Iliohypogastric Block Research Articles

Analgesic Effect of Bilateral Sonography-Guided Ilioinguinal Iliohypogastric Block and Caudal Block in Children: A Randomized Trial

Background: Herniorrhaphy is the most common inguinal surgery in children. Several methods such as caudal block, ilioinguinal iliohypogastric block, and wound infiltration have been studied for postoperative pain management in these patients. Caudal block is common in pediatrics. However, ilioinguinal iliohypogastric block is effective and less invasive. Previous studies have shown different comparative results regarding these blocks. This study compares the analgesic effect of caudal and bilateral ilioinguinal iliohypogastric block with ropivacaine in children. Methods: This study is a randomized double-blind clinical trial. A total number of 66 patients aged between 1-7 years that volunteered for bilateral inguinal hernia repair were randomly assigned to two groups. After general anesthesia, caudal block with 1cc/kg ropivacaine 0.2% was performed for 33 patients and sonography-guided ilioinguinal iliohypogastric block with 0.1 cc/kg ropivacaine for each side was considered for another group. Hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) during anesthesia, pain score (CHEOPS), delirium score (PAED), nurses’ satisfaction score (RN), need for additional narcotic, recovery time, and complications were compared in these two groups. Results: There was no statistically significant difference between the two groups in terms of hemodynamic parameters during the anesthesia process. Furthermore, the two groups had no statistically significant difference in CHEOPS score (6.27 in ilioinguinal block and 5.70 in caudal block, P=0.061), PAED score (5.64 vs 5.30, P=0.144), and RN satisfaction score. However, the need for narcotics, mean recovery time, and block complications were comparable in two groups. Conclusion: Caudal block and ilioinguinal block are equally effective for post herniorrhaphy pain and emergence agitation management in pediatrics. Additionally, no differences were observed in complications. It is recommended that the study be performed with a larger sample size.

Evaluation of Efficacy of Ultrasound Guided Ilioinguinal and Iliohypogastric Nerve Block for Post Operative Analgesia after Addition of Dexamethasone in Adult Patients Undergoing Unilateral Inguinal Hernioplasty under Subarachnoid Block

Background: We assessed postoperative analgesic effect of ultrasound guided ilioinguinal and iliohypogastric nerve block, duration of action of the said block as well as the overall analgesic consumption in the first 24 hours of postoperative period after addition of dexamethasone.
 Methods: After approval from the institutional ethics committee, hospital based randomized prospective study was carried out in patients of age group 40-60 years by dividing them into two groups A and B, posted for unilateral inguinal hernioplasty, comparing ilioinguinal and iliohypogastric block with ropivacaine 0.375% and ropivacaine 0.375% with dexamethasone 4mg respectively. The aim of the study was to assess the postoperative analgesia with visual analogue scale (VAS) and satisfactory score and total analgesic consumption and time till rescue analgesia. Statistical Analysis: We used Chi-square test and paired t test and P<0.05 was considered statistically significant.
 Results: Mean of duration of analgesia was significantly prolonged in group B (14.13±3.461 h) as compared to group A (5.77±2.161 h). Patients in group B had significantly lower VAS score and less number of rescue analgesic requirements in first 24 hours (h) postoperatively. No adverse effects recorded in any group.
 Conclusion: Dexamethasone as an adjuvant with ropivacaine in ultrasound guided ilioinguinal and iliohypogastric block provided profound prolongation of duration of postoperative analgesia and reduces analgesic consumption of patients undergoing subarachnoid block for unilateral inguinal hernioplasty.

