Ultrasound-guided ilioinguinal-iliohypogastric nerve block with local anesthesia and fentanyl analgesia versus local anesthesia and fentanyl analgesia prior to Shouldice inguinal hernia repair in adults: a retrospective matched-pair analysis among 100 individuals.

PURPOSE: There is limited research on the impact of an ilioinguinal-iliohypogastric nerve block on intraoperative opioid consumption when conducting groin hernia repair in adults. Thus, the aim was to evaluate ilioinguinal-iliohypogastric nerve block for groin hernia patients at Shouldice Hospital. METHODS: The study was a pilot retrospective chart review on patients who underwent a Shouldice Repair from November 2023 to December 2023. This study compared individuals receiving an ilioinguinal-iliohypogastric nerve block with local anesthesia and fentanyl analgesia to those who received local anesthesia and fentanyl analgesia, by manually matching 1:1 on 12 demographic and intraoperative characteristics. Comparison between groups was performed using chi-square/Fisher Exact test for categorical and t-test/Mann-Whitney test for numerical variables depending on data distribution. Multivariable regression analysis was used to examine predictors of intraoperative use of fentanyl. RESULTS: In this study 50 matched pairs of unilateral primary inguinal hernia patients were analyzed. The ilioinguinal-iliohypogastric nerve block patients had lower recorded intraoperative fentanyl (85mcg less than control, p < .001) and dimenhydrinate (13 mg less than control, p < .001) than the control group patients. No differences were found in postoperative day 0 to 3 for acetaminophen, non-steroidal anti-inflammatory drug, and opioid consumption between the patients who did receive an ilioinguinal-iliohypogastric nerve block prior to surgery and those that did not. CONCLUSION: The administration of an ilioinguinal-iliohypogastric nerve block prior to primary inguinal hernia repair using a Shouldice Repair is associated with a significantly lower intraoperative fentanyl consumption compared to non-administration.

Analgesic efficacy of bupivacaine with or without magnesium adjunct in bilateral ilioinguinal and iliohypogastric nerve blocks following cesarean section under subarachnoid block: A randomized controlled trial.

Background: Pain relief is a basic aspect of anesthesia care. Optimal post-cesarean section analgesia should minimize postoperative complications, facilitate infant care, and prevent postoperative morbidity. Bilateral ilioinguinal-iliohypogastric (IIIH) nerve block has been considered as a part of the multimodal approach. This study was designed to explore the efficacy of adding magnesium sulfate as an adjunct to bupivacaine to provide analgesia following cesarean delivery, using bilateral IIIH nerve block. Materials And Methods: Seventy-two parturients who were scheduled for elective cesarean section were randomized into two groups of 36 patients each. Group MB patients were given bilateral IIIH nerve block with 250 mg of magnesium sulfate and 95 mg of 0.25% plain bupivacaine. Group B patients were given bilateral IIIH nerve block with 0.9% normal saline and 95 mg of 0.25% plain bupivacaine. Postoperative visual analog scale (VAS) pain scores at post-anesthesia care unit (PACU), 2, 4, 6, 12, and 24 h, both at rest and with activity were measured. Rescue doses of opioid (intravenous [IV] tramadol 50 mg) at each time point of assessment, total tramadol consumption, time to patients' first request for rescue analgesic agent, and patients' satisfaction score were recorded. Results: The demographic and social parameters of patients in both the groups were comparable. The mean postoperative VAS pain score in group MB was significantly lesser both at rest and with movement than in group B at 12 and 24 h after surgery (P < 0.05). Total postoperative tramadol consumed over 24 h was significantly lesser in the magnesium group than in the control group (125.55 ± 20.76 vs. 160.24 ± 25.82 mg), with a P value of 0.026. The time to patient's first analgesic request was significantly prolonged in group MB compared to group B (505.2 ± 41.4 vs. 372.6 ± 88.8 min, respectively), with a P value of 0.040. However, patients in both groups expressed good satisfaction scores. Conclusion: Magnesium sulfate as an adjunct to bupivacaine in bilateral IIIH nerve block reduced VAS pain scores, total tramadol consumption, and prolonged post-cesarean section analgesia.

