Abstract
ObjectiveTo determine the impact of pre-operative and intra-operative ilioinguinal and iliohypogastric nerve block on post-operative analgesic utilization and length of stay (LOS).MethodsWe conducted a prospective randomized double-blind placebo controlled trial to assess effectiveness of ilioinguinal-iliohypogastric nerve block (IINB) on post-operative morphine consumption in female study patients (n = 60). Patients undergoing laparotomy via Pfannenstiel incision received injection of either 0.5% bupivacaine + 5 mcg/ml epinephrine for IINB (Group I, n = 28) or saline of equivalent volume given to the same site (Group II, n = 32). All injections were placed before the skin incision and after closure of rectus fascia via direct infiltration. Measured outcomes were post-operative morphine consumption (and associated side-effects), visual analogue pain scores, and hospital length of stay (LOS).ResultsNo difference in morphine use was observed between the two groups (47.3 mg in Group I vs. 45.9 mg in Group II; p = 0.85). There was a trend toward lower pain scores after surgery in Group I, but this was not statistically significant. The mean time to initiate oral narcotics was also similar, 23.3 h in Group I and 22.8 h in Group II (p = 0.7). LOS was somewhat shorter in Group I compared to Group II, but this difference was not statistically significant (p = 0.8). Side-effects occurred with similar frequency in both study groups.ConclusionIn this population of patients undergoing inpatient surgery of the female reproductive tract, utilization of post-operative narcotics was not significantly influenced by IINB. Pain scores and LOS were also apparently unaffected by IINB, indicating a need for additional properly controlled prospective studies to identify alternative methods to optimize post-surgical pain management and reduce LOS.
Highlights
Laparotomy performed through a Pfannensteil incision is one of the most common operations involving the female abdomen [1]; effective post-operative analgesia is essential in such cases
The advent of various multimodal analgesia techniques has greatly facilitated the management of postoperative pain [2,3], and i.v. morphine has emerged as the most widely used and cost-effective agent
Augmentation of i.v. analgesia has been achieved with regional nerve blockade, for patients undergoing hysterectomy [4] or Cesarean delivery [5]
Summary
Laparotomy performed through a Pfannensteil incision is one of the most common operations involving the female abdomen [1]; effective post-operative analgesia is essential in such cases. Augmentation of i.v. analgesia has been achieved with regional nerve blockade, for patients undergoing hysterectomy [4] or Cesarean delivery [5]. Since others have studied preincisional and post-operative analgesia with placebo (saline) controls to examine either standard nerve block or direct infiltration of the surgical site [6], we speculated that a multi-stage nerve block (where epinephrine is added to bupivacaine) might offer reduced untoward effects of narcotics, earlier mobilization and shorter post-operative hospitalization. Our prospective investigation sought to assess combined preincisional and intraoperative/preclosure analgesia with bupivacaine + epinephrine against placebo in a study population of female patients undergoing laparotomy via Pfannensteil incision
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