Assessment of Postoperative Analgesic Efficacy of Ilioinguinal-Iliohypogastric Block as Compared to Caudal Block in Children Undergoing Inguinal Herniotomy: A Randomised Clinical Study

Introduction: An Inguinal herniotomy is most frequently performed surgery in children under general anaesthesia along with various regional anaesthesia techniques such as ilioinguinal-iliohypogastric block (hernia block) or caudal block. Aim: To compare postoperative analgesic efficacy of hernia block (anatomical landmark guided ilioinguinal- iliohypogastric block) versus caudal block using bupivacaine as a local anaesthetic in children undergoing inguinal herniotomy. Materials and Methods: This single-centre, randomised clinical study was conducted at tertiary medical college and hospital (Lokmanya Tilak Municipal Medical College and General Hospital), Mumbai, Maharashtra, India, from December 2016 to December 2018. The study included 100 children from age 6 months to 6 years with American Society of Anesthesiologists (ASA) grade I and II, posted for elective inguinal herniotomy (unilateral). All children were given either hernia block or caudal block, based on computerized randomisation method. Total 55 patients received hernia block (Group H) with 0.3 mL/kg of 0.25% concentration of bupivacaine and another 45 patients received caudal block (Group C) with 0.75 mL/kg of 0.25% bupivacaine. In the postoperative period, mean pain free period and total duration of rescue analgesia were recorded in both the groups. Chi-square test and Fisher’s-exact test. The p-value <0.05 was indicated as statistically significant. Results: Demographic data was comparable in two groups. The mean drug volume (bupivacaine 0.25%) used in group C was 8.44 ±3.46 mL and in group H was 4.24 ±1.6 mL. The mean pain free period, with in the first 24 hours, in group C was 8.80±6.43 hours and in group H, it was 11.77±8 hours. Rescue analgesia and FLACC score (the Face, Legs, Activity, Cry, Consolability scale) at 0 min, 15 min, 30 min and every hour upto 4 hours was comparable in both the groups. Mean time of discharge of patients receiving either of blocks, FLACC score at the time of discharge were comparable in both the groups. Conclusion: Hernia block was more effective than caudal block based on duration of postoperative analgesia. There was higher margin of safety with lower volume of local anaesthetic used.

AN OBSERVATIONAL STUDY OF CAUDAL BLOCK VS ILIOINGUINAL/ILIOHYPOGASTRIC BLOCK IN INTRAOPERATIVE AND POSTOPERATIVE ANALGESIA FOR INGUINAL SURGICAL PROCEDURES IN PAEDIATRIC PATIENTS

Inguinal surgeries are most commonly performed in paediatric age group. Surgical pain is better controlled by regional anaesthetic technique compared to IVopioids. Caudal block and ilioinguinal / iliohypogastric block are the oldest and still most commonly used techniques of regional anaesthesia in children.Both caudal and ilioinguinal / iliohypogastric blocks have been used to provide effective intra operative and post operative analgesia in combination with opioids to increase duration of analgesia. Both are comparable in terms of quality, duration of analgesia and clinical efcacy with some residual motor block with caudal block.

A Comparative Study between Effects of Ultrasound Guided Ilioinguinal /Iliohypogastric Nerve Block versus Caudal Block on Postoperative Analgesia in Children Undergoing Inguinal Surgery

