Iliohypogastric Research Articles

Review of Bladder Pain and Referred T12–L2 Input as One Etiology for Interstitial Cystitis

Abstract Background The etiology of interstitial cystitis (IC)/bladder pain syndrome (BPS) remains a mystery. Based on two patients, whose IC/BPS was relieved by resection of injured iliohypogastric (IH) and ilioinguinal (II) nerves, injured by endoscopic prostatectomy in the first patient and a stretch/traction injury in the second patient, a referred pain pathway is hypothesized that can be applied to patients with IC/BPS and previous abdominal wall surgery/injury. Methods The known neurophysiology of bladder function was reviewed as were the pathways for accepted referred pain syndromes. Results Perception of bladder filling occurs by impulses generated from stretch receptors in the bladder wall, traveling along visceral afferent fibers that enter the thoracolumbar spinal cord at T12, L1, and L2, the same location as the sympathetic outflow to the viscera and the same location as some of the visceral afferents from the bladder. The II and IH nerves originate from T12, L1, and sometimes L2 somatic, dorsal root ganglia. It is hypothesized that somatic afferent pain impulses, from the lower abdominal wall, are misinterpreted as visceral afferent impulses from the bladder, giving rise to the urinary frequency and urgency of IC/BPS. Resecting injured cutaneous afferents (II and IH) permitted long-term IC/BPS relief in the first patient for 59 months and in the second patient for 30 months. Neural inputs from the sacral visceral afferents and sacral somatic afferents did not appear to be involved in this referred pain pathway. Conclusion Nerve blocks of the T12 -L2 spinal nerves in patients with bladder pain who also have had abdominal wall surgery/injury may identify IC/BPS patients for whom resection of the II and IH nerves may prove beneficial in obtaining lasting IC/BPS relief.

Randomized trial of ultrasound-guided superior cluneal nerve block

Background and objectivesThe superior cluneal nerves originate from the dorsal rami of primarily the upper lumbar spinal nerves. The nerves cross the iliac spine to innervate the skin and subcutaneous...

Anatomical Variations in Formation and Branching Pattern of the Border Nerves of Lumbar Region

Abstract Background Ilioinguinal, iliohypogastric, and genitofemoral nerves are together known as “border nerves” of the lumbar plexus. Aim of this study was to find out the variations in formation and branching pattern of these nerves and correlate with their clinical relevance. Materials and Methods For this study 30 formaldehyde preserved cadavers were used, and the nerves were studied on both the sides, thus making the sample size of 60. Results Iliohypogastric nerve was absent in 6.6% and double in 1.6%. It was prefixed with a twig from T12 in 6.6% and had origin from both L1 and L2 in 1.6%. The ilioinguinal nerve was absent in 3.3% and double in 3.3%. The genitofemoral nerve exhibited a large number of variations. It was absent in 1.6%. Early division of the nerve prior to emergence from the psoas major muscle was noticed in 13.3%, and early division soon after emergence from the muscle was noted in 3.3%. In one cadaver, on one side, genital branch was absent, and it continued as femoral branch only. In another cadaver, the nerve continued as genital branch only. In two other cases, genital and femoral branches were seen to arise separately from the lumbar plexus. The nerve had its origin from L1 and L2 in 25%, L2 and L3 in 25%, L1 in 3.3%, L2 in 46.66%, and L3 in 1.6% of the cases. Conclusion Knowledge of these variations would be of immense help during surgical approach and giving nerve block for anesthesia and postoperative analgesia in this region.

The supra-iliac anterior quadratus lumborum block: a cadaveric study and case series.