Efficacy of analgesia using ilioinguinal-iliohypogastric (IIIH) nerve block, transversus abdominis plane (TAP) block and diclofenac after caesarean delivery under spinal anaesthesia: A non-randomised clinical trial.

Background and Aims: Our aim was to assess the efficacy of analgesia using ilioinguinal-iliohypogastric (IIIH) nerve block, transversus abdominis plane (TAP) block and diclofenac after caesarean delivery (CD) under spinal anaesthesia (SA).]. Methods: A total of 457 healthy parturients undergoing CD under SA were included in this prospective, observational study. Groups differed in the postoperative analgesic strategies received by the parturient at the end of surgery: group D (n = 148) received intramuscular diclofenac sodium, group I (n = 153) received bilateral IIIH block with bupivacaine plus clonidine and group T (n = 156) received bilateral TAP block with bupivacaine plus clonidine. Total duration of postoperative analgesia, numerical pain rating scale (NRS) scores, patient satisfaction score, rescue analgesics in the first 48 h postoperatively and adverse effects were observed. A value of P < 0.05 was taken as significant. Results: Total duration of analgesia was longest (18.2 ± 1.3 h) in group T and shortest in group D (6.3 ± 0.8 h) compared to group I (13.1 ± 1.2 h) (P < 0.001). Total analgesic requirement in postoperative 48 h was lowest in group T (152.1 ± 34.9 mg), highest in group D (355.0 ± 25.6 mg) and intermediate in group I (221.0 ± 30.0 mg) (P < 0.001). Mean NRS scores were lower in group T compared to those in groups D and I. The patients in group T were extremely satisfied, in group I were satisfied and in group D were dissatisfied (P < 0.001). Conclusion: Bilateral TAP block with bupivacaine and clonidine after CD under SA increases the duration of postoperative analgesia.

Ultrasound-Guided Erector Spinae versus Ilioinguinal/Iliohypogastric Block for Postoperative Analgesia in Children Undergoing Inguinal Surgeries.

CONTEXT: Erector spinae plane (ESP) block is a promising technique in the field of pediatric postoperative analgesia considering its safety and simplicity. OBJECTIVE: The objective of the study is to compare the efficacy of ultrasound (US)-guided ilioinguinal/iliohypogastric nerve (IIN) block and ESP block for postoperative analgesia after pediatric unilateral inguinal hernia repair. PATIENTS AND METHODS: Sixty patients randomized into two equal groups. ESP group received US-guided ESP block, and IIN group received US-guided IIN block. Block in both groups was done with 0.5 mL/kg 0.125 bupivacaine + fentanyl 1 µg/mL injectate. Primary outcome is to compare both groups regarding time to first analgesic request. Secondary outcomes include evaluation of postoperative FLACC score, number of patients requiring rescue analgesic, number of rescue analgesic doses, parental satisfaction, incidence of postoperative vomiting, and motor weakness. RESULTS: IIN group showed a significantly higher FLACC score at 4 and 6 h, significantly higher number of rescue medication doses and number of patients needed rescue analgesia. The ESP group carries a significantly higher parental satisfaction and a significantly longer time to first rescue analgesic compared to IIN group. CONCLUSION: The findings suggest that US guided ESP block resulted in a more effective and longer duration of postoperative analgesia following a pediatric unilateral inguinal hernia repair compared to IIN block.

Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial.

PURPOSE: Analgesic efficacy of ultrasound-guided transverse abdominis plane block, administered a little more medially, just close to the origin of the transverse abdominis muscle has not yet been investigated in patients undergoing unilateral inguinal hernia repair. We hypothesised that medial transverse abdominis plane block would provide comparable postoperative analgesia to ilioinguinal-iliohypogastric nerve block in inguinal hernia repair patients. METHODS: This prospective, randomised trial was conducted in 50 ASA I and II male patients≥18 years of age. Patients were randomised into two groups to receive either pre-incisional ipsilateral ultrasound-guided ilioinguinal-iliohypogastric nerve block or medial transverse abdominis plane block, with 0.3ml/kg of 0.25% bupivacaine. Our primary objective was postoperative 24-hour analgesic consumption and secondary outcomes included pain scores, time to first request for rescue analgesic and side effects, if any, in the postoperative period. RESULTS: There was no significant difference in the total postoperative analgesic consumption [group I: 66.04mg; group II: 68.33mg (P value 0.908)]. Time to first request for rescue analgesic was delayed, though statistically non-significant (P value 0.326), following medial transverse abdominis plane block, with excellent pain relief seen in 58.3% patients as opposed to 45.8% patients in ilioinguinal-iliohypogastric nerve block group. CONCLUSION: Medial transverse abdominis plane block being a novel, simple and easily performed procedure can serve as an useful alternative to ilioinguinal-iliohypogastric nerve block for providing postoperative pain relief in inguinal hernia repair patients.