Abstract Background The most commonly performed inguinal surgeries in children include inguinal hernia repair with or without orchidopexy and hydrocele repair. For postoperative pain with these surgeries, a regional analgesic modality such as caudal analgesia (CA), ilioinguinal and iliohypogastric nerve block (IL/IH), or even local infiltration is combined with a general anaesthetic (GA). Regional analgesia techniques are commonly used to facilitate pain control during pediatric surgical practice, decrease parenteral opioids requirements and improve the quality of post-operative pain control and patient-parent satisfaction. When compared to intravenous (IV) opioids, regional techniques reduce the risk of side effects such as somnolence, respiratory depression, emesis, and ileus. Patients and Methods: After approval of anesthesia, intensive care and pain management department, scientific and ethical committees, and after informed parental written consents, this prospective randomized clinical trial study was conducted in Ain Shams University Hospitals. This study is considered to be a pilot exploratory study. Forty five children patients were included in the study scheduled for elective inguinal surgeries (e.g.; unilateral inguinal hernia repair, hydrocele repair, or orchidopexy). Patients will be randomized using a random number table and the use of a closed envelopes technique to receive either combined general anesthesia with ultrasound guided caudal block (Group A), combined general anesthesia and ultrasound guided ilioinguinal /iliohypogastric block (Group B), or general anesthesia with intravenous morphine (group C). Results Among 45 children of (27 boys and 18 girls), aged from one to six years old, ASA physical status I–II who were scheduled for elective unilateral inguinal surgeries, fifteen patients received general anesthesia with ultrasound guided caudal epidural anesthesia (1ml/kg bupivacaine 0.25%), fifteen patients received general anesthesia with ultrasound-guided ilioinguinal/ iliohypogastric nerve block (0.5ml/kg bupivacaine 0.25%) and fifteen patient received general anesthesia with intravenous morphine (0.1 mg/kg). Conclusion The current study demonstrated that ultrasound-guided ilioinguinal /iliohypogastric nerve block was more effective than ultrasound guided caudal epidural block or intravenous morphine usage in children aged 1-6 years old undergoing unilateral inguinal surgeries as it carried the advantages of faster onset of action, longer duration of postoperative analgesia, the need of lower volumes of local anesthetic agents with no recorded complications.

Comparative study of ilioinguinal - iliohypogastric block versus wound infiltration using 0.5% bupivacaine after elective hernia repair for postoperative pain relief

Comparative study of ilioinguinal - iliohypogastric block versus wound infiltration using 0.5% bupivacaine after elective hernia repair for postoperative pain relief

Ilioinguinal and iliohypogastric block in children undergoing appendectomy: controlled, randomized, double-blind clinical trial

Ilioinguinal and iliohypogastric block in children undergoing appendectomy: controlled, randomized, double-blind clinical trial

Comparative evaluation of addition of polygeline to bupivacaine in ilioinguinal-iliohypogastric nerve blocks in patients undergoing hernioraphy—a randomized, double-blind, controlled trial

Background: Postoperative pain care is an essential component of the anesthesia armamentarium. Nerve blocks with local anesthetic drugs do an important role in that care. Many drugs have been added to prolong the duration of action of local anesthetics. We wished to add polygeline to look into the prolongation possibly because of its physical effects. Aims and Objective: To evaluate the addition of polygeline to bupivacaine in ilioinguinal and iliohypogastric nerve blocks in patients undergoing hernioraphy. Materials and Methods: Sixty patients undergoing hernioraphy under spinal anesthesia were randomly divided into three groups of 20 each. End operatively, they received saline (group C), bupivacaine with saline (group B), or bupivacaine with polygeline (hemaccel) (group BH) as the drug for ilioinguinal and iliohypogastric blocks. Postoperatively, 0–10 pain scores numerical rating scale (NRS), sedation scores, time to first analgesia, and narcotic requirements were noted. The narcotic was in the form of intravenous pentazocine (12 mg). Any side effects including 3-month follow-up for any neurological symptoms were noted. One way ANOVA with SPSS software, version 16.0 was used. Result: The age, sex, and the duration of surgery were similar in all the three groups. The NRS and the sedation scores were significantly high in 0 h in group C than the other groups. Later, they were similar and comparable between groups. The narcotic requirement was significantly higher in group C than other groups. In a comparison between groups, the pentazocine requirement was higher in group B than group BH but was not statistically significant. The time to first analgesia was significantly higher in group BH, which was higher than group C. There were no undue side effects in any group. A 3-month follow-up did not report any neurological symptom in patients of any group. Conclusion: Addition of polygeline to bupivacaine in nerve blocks provides early postoperative pain relief by possibly prolonging the duration of action of bupivacaine. Even though the narcotic requirements are less with addition of polygeline in the first postoperative 12 h, it is not statistically significant. There were no untoward side effects.

