Ilioinguinal-iliohypogastric Nerve Research Articles

Effect of ultrasound-guided ilioinguinal-iliohypogastric nerve block on chronic pain in patients undergoing open inguinal hernia surgery under spinal anesthesia: a randomized double-blind study.

Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia. Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests. The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of -8.43 mg (95% CI -10.54, -6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180-360]) versus (180 min [180-360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups. Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months.

Reply to comments regarding ‘efficacy of analgesia using ilioinguinal-iliohypogastric (IIIH) nerve block, transversus abdominis plane (TAP) block and diclofenac after cesarean delivery under spinal anaesthesia: A non-randomised clinical trial’

Reply to comments regarding ‘efficacy of analgesia using ilioinguinal-iliohypogastric (IIIH) nerve block, transversus abdominis plane (TAP) block and diclofenac after cesarean delivery under spinal anaesthesia: A non-randomised clinical trial’

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.

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. 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. 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 (13mg 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. 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.

Comments on the published article: Efficacy of analgesia using ilioinguinal-iliohypogastric nerve block, transversus abdominis plane block and diclofenac after caesarean delivery under spinal anaesthesia: A non-randomised clinical trial.

Comments on the published article: Efficacy of analgesia using ilioinguinal-iliohypogastric nerve block, transversus abdominis plane block and diclofenac after caesarean delivery under spinal anaesthesia: A non-randomised clinical trial.

Comparison of the Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block and Ilioinguinal-Iliohypogastric Nerve Block in Paediatric Patients After Inguinal Hernia Surgery: A Prospective Randomized Controlled Trial.

To compare the postoperative analgesic efficacy of quadratus lumborum block (QLB) and ilioinguinal-iliohypogastric nerve block (IIIHB) in paediatric patients who have undergone unilateral inguinal hernia surgery. This prospective randomized controlled study was designed in a single center and included 60 paediatric patients aged 2-7 years who had undergone inguinal hernia repair surgery and received an American Society of Anesthesiologists score of 1-2. Patients were randomized into two groups: those receiving ultrasound-guided QLB and those receiving IIIHB. The primary outcomes of the study were patients' face, legs, activity, cry, and consolability (FLACC) scores at 1, 2, 6, 12, and 24 hours post-surgery. The mean heart rate 15 and 30 minutes post-surgery in the QLB group was lower than that of the IIIHB group, and the difference at both times was statistically significant (P < 0.001). The mean FLACC score of the QLB group was lower than that of the IIIHB group at 6, 12, and 24 hours post-surgery, and the differences were statistically significant (P=0.004, P=0.006, and P < 0.001, respectively). Between the groups, there was no statistically significant difference in the number of patients who were administered rescue analgesics or oral ibuprofen, the time of first ibuprofen administration, or the frequency of complications (P=1.000, P=0.145, P=0.195, and P=1.000, respectively). Compared with IIIHB, QLB achieves superior postoperative analgesic effects in paediatric patients who have undergone inguinal hernia surgery, as evidenced by longer analgesic periods, lower pain scores, and lower analgesic consumption.

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.

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).]. 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. 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). Bilateral TAP block with bupivacaine and clonidine after CD under SA increases the duration of postoperative analgesia.

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.

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. 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. 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. 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.

Postoperative Analgesic Efficacy Of Ilioinguinal-Iliohypogastric Block In Inguinal Hernia Surgeries: A Prospective Randomized Single-Blind Study

Introduction: Ilioinguinal-iliohypogastric (II/IH) nerve block is used for postoperative analgesia in lower abdominal surgeries. We aimed to compare the postoperative analgesic efficacy of ultrasound (US) guided II/IH nerve block, tramadol, and paracetamol in patients scheduled for unilateral inguinal hernia surgery. Materials and Methods: The study population consisted of patients who underwent surgery diagnosed with inguinal hernia. Sixty male cases aged 18-65 years and ASA I-II were included in the study. After spinal anesthesia, those who underwent II/IH nerve block under US guidance for postoperative analgesia were classified as Group B (n=20), those who received tramadol were classified as Group T (n=20), and those who received paracetamol were classified as Group P (n=20). Demographic characteristics, hemodynamic parameters, time before postoperative first analgesic requirement, amount of analgesic used in the first 24 hours, additional analgesic requirement, Visual Analogue Scale (VAS) score, and patient satisfaction were recorded. Results: There was no significant difference between the groups regarding demographic data, ASA score, and operation. Up to 24 hours postoperatively, patient satisfaction in Group B was significantly higher than in the other two groups. While the time before the first analgesic requirement was 295 minutes in Group B, it was 129.5 minutes in Group T and 122 minutes in Group P (p=0.001). While the VAS scores in the first 12 hours postoperatively were lower in Group B, they were similar in all three groups after the 12th hour. Conclusion: The study findings demonstrated II/IH nerve block reduces the need for analgesia in the first 24 hours postoperatively in inguinal hernia operations performed under spinal anesthesia. In addition, it was determined that II/IH nerve block ensures better postoperative patient satisfaction and prolongs the first analgesic requirement time.

Three-point mesh fixation in robot-assisted transabdominal preperitoneal (R-TAPP) repair of 208 inguinal hernias: preliminary results of a single-center consecutive series.