The local anesthetic injectate spread with fascial plane blocks and corresponding clinical outcomes may vary depending on the site of injection. We developed and evaluated a supra-iliac approach to the anterior quadratus lumborum (QL) block and hypothesized that this single injection might successfully block the lumbar and sacral plexus in cadavers and provide analgesia for patients undergoing hip surgery. Ultrasound-guided bilateral supra-iliac anterior QL blocks were performed with 30 mL of India ink dye in six fresh adult cadavers. Cadavers were subsequently dissected to determine distribution of the dye. In five patients undergoing hip surgery, a unilateral supra-iliac anterior QL block with 25 mL ropivacaine 0.5% followed by a continuous catheter infusion was performed. Patients were clinically assessed daily for block efficacy. The cadaveric injections showed consistent dye involvement of the majority of the branches of the lumbar plexus, including the femoral nerve, lateral femoral cutaneous nerve, ilioinguinal nerve, and iliohypogastric nerve. The majority of cadaveric specimens (83%) also exhibited thoracic paravertebral spread of dye to the T10 level. No specimens showed L5 or sacral nerve root staining or caudal spread below L5. All patients had effective analgesia for total hip surgery and a T11-L3 sensory level following the initial bolus of local anesthetic as well as during the period of continuous catheter infusion. This cadaveric study and case series show that a supra-iliac approach to the anterior QL block involved T10--L3 nerve territories and dermatomal coverage with no sacral plexus spread. This technique may have clinical utility for analgesia in hip surgery.

Safety and efficacy of ilioinguinal and iliohypogastric nerve blocks for treatment of pelvic pain

Objective: To assess the safety and efficacy of ilioinguinal/iliohypogastric nerve blocks for patients with lower abdominal wall pain in a gynaecology setting. Methods: A retrospective chart review of 131 patients who received ilioinguinal/iliohypogastric nerve blocks at a tertiary referral centre for pelvic pain between 1 January 2012 and 13 July 2017 was performed. Patient demographics, history, examination findings and block data were extracted. Chi-square and Mann–Whitney U tests explored differences in patient characteristics between patients with and without effective response to their initial ilioinguinal/iliohypogastric nerve block. Results: A total of 465 ilioinguinal/iliohypogastric nerve blocks were performed among patients. The effect of the initial block was available for 99 out of 131 patients. Of these patients, 70% (n = 69) reported a great improvement in pain, 9% (n = 9) some improvement in pain, 18% (n = 18) no response and 3% (n = 3) worsening of pain. A significantly greater number of patients who were not responsive to their first block reported unilateral pain (p = 0.040) and had a history of vulvodynia (p = 0.038) when compared to patients who were responsive to their first block. Seven patients (5%) reported minor adverse events related to blocks. Conclusion: Ilioinguinal/iliohypogastric nerve blocks provide pain relief for those with pelvic pain localized to the lower abdominal wall, with a low rate of minor adverse events.

Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study.

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

Ultrasound-Guided Microwave Ablation for the Management of Inguinal Neuralgia: A Preliminary Study with 1-Year Follow-up

PurposeTo evaluate the feasibility and efficacy of ultrasound-guided microwave ablation for the treatment of inguinal neuralgia. Materials and MethodsA retrospective review of 12 consecutive ultrasound-guided microwave ablation procedures was performed of 10 consecutive patients (8 men, 2 women; mean age, 41 years [range, 15–64 years]), between August 2012 and August 2016. Inclusion criteria for inguinal neuralgia included clinical diagnosis of chronic inguinal pain (average, 17.3 months [range, 6–46 months]) refractory to conservative treatment and a positive nerve block. Pain response—reduction of pain level and duration and percent pain reduction using a 10-point visual analog scale (VAS) at baseline and up to 12 months after the procedure—was measured. Nine patients had pain after the inguinal hernia repair, and 1 patient had pain from the femoral artery bypass procedure. The microwave ablation procedure targeted the ilioinguinal nerve in 7 cases, the genitofemoral nerve in 4 cases, and the iliohypogastric nerve in 1 case. ResultsAverage baseline VAS pain score was 6.1 (standard deviation, 2.5). Improved pain levels immediately after the procedure and at 1, 6, and 12 months were statistically significant (P = .0037, .0037, .0038, .0058, respectively). Also, 91.7% (11/12) of the procedures resulted in immediate pain relief and at 1 month and 6 months. At 12 months, 83.3% (10/12) of patients had an average of 69% ± 31% pain reduction. Percent maximal pain reduction was 93% ± 14% (60%–100%), and the average duration of clinically significant pain reduction was 10.5 months (range, 0–12 months.). No complications or adverse outcomes occurred. ConclusionsUltrasound-guided microwave ablation is an effective technique for the treatment of inguinal neuralgia after herniorrhaphy.

