Pain control with ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with local infiltration anesthesia in patients undergoing transfemoral transcatheter aortic valve implantation: a prospective randomized trial

Abstract

Introduction Ilioinguinal-ilioinguinal nerve block is frequently performed for analgesia in inguinal surgery. The authors hypothesized that preoperative ultrasound-guided ilioinguinal-iliohypogastric (II-IH) nerve block produce better intraoperative analgesia and less analgesic requirement in comparison to commonly used local infiltration anesthesia in patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI). Methods 87 elderly patients scheduled for TF-TAVI were randomized to receive either II-IH nerve block (Group A) or local infiltration anesthesia (Group B) between July 2018 and April 2019 (ClinicalTrials.gov; ID: NCT03863899). In patients in group A ultrasound-guided II-IH nerve block was performed preoperatively by anesthesiologist. Patients in group B received local anesthetic infiltration of the operative area performed by surgeon. Pain intensity was assessed using numeric rating scale (NRS 0-10; 0 = no pain; 10 = the worth pain imaginable) in five time-points intraoperatively (femoral artery cannulation (1), aortic valve system introduction (2), aortic valve system removal (3), vessel closure devices insertion (4), the end of the operation (5)). When NRS was 4, fentanyl was given. The need for additional analgesics was also evaluated during the procedure. Results After exclusion of 10 patients the analysis was performed in 77 patients: 40 in group A and 37 patients in group B. In time points (1-4) pain intensity was lower in group A than in group B (p The need for supplementary fentanyl administration was lower in group A in comparison to group B (p = 0.02). Time from arrival in operation room to start surgery was longer in group A than in group B (median: 60 min. vs. 50 min., respectively; p = 0.01). Discussion Ultrasound-guided II-IH nerve block produce better intraoperative analgesia and less analgesic consumption than local infiltration anesthesia in patients undergoing TF-TAVI, at the cost of slightly longer patient's preparation to surgery.