Hernioplastia inguinal con anestesia local y bloqueo nervioso: experiencia en el hospital Dr. Francisco Antonio Rísquez / Inguinal hernioplastia with local anesthesia and nervous block: experience in the hospital Dr. Francisco Antonio Rísquez

La anestesia local es una opción válida para realizar procedimientos quirúrgicos de pequeña o mediana consideración. Permite la deambulación y el alta precoz. Objetivo: Evaluar los resultados del uso de anestesia local y bloqueo de los nervios ilioinguinal e iliohipogástrico, en pacientes a quienes se les realizó cura operatoria de hernia inguinal, en el Servicio de Cirugía del Hospital "Dr. Francisco Antonio Rísquez", en el periodo octubre 2017 - octubre 2018. Métodos: Estudio prospectivo, transversal que incluyó 23 pacientes que aceptaron se le realizara la hernioplastia con anestesia local. Resultados: Se realizaron 46 curas operatorias de hernia inguinal, y en 23 se realizó con anestesia local (50 %). Predominaron pacientes masculinos (87 %), con una distribución bimodal en relación a la edad (26,1 % entre 30 y 39 años y entre 70 a 79 años). La hernia inguinal derecha fue la más frecuente con el 40 % (10 casos). Todos los pacientes reportaron una puntuación de 0-1 en la escala visual análoga, tanto en el transoperatorio como en el posoperatorio. El 96% de los pacientes logró una deambulación precoz (antes de 4 horas) y todos toleraron la vía oral antes de las dos horas en el posoperatorio. No se observó ninguna complicación en el transoperatorio; hubo 1 recidiva. Conclusiones: La cura operatoria de hernia inguinal con anestesia local, resultó ser efectiva y bien tolerada por los pacientes, brindando un reintegro casi inmediato a sus actividades, lo que representa una disminución en los costos intrahospitalarios(AU)

Local anesthesia is an option to perform surgical procedures of small or medium account. It allows the ambulation, and early discharge. Objective: To evaluate the results of the use of local anesthesia and nerve block ilioinguinal and iliohypogastric, in patients who underwent surgical cure of inguinal hernia, surgery of the Hospital "Dr. Francisco Antonio Rísquez" service, in the October 2017 period - October 2018. Methods: Prospective, cross-sectional study involving 23 patients who accepted it will be the hernioplasty under local anesthesia. Results: 46 surgical cure of inguinal hernia were performed, and in 23 was held with local anesthesia (50%). Dominated male patients (87%), with a bimodal distribution in relation to the age (26.1% between 30 and 39 years and between 70 to 79 years). Right inguinal hernia was the most frequent with 40% (10 cases). All patients reported a score of 0-1 in the Visual analog escale, both in the intraoperative and postoperative. 96% of patients achieved early ambulation (within 4 hours) and all tolerated the mouth before the two hours in the postoperative. There were no complications in the intraoperative; there was 1 recurrence. Conclusions: e surgical cure of inguinal hernia under local anesthesia, proved to be effective and well tolerated by the patients, providing a return almost immediately to their activities, which represents a decrease in hospital costs(AU)

A comparative study to evaluate ultrasound-guided transversus abdominis plane block versus ilioinguinal iliohypogastric nerve block for post-operative analgesia in adult patients undergoing inguinal hernia repair.