Ultrasound for pelvic neuralgia

This presentation will discuss in detail the anatomy of the nerves of the lumbar plexus which are: • Iliohypogastric nerve • Ilioinguinal nerve • Genitofemoral nerve • Lateral femoral cutaneous nerve • Obturator nerve • Femoral nerve The etiology of nerve injury and clinical symptoms the patient may experience in these nerve entrapment syndromes will be reviewed. Ilioinguinal and Iliohypogastric nerves are commonly entrapped in the fascia between the internal oblique and transversus abdominis muscles. Entrapment usually occurs after surgery to this area or the presence of an inguinal hernia. Symptoms are generally pain at the region of entrapment. The genitofemoral nerve can be entrapped throughout its course either due to adhesions from previous surgery or intrapelvic trauma. Symptoms may be chronic groin pain and / or paraesthesia in the upper anterior thigh below the inguinal ligament. Entrapment of the lateral femoral cutaneous nerve occurs at ASIS under the inguinal ligament causing burning and numbness over the anterolateral thigh. Obturator tunnel syndrome is a common cause of groin pain in athletes where the obturator nerve is entrapped either in the obturator tunnel or within the proximal adductor muscles. The femoral nerve is the largest branch of the lumbar plexus and can be entrapped at 2 sites – superiorly between the psoas and iliacus muscles and inferiorly at the level of the inguinal ligament. Intrapelvic causes of entrapment can be previous surgery or breech lie in utero or the nerve can be compressed by surrounding pathology such as iliopsoas bursitis or a large hip joint synovitis. The patient may complain of groin pain with numbness in the anterior thigh to the knee. They may have difficulty going up and down stairs and cannot stand from a seated position. The aim of this presentation is to highlight the ease of which these nerves can be assessed with ultrasound and to encourage routine imaging of them in a hip or groin ultrasound study.

A modified technique of lichtenstein repair using fibro-cremasteric sheath to cover the mesh versus traditional Lichtenstein hernioplasty

Introduction The Lichtenstein hernioplasty is the most widely used repair for inguinal hernia, with recurrence rate of 1–2%. Incidence of chronic postsurgery pain ranges from 10 to 50%. Pain may be due to peripheral neuropathy in the ilioinguinal and iliohypogastric nerves, which are entrapped in inguinal canal in contact with mesh, which produces a massive fibrotic reaction. In this study, a modification in Lichtenstein repair was suggested, in which the mesh was covered by a layer derived from cremasteric sheath of the cord to avoid contact of the cord and nerves of the canal with the mesh thus reducing their affection by massive fibrotic reaction. A comparative study between this modified technique and traditional Lichtenstein repair was done. Aim To evaluate the results of the modified technique versus traditional method of Lichtenstein repair especially on postoperative pain and other postoperative complications. Patients and methods A total of 90 patients are classified into two groups: group A (45 patients) was operated by modified technique and group B (45 patients) was operated by traditional technique. Operative time, hospital stay, return to normal activities, and early and late complications, particularly pain, were assessed, and data were collected for statistical analysis in a follow-up period of 18 months. Results No intraoperative complications or recurrences were reported in both groups. The operative time in the new technique was 58.4±9.2 min compared with 51.3±10.6 min in the traditional method, which is significantly shorter. The mean hospital stay was 1±0.4 days in the modified technique group and 1.2±0.6 in the traditional group. Hospital stay and complications other than postoperative pain were similar in both groups and had no significance. Early postoperative pain showed minimal nonsignificant difference as mean visual analogue scale was slightly lower in patients of the modified method (3.9) than in the traditional group (4.1). A total of 17 (37.7%) patients in group A and 15 (33.3%) patients in group B required no medication, whereas others were administered nonsteroidal analgesics. Patients who needed analgesics in the first week postoperatively were 10 (22%) in group A and 12 (26.6%) in group B. In the second and third weeks, none of patients in group A and three (6.5%) patients in group B needed pain medication. At 6-month follow-up, it was reported that the rate of pain-related impairment of function was 11% (five cases) after modified method and 17.7% (eight cases) after Lichtenstein repair. Pain-related impairment of function at 1-year follow-up occurred in three (6.5%) patients of group A and six (13.3%) patients in group B. At 18 months, two (4.4%) patients in group A and five (11%) patients in group B had pain and discomfort at the inguinal region. There were statistically significant differences in chronic pain between both groups at 6, 12, and 18 months. Conclusion The results showed that suggested modification may be better or at least comparable to traditional Lichtenstein procedure in reduction of chronic postoperative pain with no increase in complication rates. However, larger studies with long-term follow-up are needed to assess this technique.

