Relative Efficacy of Ultrasound‑guided Ilioinguinal‑iliohypogastric Nerve Block Versus Transverse Abdominis Plane Block for Postoperative Analgesia Following Lower Segment Cesarean Section: A Prospective, Randomized Observer‑blinded Trial (original) (raw)

IntroductIon After cesarean patients, pain has to be addressed effectively with minimal interruptions and complications to ensure that they are alert and comfortable to take care of their newborn. [1-3] Conventionally, opioids are administered to provide effective pain relief in the postoperative period. However, opioids are associated with dose-dependent side effects including nausea, vomiting, pruritus, sedation and respiratory depression. [4] Various regional anesthetic techniques have been tried including transverse abdominis plane (TAP) and ilioinguinal-iliohypogastric (ILIH) nerve blocks to spare opioid analgesics and achieve the same goals but the relative efficacy is unknown. Ultrasound guidance of the simple anatomic technique (ILIH) may greatly improve the success of the inguinal nerve blocks, reduce the volume of local anesthetic, and prevent potential injury of adjacent Background: Quality of postoperative analgesia after cesarean section makes difference to mother in child bonding, early ambulation, and discharge. Ilioinguinal iliohypogastric (ILIH) and transverse abdominis plane (TAP) block had been tried to reduce the opioid analgesics, but the relative efficacy is unknown. Hence, this study was designed to compare the efficacy of these two regional analgesic techniques in sparing postoperative rescue analgesic requirement following lower segment cesarean section (LSCS). Methods: Sixty patients who underwent LSCS were randomly allocated into two groups to receive either US-guided TAP block or ILIH nerve block using sealed envelope technique at the end of the surgery. In the postoperative ward, whenever patient complained of pain, pain nurse in-charge administered the rescue analgesics as per the study protocol. A blinded observer visited the patient at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperative intervals and recorded the quality of pain relief and the amount of rescue analgesic consumed. Results: All patients in both the study groups required one dose of rescue analgesics in the form of injection diclofenac sodium 50 mg intravenously but subsequently 57% of patients did not require any further analgesics till 24 h in the TAP block group whereas in ILIH group, only 13% did not require further analgesics (P = 0.00), correspondingly the cumulative tramadol dose was significantly higher at all the time interval in the ILIH group when compared to the TAP group. Conclusion: Quality of postoperative analgesia provided by TAP block was superior to ILIH block following LSCS.