Ultrasound-guided ilioinguinal and iliohypogastric nerve block, a comparison with the conventional technique: An observational study (original) (raw)
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Indian journal of anaesthesia, 2018
Both transversus abdominis plane (TAP) block and combined ilioinguinal-iliohypogastric (IIN/IHN) blocks are used routinely under ultrasound (USG) guidance for postoperative pain relief in patients undergoing inguinal hernia surgery. This study compares USG guided TAP Vs IIN/IHN block for post-operative analgesic efficacy in adults undergoing inguinal hernia surgery. Sixty adults aged 18 to 60 with American Society of Anesthesiologsts' grade I or II were included. After general anaesthesia, patients in Group I received USG guided unilateral TAP block using 0.75% ropivacaine 3 mg/kg (maximum 25 mL) and those in Group II received IIN/IHN block using 10 mL 0.75% ropivacaine. Postoperative rescue analgesia was with tramadol (intravenous) IV ± diclofenac IV in the first 4 h followed by oral diclofenac subsequently. Total analgesic consumption in the first 24 h was the primary objective, intraoperative haemodynamics, number of attempts and time required for performing the block as well...
Journal of Pain Research
Objective: To compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair. Patients and methods: This was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire. Results: NRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant (P=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, P=0.001). Postoperative opioid requirements did not differ between the two groups. Conclusion: This study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB.
Hernia : the journal of hernias and abdominal wall surgery, 2013
The aim of this study was to evaluate the outcome of ilioinguinal and iliohypogastric nerve blocks in patients with chronic pain after herniorrhaphy, by comparing nerve stimulator and ultrasound guidance to administer the block. A total of 43 patients who received nerve blocks for chronic inguinal post-herniorrhaphy pain received standardized questionnaires. Nerve stimulator-guided blocks were performed prior to January 2009, and thereafter, ultrasound-guided blocks were performed using a local anaesthetic solution and a corticosteroid. The questionnaire was completed by 38 patients (88 %). The inguinal hernia repair was performed for a median 16 months (range 3-219) ahead of the nerve blocks. A median of 2 pain treatments (range 1-7) was calculated. Median follow-up was 21 months (range 3-68). According to the DN4, 21 patients (55.3 %) no longer reported neuropathic pain. Subjectively, 32 % no longer reported moderate-to-severe pain. After ultrasound-guided blocks, a higher VAS sco...
Background: For postoperative pain relief in patients undergoing open inguinal hernia repair both TAP block and combined ilioinguinal-iliohypogastric blocks are used under ultrasound guidance. Materials and Methods: In this prospective randomised controlled study, 60 patients of ASA physical status I and II belonging to age group of 18-60years undergoing elective open inguinal hernia repair surgery under sub-arachnoid block were randomly allocated into 2 groups o30patients each, Group A (Transversesabdominisplane block) and Group B (Ilioinguinal-iliohypogastricnerve block). Group A received 20ml of 0.25%Bupivacaine for transversesabdominis planeblock and group B received 20ml of 0.25% Bupivacaine for ilioinguinal-iliohypogastric nerve block.Both groups of patients were monitored for postoperative pain for the next 24 hours.Postoperative rescue analgesia was with intravenous tramadol for the first 4 hrs and later with injection diclofenac intramuscularly.Total analgesic consumption in the first 24 hours postoperative period was the primary objective,.secondary objectives were intraoperative hemodynamics,number of attempts,time required for performing the block and postoperative pain scores were evaluated. Results: There was no difference in age, BMI,and duration of surgery between two groups. Postoperative analgesia was better with ilioinguinal-iliohypogastric block when compared to transverse abdominis plane block and rescue analgesia was lesser with groupB when compared to groupA. The postoperative analgesia was significantly prolonged with ilioinguinal-iliohypogastric group (p<0.05) when compared to transverse abdominis group. Conclusion: Ilioinguinal-iliohypogastric nerveblock provide better postoperative analgesia when compared to TAP block for open inguinal hernia repair.
journal of medical science and clinical research, 2020
Anesthetic management in patients with preexisting cardiorespiratory disorder is painstaking task with numerous challenges. Most common cause of peri-operative morbidity and mortality in such patients is ischemic heart disease (IHD). Infraumbilical surgeries like hernioplasty are routinely performed under spinal block without much difficulty. However, a patient with cardiac co-morbidities restricts use of certain techniques in anesthesiologist’s armamentarium. Use of neuraxial blockade is prohibited in patients with low ejection fraction, restrictive valvular disease and coagulopathy. Sometimes general anesthesia remains the sole technique of choice to undergo scheduled surgery. This makes the patient bear a wide range of shortcomings like delayed recovery, ICU admission, mechanical ventilation, prolonged hospital stay with economic burden and increased risk of morbidity & mortality. Ilioinguinal nerve and iliohypogastric nerve blocks are very effective techniques in providing anest...