The impact of preemptive ropivacaine in inguinal hernioplasty – A randomized controlled trial

Introduction: This study was aimed to assess the outcome of Ilioinguinal, Iliohypogastric block and wound infiltration with 0.75% ropivacaine on pain perception, first analgesic request and hospital stay following inguinal Lichtenstein mesh repair. Method: This was a prospective, randomized, double-blind study with 60 patients undergoing inguinal hernioplasty under general anesthesia. Patients were randomly allocated to one of the two groups by the sealed envelope method. Group 1 (n = 30) received nerve blocks and incision infiltration with 0.75% ropivacaine while group 2 (n = 30) received isotonic saline. Postoperatively pain intensity, time of demand for the first analgesic and duration of hospital stay were assessed. Results: Median Visual Analog Scale (VAS) score of group 1 was 4 (high = 6, low = 3) while for group 2 was 5.50 (high = 8, low = 4) and the p value was <0.001. Mean time for the demand of the first analgesic was prolonged from 1.19 ± 1.05 h to 5.31 ± 1.14 h with the p value of <0.0005, while the mean time of hospital stay was reduced from 22.5 ± 3.30 h to 14.1 ± 2.99 h with the p value of <0.0005. Conclusion: Preemptive analgesia with 0.75% ropivacaine causes significant reduction in pain perception, request for an analgesic and hospital stay. Therefore it is advisable before inguinal hernioplasty.

Ilioinguinal-Iliohypogastric Nerve Block with Intravenous Dexketoprofen Improves Postoperative Analgesia in Abdominal Hysterectomies

Background and objectiveIn this study, our aim was to evaluate the effects of intravenous dexketoprofen trometamol with ilioinguinal and iliohypogastric nerve block on analgesic quality and morphine consumption after total abdominal hysterectomy operations. MethodsWe conducted this randomized controlled clinical study on 61 patients. The study was conducted in the operation room, post-anesthesia care unit, and inpatient clinic. We randomly grouped the 61 patients into control group (group C), block group (group B) and dexketoprofen-block group (group DB). Before the skin incision performed after anesthesia induction, we performed ilioinguinal iliohypogastric block (group C given saline and group P and DB given levobupivacaine). In contrast to group C and B, group DB was given dexketoprofen. We administered morphine analgesia to all patients by patient-controlled analgesia (PCA) during the postoperative 24hours. We recorded Visual Analogue Scale (VAS), satisfaction scores, morphine consumption and side effects during postoperative 24hours. ResultsWe found the DB group's VAS scores to be lower than the control group and block group's (p < 0.05) values at postoperative 1st, 2nd, 6th and 12th hours. VAS scores of group C were higher than of group B at postoperative first 2hours. Time to first PCA demand was longer, morphine consumption values were lower and satisfaction scores were higher in group DB than in the other two groups (p < 0.05). ConclusionsIlioinguinal-iliohypogastric nerve block with IV dexketoprofen increases patient satisfaction by decreasing opioid consumption, increasing patient satisfaction, which suggests that dexketoprofen trometamol is an effective non-steroidal anti-inflammatory analgesic in postoperative analgesia.

Treatment of inguinal hernia in a difficult environment: feasibility and efficacy of ilioinguinal and iliohypogastric blocks

Hernia repair is a very frequent surgical procedure; it is estimated that one African in five undergoes this procedure during his lifetime. Patients and methods. We evaluated the feasibility of this surgery under ilioinguinal and iliohypogastric nerve blocks in difficult environments. The medical-surgical group supporting Operation Unicorn has treated 48 inguinal hernias as medical aid to population, including 34 with these nerve blocks. Results. The block did not fail in any case. The mean time until discharge was 6.85h, which meant that outpatient surgery was possible. Discussion and conclusion. This type of anesthesia is interesting in difficult environments. It is a safe, inexpensive, and easy to learn technique. These qualities should promote its use in countries with a low GNP.