BACKGROUND AND AIMS: 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. METHODS: 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 as the postoperative pain scores were also evaluated. RESULTS: Time to first analgesic request was 319.8 ± 115.2 min in Group I and 408 ± 116.4 min in Group II (P = 0.005). Seven patients (23.33%) in Group I and two (6.67%) in Group II required tramadol in first four hours. No patient in either groups received diclofenac IV. The average dose of tablet diclofenac was 200 ± 35.96 mg in Group I and 172.5 ± 34.96 mg in Group II (P = 0. 004). CONCLUSION: USG guided IIN/IHN block reduces the postoperative analgesic requirement compared to USG guided TAP block.

Transversus Abdominis Plane Block versus Ilioinguinal/Iliohypogastric Nerve Block with Wound Infiltration for Postoperative Analgesia in Inguinal Hernia Surgery: A Randomized Clinical Trial.

BACKGROUND: Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair. AIM: The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery. SETTINGS AND DESIGN: This was a randomized clinical trial performed in a tertiary care hospital. MATERIALS AND METHODS: Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine - TAP block and Group I received 10 ml of 0.25% ropivacaine - IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain. STATISTICAL ANALYSIS: Statistical comparisons were performed using Student's t-test and Chi-square test. RESULTS: Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h (P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block. CONCLUSION: As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.

Ilioinguinal and iliohypogastric nerve block / Монголын Анагаах Ухаан

Ilioinguinal (II) and iliohypogastric (IH) nerve blocks are often performed to provide intra- andpostoperative analgesia for hernia repair in children and adults. Several techniques are describedin the literature. Recently an ultrasound guided technique for II and IH nerve blocks were describedin the international journals. The block success rates are variable specially for using anatomicallandmark blind techniques. In the present study, the anatomical variations in course of the II andIH nerves are described. Knowledge of the course of these nerves in the inguinal region, and anunderstanding of variations seen in their topography, can decrease the incidence of postoperativecomplications and adverse effects. Ultrasound guidance of block performance will shorten the time,reduce the number of needle passes and shorten the block onset time. Blocks may be performedusing lower local anesthetic doses.

The Effect of Pre-Incision Field Block versus Post-Incision Inguinal Wound Infiltration on Postoperative Pain after Paediatric Herniotomy.

BACKGROUND: The Ilioinguinal/iliohypogastric nerve block has been shown to significantly decrease opioid analgesic requirements and side effects after inguinal herniotomy. We compared the effect of pre-incisional field block with 0.25% bupivacaine and post-incisional wound infiltration with 0.25% bupivacaine for postoperative pain control after inguinal herniotomy. PATIENTS & METHODS: This was a randomized controlled double blind study in 62 ASA I and II children aged 1-7 years scheduled for inguinal herniotomy. They were assigned to receive either pre-incision field block (group I) or post-incision wound infiltration at the time of wound closure (group II). The pain score was assessed in the recovery room using mCHEOPS score and VAS or FLACC score at home by the parents for 24 hours. RESULTS: The mean pain scores during the 2 hour stay in the recovery room, at 12 and 18 hours at home were similar in both groups, p > 0.05. However, the mean pain scores were significantly lower at 6 hours at home in group I (1.22 ± 0.57) than in group II (1.58 ±0.90), p <0.001, but significantly higher at 24 hours at home in group I (3.29 ± 0.46) than in group II (2.32 ± 0.24), p = 0.040. There was no difference in mean paracetamol requirement, and in the number of patients who required paracetamol for pain relief at home in both groups, p > 0.05. CONCLUSION: We have demonstrated that both pre-incisional ilioinguinal/iliohypogastric field block and post incisional wound infiltration provided adequate postoperative analgesia for 24 hours after inguinal herniotomy.

A Comparison between Ilioinguinal and Iliohypogastric Nerve Block and Infiltration of Local Anesthetics for Postoperative Pain after Inguinal Herniorrhaphy in Children / 소아외과

