif R, Thalmann G, Eichenberger U. Ultrasound-guided spermatic cord block for scrotal surgery. British Journal of Anaesthesia. 2011;106(2):255–259. DOI: https://doi.org/10.1093/bja/aeq301.

27. Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H. Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. British journal of anaesthesia, 2005;94(2):243-246. DOI: https://doi.org/10.1093/bja/aei031

28. Birkhäuser FD, Wipfli M, Eichenberger U, Luyet C, Greif R, Thalmann GN. Vasectomy reversal with ultrasonography-guided spermatic cord block. BJU International. 2012;110(11):1796–1800. DOI: https://doi.org/10.1111/j.1464-410X.2012.11099.x.

29. Huang Z, Xia W, Peng XH, Ke JY, Wang W. Evaluation of ultrasound-guided genitofemoral nerve block combined with ilioinguinal/iliohypogastric nerve block during inguinal hernia repair in the elderly. Current Medical Science. 2019;39(5):794–799. DOI: https://doi.org/10.1007/s11596-019-2107-2.

30. Frassanito L, Zanfini BA, Pitoni S, Germini P, Del Vicario M, Draisci G. Ultrasound-guided genitofemoral nerve block for inguinal hernia repair in the male adult: A randomized controlled pilot study. Minerva Anestesiologica. 2018;84(2):189–195. DOI: https://doi.org/10.23736/S0375-9393.17.11948-6.

31. Gao QQ, Wu N, Li YZ, Dai YT. The effect of spermatic cord block on reducing the risk of vagal reflex during microsurgical subinguinal varicocelectomy: A randomized trial. Heliyon, 10(14), e34414. DOI: https://doi.org/10.1016/j.heliyon.2024.e34414