Application of ultrasound guidance for ilioinguinal or iliohypogastric nerve block in pediatric inguinal surgery

To evaluate the efficacy of ultrasound guidance for ilioinguinal or iliohypogastric nerve block in pediatric outpatients undergoing inguinal surgery. The present study was approved by the ethics committee of our hospital. One hundred children with ASA status I, aged 4 - 8 years old, scheduled for unilateral inguinal surgery were randomly divided into ultrasound group (Group U) and traditional group (Group T) (n = 50 each). Upon entering operation room, they were monitored by electrocardiography (ECG), heart rate (HR) and oxygen saturation (SpO(2)). After an induction of general anesthesia, intravenous access was established and laryngeal mask inserted with spontaneous breathing. Intraoperative anesthesia was maintained with 2% sevoflurane in 50% nitrous oxide with 50% oxygen. Children in Group U received an ilioinguinal or iliohypogastric block under ultrasonic guidance with a mixture of 0.8% lidocaine and 0.25% levobupivacaine at 0.2 ml/kg while those in Group T performed according to the traditional method of anatomical localization with the same local anesthetic at 0.3 ml/kg. During surgery, the vital signs of HR, respiratory rate (RR), SpO(2), partial pressure of end-tidal carbon dioxide (P(ET)CO(2)) and exhaled sevoflurane concentration were recorded. Additional intraoperative analgesic requirements were recorded. Face legs activity cry consolability (FLACC) score was used to assess the pain score postoperatively at recovery time, 2 and 4 h postoperation respectively. If the pain score was above 3, the child received acetaminophen rectally. The number of postoperative rectal acetaminophen was recorded. The degrees of parental satisfaction were investigated at 2 and 4 h postoperation. Intra-or postoperative adverse events were also recorded. HR at skin incision and sac traction in Group U was significantly lower than those in Group T (P < 0.05). Six children (12%) needed to increase inhaled sevoflurane concentration during operation in Group U versus 17 (34%) in Group T (P < 0.05). The pain score at recovery time, 2 and 4 h postoperation in Group U was significantly lower than those in T group (P < 0.05). Only 4 children (8%) needed postoperative rectal acetaminophen in Group U versus 13 (26%) in Group T (P < 0.05). The degree of parental satisfaction at 2 h postoperation was significantly higher in Group U than that in Group T (P < 0.05). One case in Group T had needle puncturing into blood vessels. No other adverse event was observed in two groups. The method of ultrasonic guidance for ilioinguinal or iliohypogastric nerve block is both feasible and effective. It can not only enhance the effect of nerve block, reduce the occurrences of complications, lower the quantity of local anesthetic and alleviate the medicinal toxicity.

Tramadol for pain relief in children undergoing herniotomy: a comparison with ilioinguinal and iliohypogastric blocks

Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Preoperative ilioinguinal and iliohypogastric nerve blocks have been widely used to provide analgesia in children undergoing herniorrhaphy. Tramadol is an analgesic with micro-opioid and nonopioid activity. In this study we compared the usage of intravenous tramadol with ilioinguinal and iliohypogastric nerve blocks for control of post-herniorrhaphy pain in children aged 2-7 years. Sixty patients were randomly allocated to two groups of thirty. One group received tramadol 1.5 mg.kg(-1) i.v. before induction of general anesthesia and the other had an ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine (0.25 ml.kg(-1)) before skin incision. We assessed pain using the Children's Hospital of Eastern Ontario Pain Scale and the Categorical Pain Scale. At 1, 4 and 24 h after surgery the two groups had identical pain scores. At 2 and 3 h after surgery the tramadol group experienced significantly less pain (P < 0.05). The rescue drug for residual pain, was used equally in the two groups. None of the 60 patients had respiratory depression but the tramadol group patients were found to have more episodes of nausea and vomiting (P < 0.05). We concluded that tramadol can have at least the same analgesic effect as that of ilioinguinal and iliohypogastric nerve blocks for post-herniorrhaphy pain in children, with even a superior effect at the time of maximal analgesia. We also highlight the troublesome side-effect of nausea and vomiting which brings into question the benefits of using this opioid that seems to lack respiratory depression.