A clinical trial comparing ultrasound-guided ilioinguinal/iliohypogastric nerve block to transversus abdominis plane block for analgesia following open inguinal hernia repair.

ObjectiveTo 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 methodsThis 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.ResultsNRS 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.ConclusionThis 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.

Laparoscopic total extraperitoneal superior and inferior lumbar hernias repair without traumatic fixation: Two case reports

BACKGROUND: The lumbar area is limited by the bone structures (superiorly by the 12th rib and inferiorly by the iliac crest); furthermore, several important nerves, including the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal and iliohypogastric nerves, are all exposed in this area after retroperitoneal dissection during lumbar hernia repair, which render the risk and challenge for lumbar hernia repair and mesh fixation. In addition, the superior and inferior lumbar hernias, although had the same name of lumbar hernia, are quite different according to the anatomical location, and there is no standard and preferred method for lumbar hernia repair. In the present study, we present our techniques of total extraperitoneal (TEP) superior and inferior lumbar hernia repair. METHODS: The TEP approaches were performed in the superior and inferior lumbar hernias. Due to the different anatomic locations of the superior and inferior lumbar hernias, the trocar sites were also different. In the present procedure, with the use of self-gripping mesh, the traumatic fixation was avoided. RESULTS: After TEP lumbar hernia repair, both patients had minimal postoperative pain and were discharged 1 day and 3 days after operation without complications, respectively. CONCLUSION: Different pathways and trocar arrangement are necessary according to the different locations of superior and inferior lumbar hernias. The use of self-gripping mesh in the retroperitoneal space avoids the traumatic fixation, and TEP could be a promising technique for primary lumbar hernia repair.

Tudy of Dexmeditomidine as an adjuvant to bupivacaine in Ilioinguinal, Iliohypogastric nerve block in transverse abdominis plane in lower abdominal surgeries

tudy of Dexmeditomidine as an adjuvant to bupivacaine in Ilioinguinal, Iliohypogastric nerve block in transverse abdominis plane in lower abdominal surgeries

Comparison of Analgesic Efficacy of Transversus Abdominis Plane Block with Ilioinguinal Iliohypogastric Nerve Block in Lower Abdominal Surgeries under Spinal Anesthesia: A Double Blind Randomized Study

Comparison of Analgesic Efficacy of Transversus Abdominis Plane Block with Ilioinguinal Iliohypogastric Nerve Block in Lower Abdominal Surgeries under Spinal Anesthesia: A Double Blind Randomized Study