Ultrasound-Guided Nerve Block for Inguinal Hernia Repair
Regional Anesthesia and Pain Medicine, 2012
Background and Objectives: Open inguinal hernia repair in adults is considered a minor surgical procedure but can be associated with significant pain. We aimed to evaluate acute postoperative pain management in male adults randomized to receive an ultrasound-guided ilioinguinal and iliohypogastric nerve block administered before surgery, in addition to a standard analgesic regimen.
Benha Journal of Applied Sciences, 2019
Postoperative management of pain in pediatric population is of major concern as it reduces the incidence of complications and leads to earlier hospital discharge. to evaluate efficacy of ultra-sound guided transverses abdominus plane block versus local anaesthetic wound infiltration versus ultra-sound guided ilioinguinal /iliohypogastric nerve block with or without using of dexmedetomidine as an additive to bupivacaine, in the management of the postoperative pain in pediatric patients undergoing unilateral inguinal hernia repair. This prospective randomized blinded, controlled, clinical study,in which 140 Patients were randomized into four groups, The primary targets of this current study were FLACC score for pain and measuring the mean paracetamol consumption in 24 hours. Regarding comparison between the four groups involved in our study , the postoperative analgesia is more effective with TAP group [ the gold standard ] than groupII,groupIII and groupIV, the latter is being the least effective in postoperative pain control. Also the postoperative consumption of paracetamol in TAP group is lower than other groups.Using dexmedetomidine as an additive to bupivacaine provides prolonged duration of postoperative analgesia, and lowered FLACC pain scores. As regard demographic data were not significantly different between the groups. Vital parameters [heart rate, systolic and diastolic blood pressure, respiratory rate per minute] were also not significantly different between the groups. ultra-sound guided transverses abdominus plane block is more effective in postoperative analgesia when compared to local anaesthetic wound infiltration and ultrasound guided ilioinguinal /iliohypogastric nerve block. Using dexmedetomidine as an additive to bupivacaine provides prolonged duration of postoperative analgesia, and lowered FLACC pain scores.
Introduction: Inguinal hernia repair is usually performed under spinal anaesthesia. However, local anaesthesia technique provides stable hemodynamics with early ambulation and less postoperative pain. We compared efficacy, feasibility and safety of ilioinguinal/iliohypogastric nerve block for inguinal hernia repair with spinal anaesthesia. Material and methods: Sixty adult male patients scheduled for elective inguinal hernia repair were randomized into two groups to receive either ilioinguinal/iliohypogastric nerve block or spinal anaesthesia. The total time to perform anaesthetic procedures, time of onset, hemodynamic variations, supplemental sedation, intraoperative fluid requirement, duration of postoperative analgesia and ambulation were compared in both groups. Continuous data are presented as mean±S.D. Unpaired t-test and paired t-test were applied for intergroup and intragroup comparisons respectively. P <0.05 was taken as significant. Results: Duration to perform ilioinguinal/iliohypogastric nerve block was significantly longer (7.95±0.461 minutes) than that of spinal block (3.73±0.679 minutes). Systolic and mean blood pressure showed statistically significant reduction in first 40 minutes with higher intraoperative fluid requirement in Group II patients (1280±190.1 ml vs 348.33±77.106 ml). Group I patients required higher dose of midazolam (3.00±0.347 vs 2.23±0.254 mg) (p<0.05). Supplemental anaesthetic infiltration was required in 36.7% patients in Group I and 45.45% of them required propofol for sedation (55.56±5.11 mg). The duration of postoperative analgesia was longer in Group I (5.163±0.4542 vs 3.871±0.4801 hours) (p<0.05). Duration of ambulation was significantly shorter in Group I (3.95±2.56 vs 9.58± 0.87 hours) (p<0.05). Conclusion: Ilioinguinal/iliohypogastric nerve block can be a safe alternative to spinal anaesthesia for elective unilateral inguinal hernia repair.