Effect of bupivacaine with epinephrine wound instillation for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy

Background and Objectives: To evaluate the effect of a 20- or 60-second instillation period using 0.5% bupivacaine with epinephrine for pain relief after pediatric inguinal herniorrhaphy and hydrocelectomy. Methods: In a randomized, double-blind study, 103 children (aged 1 to 12 years, American Society of Anesthesiologists [ASA] physical status I or II) were allocated into 4 groups after induction of anesthesia. Group 1: normal saline 0.25 mL/kg instilled, which remained in the wound for 20 or 60 seconds before wound closure. Group 2: 0.25 mL/kg 0.5% bupivacaine with epinephrine 5 μg/mL instilled, which remained in the wound for 20 seconds. Group 3: the same quantity and dose of drug 2 instilled as group, but remained in the wound for 60 seconds. Group 4: an ilioinguinal and iliohypogastric block performed before operation using 0.5 mL/kg 0.25% bupivacaine with epinephrine. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Aldrete-Kroulik recovery scores were used to monitor postoperative pain and recovery status. Analgesic was given when the CHEOPS score was ≥ 7 despite other supportive therapy. Results: The number of patients requiring analgesics within 2 hours in group 1 (73.1%) was more than groups 2, 3, and 4 (23.1%, 20.8%, and 16%, respectively, P < .001). The median time to first analgesic in group 1 (50 minutes) was also less than groups 2, 3, and 4 (420, 525, and 425 minutes, respectively, P < .0001). Conclusion: 0.5% Bupivacaine with epinephrine for as short an instillation period as 20 or 60 seconds can provide a good analgesic alternative after herniorrhaphy and hydrocelectomy in pediatric patients. All studied blocks had comparable duration of action. Reg Anesth Pain Med 2003;28:24-28.

Local anaesthesia in postoperative analgesia for herniorrhaphy

Objective: To test the hypothesis that local infiltration with bupivacaine at the time of herniorrhaphy would decrease postoperative pain. Design: Sixty-five patients in whom a polypropylene mesh was implanted to treat an inguinal hernia were included in a random double-blind study. Operative anaesthesia was intradural with prilocaine 5%, 1.25 mg/kg. After the procedure, an ilioinguinal and iliohypogastric block was performed by infiltration of soft tissues with 0.25 ml/kg of either bupivacaine 0.5% or NaCl 9 g/l. Postoperative pain was assessed with an analog pain scale, (range 0–5) in the recovery room, 8 h later and 24 h later. The patient assessed the pain 24 h after surgery (range 0–5) and the relationship with the pain he expected (range 0–2). The time when the first dose of analgesia (diclofenac 75 mg i.v.) was given was also noted (range 0–6). A score (range 0–28) was calculated to quantify postoperative pain. Results: Thirty-three patients were infiltrated with bupivacaine and 32 patients received placebo. Both groups were similar in sex, age, weight and operating time (44 (20 min)). No pain was reported for bupivacaine (score 1.4 (0.9)) and minor pain for placebo (score 2.1 (1.0)) in the recovery room ( P < 0.05), Further pain assessment was similar in both groups (scores range: 1.1–1.5). The first dose of analgesia was administered 2–3 h postoperatively (score 4.4 (2.0)) in the placebo group and 4 to 5 h postoperatively (score 2.9 (2.4)) in the bupivacaine group ( P < 0.05). The final postoperative pain score was 11.3 (3.9) in the placebo group and 9.2 (4.4) in the bupivacaine group ( P < 0.05). Conclusions: Local infiltration of the abdominal wall with bupivacaine reduces immediate postoperative pain and delays the administration of postoperative analgesia.