A step up therapeutic regimen for chronic post-Pfannenstiel pain syndrome

ObjectiveUp to 8% of patients undergoing surgery via a Pfannenstiel incision may develop chronic inguinal pain. This type of pain is frequently caused by inguinal nerve entrapment and may strongly interfere with daily functioning. We report our long term experience of a step up approach using tender point infiltration and surgical neurectomy for intractable neuropathic post-Pfannenstiel groin pain. Study designA retrospective database analysis identified patients with neuropathic groin pain due to iliohypogastric and/or ilioinguinal nerve entrapment following a Pfannenstiel incision in a single center between 2000 and 2015. Patients who underwent a neurectomy completed a previously published questionnaire including preoperative pain characteristics, pain reduction (5-point Verbal Rating Scale (VRS) and percentages), functional impairment, complications, recurrence of pain and current need for pain medication. ResultsData of 186 women treated for chronic post-Pfannenstiel neuralgia during this 15 year time period were available. Pain reduction following tender point infiltration was successful in 24 patients (13%). In total, 134 of 144 women who underwent a neurectomy were available for follow up via the questionnaire, and 101 responded (response rate 75%). Median age was 52 years (49–54). Before operation, 87% (n = 88) suffered from (very) severe pain (median VRS of 4, range 3–5). Almost 5 years after the operation (median 57 months, range 8–189), 54% (n = 55) had no or only mild pain (p < 0.001). Two of three women reported at least >50% pain reduction and improvement of daily functioning. Eight patients (8%) experienced recurrence of pain after an initial substantial pain reduction. ConclusionsA step-up approach of tender point infiltration and surgical neurectomy is an effective treatment option in the majority of women with chronic post-Pfannenstiel pain syndrome. Surgeons, gynecologists and pain specialists should consider adopting this treatment regimen for chronic post-Pfannenstiel pain due to nerve entrapment.

Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury.

Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery. Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery.

Use of genitofemoral and ilioinguinal and iliohypogastric nerve block during orchiectomy in a post-lung transplant patient. A case report

Abstract The case is presented of a post-lung transplant patient, ASA III, proposed for orchiectomy due to testicular cancer. A combination of iliohypogastric (ILH), ilioinguinal (ILI) and genitofemoral (GF) nerve block together with sedation was used as anaesthetic technique. The inguinal area received sensory innervation mainly from ILI, ILH and GF nerves. The genital branch of the GF nerve supplies innervation to skin of the anterosuperior portion of the scrotum. When performing the echo-guided block of GF nerve, it is necessary to identify the spermatic cord, and administer the local anaesthetic on the inside and periphery of the cord. Peripheral nerve blocks are a valid option for complex patients. Its main advantage is the anaesthesia and analgesia level that it provides without the haemodynamic instability associated with general or neuraxial anaesthesia. GF nerve block provides hemi-scrotal anaesthesia, allowing manipulation and intervention in the inguinal-scrotal area, complementing the anaesthesia provided by ILI and ILH nerve blocks.

A comparative study of bilateral ilioinguinal and iliohypogastric nerve block for postoperative analgesia in lower segment cesarean section

Background: Modern techniques incorporate regional anesthesia in pain management and it is the best and safest technique. It avoids the side effects that remain with the traditional use of opioids. Ilioinguinal and iliohypogastric nerve block can provide a satisfactory postoperative analgesia in parturients with pfannenstiel incision thereby reducing postoperative opioid consumption.Objective: To compare opioid consumption and pain relief postoperatively with ilioinguinal and iliohypogastric nerve block in patients undergoing lower segment cesarean section.Methods: It is a hospital based comparative study done in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke in a period of one year. Total of sixty patients, thirty in each were randomly allocated into the two groups. Group B received bilateral ilioinguinal and iliohypogastric nerve block by landmark technique with 20ml of 0.5% bupivacaine; 10ml in each side. Group NS received ilioinguinal and iliohypogastric nerve block with 20ml of 0.9% normal saline. In postoperative period blood pressure, pulse, oxygen saturation, numerical rating scale score at different allocated duration, total dose of tramadol consumption and time to first dose of tramadol were recorded.Results: The total postoperative tramadol consumption in the first 24hr postoperatively was significantly less in group B (125 ± 34.11mg) than in group NS (205 ±37.93mg). The mean effective duration of analgesia measured from the time of onset of spinal blockade to the time of request for tramadol was 264 ±78.27 minutes in group B and 178.17±30.61minutes in group NS, which was statistically significant and also numerical rating scale scores were low at all points postoperatively in group B.Conclusion: Bilateral ilioinguinal and iliohypogastric nerve block significantly lowers the consumption of tramadol and also provides adequate postoperative pain relief.Journal of Society of Anesthesiologists of NepalVol. 4, No. 2, 2017, page: 81-86

Neuralgia due to iliohypogastric nerve injury after inguinal hernioplasty: a case report

BackgroundNeuralgia due to iliohypogastric nerve entrapment from sutures and mesh after inguinal hernioplasty is a rare entity in clinic. Its’ awareness and management remain a clinical challenge.Case presentationWe report a case of 54-year-old male who presented with post-operative pain after 1 month and sensory disturbances of the right lower limb. He underwent partial neurectomy and during the surgery it was found that there was injury to iliohypogastric nerve due to entrapment from sutures and mesh.ConclusionWe hope to strengthen awareness about the importance of the identification of iliohypogastric nerve during inguinal hernioplasty.