The present study compared the postoperative analgesic effects of ilioinguinal and iliohypogastric nerve block with infiltration of local anesthetics (bupivacaine) into the wound in children after inguinal hernia repair. Ninety children below 7 years old who were scheduled elective inguinal hernia repair were randomly allocated into one of three groups. The patients in nerve block (NB) group, ilioinguinal and iliohypogastric nerve block was done with 0.5 mL/kg of 0.25% bupivacaine. The patients in infiltration of local anesthetics (LI) group, 0.5 mL/kg of 0.25% bupivacaine was infiltrated into the wound after surgery. The patients in control group were allocated as a Control group. Postoperative pain was assessed at 1, 3, 5, and 24 hours after operation with FLACC scale and additional analgesic consumption were counted. The three groups were not significantly different in age, sex, body weight, and duration of operation. Pain scores at 1 hour and 3 hours after operation were significantly higher in Control group than in NB group and LI group (p<0.01), whereas there were no difference between NB group and LI group. The rescue analgesics administration was significantly higher in Control group (n=11) than in NB group (n=6) and LI group (n=7) (p<0.05). There were 2 cases of transient femoral nerve palsy in NB group. Both of ilioinguinal and iliohypogastric nerve block and infiltration of local anesthetics into the wound provided effective postoperative analgesia in early postoperative period following inguinal hernia repair in children. But no difference between the two methods. Technically, infiltration of local anesthetics into the wound was easier and safer than ilioinguinal and iliohypogastric nerve block.

Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery.

CONTEXT: Ultrasound (US) guidance is strongly recommended when performing peripheral nerve blocks in infants and children. AIMS: To assess whether US-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks with local anesthetic (LA) would provide comparable postoperative analgesia to blind technique caudal block with LA following pediatric unilateral groin surgery. Secondary endpoints included analgesic consumption, parental satisfaction, and postoperative complications. SETTINGS AND DESIGN: Prospective, crossover randomized controlled trial performed on children undergoing unilateral groin surgery. METHODS: Fifty children aged 1-6 years scheduled for unilateral groin surgery were included in the study. After induction of general anesthesia and prior to surgical incision, patients were prospectively randomized into one of two groups: Group B received US-guided II/IH nerve blocks with 0.1 ml.kg(-1) of 0.25% bupivacaine and Group C received a caudal blockade with 0.7 ml.kg(-1) of 0.25% bupivacaine. Patients were assessed in the recovery room, the day-stay unit and for 24 h at home for pain score, analgesic consumption, and parental satisfaction. STATISTICAL ANALYSIS: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test or Fisher exact test for non-continuous variables. P<0.05 was considered significant. RESULTS: The average pain scores during hospital stay were 1.82±1.71and 1.52±1.41 for group C and group B respectively (P>0.05). The average time to first rescue analgesia was longer in group B 253±102.6 min as compared to 219.6±48.4 min in group C. In recovery room, four patients in group C required pain rescue medication compared to five patients in group B (P>0.05). Similarly eight patients in the group C and six patients in group B required pain rescue medication at day-stay unit or at home (P>0.05). Group C received 0.74 pain rescue medication doses (range 0-8), while group B received 0.65 pain rescue medication doses (range 0-6) at hospital and at home (P>0.05). CONCLUSIONS: US-guided II/IH nerve blocks is an ideal postoperative analgesic for unilateral groin surgery in children, particularly hernia repairs and is as effective as caudal block, with a lower volume of local anesthetics.

Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy -A case report-.

Peripartum cardiomyopathy (PPCM) is a rare complication that occurs between the late stage of pregnancy and six months after delivery. PPCM presents as symptoms of left ventricular dysfunction and it can be fatal unless treated promptly. Furthermore, anesthesia and surgery in such patients is a large challenge to anesthesiologists. First and foremost, the maintenance of stable hemodynamics is a major concern. We report a case of combined lumbar epidural anesthesia and both ilioinguinal and iliohypogastric nerve block under ultrasound guided for a wound revision in a 37-year-old woman diagnosed with PPCM after an emergency cesarean section.

Combined epidural anesthesia and ultrasound guided peripheral nerve block for wound revision in a patient with peripartum cardiomyopathy: A case report / 대한마취과학회지

Peripartum cardiomyopathy (PPCM) is a rare complication that occurs between the late stage of pregnancy and six months after delivery. PPCM presents as symptoms of left ventricular dysfunction and it can be fatal unless treated promptly. Furthermore, anesthesia and surgery in such patients is a large challenge to anesthesiologists. First and foremost, the maintenance of stable hemodynamics is a major concern. We report a case of combined lumbar epidural anesthesia and both ilioinguinal and iliohypogastric nerve block under ultrasound guided for a wound revision in a 37-year-old woman diagnosed with PPCM after an emergency cesarean section.