Cutaneous anaesthesia of hip surgery incisions with iliohypogastric and subcostal nerve blockade: A randomised trial.

Cutaneous nerve blockade may improve analgesia after hip surgery. Anaesthesia after the lateral femoral cutaneous (LFC) nerve block is too distal for complete coverage of most hip surgery incisions, which requires additional anaesthesia of the adjacent, proximal area. The transversalis fascia plane (TFP) block potentially anaesthetises the iliohypogastric and subcostal nerves. The primary aim of the present study was to investigate, if the TFP block provides cutaneous anaesthesia adjacent to the LFC nerve block. Active vs placebo TFP blocks were compared in a paired randomised controlled trial (RCT) in 20 volunteers, who all had bilateral LFC nerve blocks. The day preceding the RCT, the area anaesthetised by a novel selective ultrasound guided subcostal nerve block was identified bilaterally in order to assess the contribution of the subcostal nerve to the area anaesthesia by the TFP block. Anaesthesia of the lateral hip region after TFP block was 80%. The cutaneous anaesthesia after active TFP block was in continuity with the LFC nerve block in 65%. Combined TFP and LFC nerve blockade significantly increased the coverage of hip surgery incisions compared to LFC nerve block alone. The success rate of blocking the subcostal nerve was 50% with the TFP block. The TFP block anaesthetises the skin proximal to the LFC nerve block by anaesthetising the iliohypogastric and subcostal nerves. TFP block as a supplement to LFC nerve block improves the coverage of the proximal surgical incisions used for hip surgery.

A Comparative Study of Diclofenac and Wound Infiltration to Additional Ilioinguinal/iliohypogastric Nerve Block With 0.25% Plain Bupivacaine for Pain Relief in Children Undergoing Groin Surgery – University Teaching Hospital (UTH), Lusaka

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Objective: Surgery in the groin region is commonly performed in paediatric patients at the University Teaching Hospital (UTH). Intramuscular (IM) Diclofenac and wound infiltration, with lignocaine, are the commonest analgesics administered intraoperatively.This study aimed at determining whether an additional ilioinguinal/iliohypogastricnerve block with 0.25% plain bupivacaine, done using the landmark technique,would improve postoperative analgesia in children undergoing groin surgery at the UTH when compared to IM diclofenac and wound infiltration with 1% lidocaine (with adrenaline 1:200,000).Methods: A non-randomized intervention study of 36 children undergoing unilateral inguinalherniotomy, hydrocelectomy and orchidopexy was conducted at UTH. The children were allocated to two groups – Group 1 (control) received IM diclofenac and wound infiltration (UTH usual care), while Group 2 (intervention group) received medication as in control plus an ilioinguinal/ iliohypogastric nerve block performed by landmark technique. The Mann-Whitney U test was used to compare the pain scores between the two groups and any resultyielding a p-value of less than 5 percent was statistically significant.Results: The operations done were unilateral inguinal herniotomy, hydrocelectomy and orchidopexy. Half of the participants were between 2-5years old and the other half between 5-7years. Post-operatively, the pain scores measured at times 0and 1 hour were statistically non-significant in both groups (p-values 0.181 and 0.355 respectively). At the 6th hour post-operative, all of the participants had pain scores of 0. Oral Paracetamol (15 - 20 mg/kg) was the only post-operative analgesic received by the patients in the study.Conclusion: This study showed that the addition of ilioinguinal/iliohypogastric nerve block, done with the landmark technique, does not offer superior pain relief during the post-operative period in children undergoing unilateral groin surgery at UTH.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;