The aim of this study was to assess the efficacy of our mesh fixation technique in robot-assisted transabdominal preperitoneal inguinal hernia repair (R-TAPP). The primary outcome was the recurrence rate. Secondary outcomes were postoperative pain, chronic pain, and return to normal activities. Between January 2018 and December 2019, we performed 208 consecutive R-TAPP in 161 patients and the mesh was fixed by three intracorporeal stiches using a Polyglactin 910 (Vicryl®) 3-0 suture. Patients were followed up at 10 and 30days after surgery with a clinical evaluation for detection of early complications, postoperative pain, need for analgesics, return to normal activities, and satisfaction rate. Patients were further followed up at study conclusion in February 2021 for recurrence and chronic pain detection. Painkillers were stopped by 57% of the patients after the first postoperative day and by 96% after 1week. Chronic pain (> 3months after surgery) was observed in three patients (1.8%) and only one of them was treated with percutaneous ilioinguinal-iliohypogastric nerve infiltration. After a mean follow-up of 24.0 ± 6.7months, only 1 recurrence (0.48%) was clinically detected and confirmed by a CT-scan. The 3-point mesh fixation technique is feasible during robot-assisted TAPP repair for inguinal hernia and seems to be a viable alternative to other fixation methods. Further long-term controlled investigations are needed to understand if this technique is effective in influencing recurrence and chronic pain rates.

Postoperative Analgesic Effectiveness of Peripheral Nerve Blocks in Cesarean Delivery: A Systematic Review and Network Meta-Analysis.

The purpose of this systematic review and network meta-analysis was to determine the analgesic effectiveness of peripheral nerve blocks (PNBs), including each anatomical approach, with or without intrathecal morphine (ITMP) in cesarean delivery (CD). All relevant randomized controlled trials comparing the analgesic effectiveness of PNBs with or without ITMP after CD until July 2021. The two co-primary outcomes were designated as (1) pain at rest 6 h after surgery and (2) postoperative cumulative 24-h morphine equivalent consumption. Secondary outcomes were the time to first analgesic request, pain at rest 24 h, and dynamic pain 6 and 24 h after surgery. Seventy-six studies (6278 women) were analyzed. The combined ilioinguinal nerve and anterior transversus abdominis plane (II-aTAP) block in conjunction with ITMP had the highest SUCRA (surface under the cumulative ranking curve) values for postoperative rest pain at 6 h (88.4%) and 24-h morphine consumption (99.4%). Additionally, ITMP, ilioinguinal-iliohypogastric nerve block in conjunction with ITMP, lateral TAP block, and wound infiltration (WI) or continuous infusion (WC) below the fascia also showed a significant reduction in two co-primary outcomes. Only the II-aTAP block had a statistically significant additional analgesic effect compared to ITMP alone on rest pain at 6 h after surgery (−7.60 (−12.49, −2.70)). In conclusion, combined II-aTAP block in conjunction with ITMP is the most effective post-cesarean analgesic strategy with lower rest pain at 6 h and cumulative 24-h morphine consumption. Using the six described analgesic strategies for postoperative pain management after CD is considered reasonable. Lateral TAP block, WI, and WC below the fascia may be useful alternatives in patients with a history of sensitivity or severe adverse effects to opioids or when the CD is conducted under general anesthesia.

Comparison between Ultrasound-Guided Bilateral Ilioinguinal-Iliohypogastric Nerve Block and Ultrasound-Guided Transverses Abdominus Plane Block with the Usage Bubivacaine and Dexamethasone for Post-Cesarean Section Analgesia: A Pilot Study

Comparison between Ultrasound-Guided Bilateral Ilioinguinal-Iliohypogastric Nerve Block and Ultrasound-Guided Transverses Abdominus Plane Block with the Usage Bubivacaine and Dexamethasone for Post-Cesarean Section Analgesia: A Pilot Study

080 Efficacy of Ilioinguinal and/or Iliohypogastric Nerve Blocks for the Treatment of Orchialgia

Orchialgia, defined as three or more months of bothersome intermittent or constant testicular pain, is a difficult to treat condition with many possible etiologies. Treatment may involve tighter-fitting underwear, scrotal support, ice, avoidance of provoking activities, non-steroidal anti-inflammatory medication(s), empiric antibiotic(s), neuropathic medication(s), or surgical intervention(s) by various sub-specialists. Those reporting inadequate pain relief despite conservative, oral pharmacological therapy, and spermatic cord block or persistent pain despite surgical intervention may be referred to a chronic pain specialist for further evaluation and management. Prospective studies in pediatric patients with orchialgia have shown that ilioinguinal-iliohypogastric nerve blocks may be a viable treatment option for pediatric patients with a history of orchialgia without an identifiable cause. No studies have been performed in adult patients to assess efficacy of nerve blocks in men presenting with orchialgia.

Ultrasound-guided transverse abdominis plane and ilioinguinal-iliohypogastric nerve block versus illioinguinal- illiohypogastric nerve block for inguinal hernia repair in patients with liver cirrhosis

ABSTRACT Background: Patients with chronic liver disease and liver cirrhosis have many anesthetic considerations with general anesthesia and limitation of ability to receive regional anesthesia due to coagulopathy and low platelets count. Our study aims to compare the combination of the Ilioinguinal-iliohypogastric (ILIH) nerve block with the Transverse Abdominis Plane block (TAB) versus the Ilioinguinal-iliohypogastric (ILIH) nerve block alone as a sole anesthetic technique in hepatic patients with liver cirrhosis for surgical repair of inguinal hernia.Methods: Sixty patients known to have chronic liver disease and liver cirrhosis undergoing unilateral repair of inguinal hernia were randomly assigned to two equal groups: Group (T) received ipsilateral transverse abdominis plane block (TAB) ultrasound-guided (US) in combination with Ilioinguinal-iliohypogastric (ILIH) nerve block intraoperatively. Group (I) received US-guided ipsilateral Ilioinguinal-iliohypogastric nerve block only intraoperatively. The degree of pain was evaluated using the VAS score for pain hourly for the first 6 h and at 12, 18, and 24 h postoperatively. Need for LA infiltration into surgical field or the conversion to GA was assessed. Onset of sensory block, duration of analgesia, the use of rescue analgesia and its total dose in 24 hours, the patient’s and surgeon’s satisfaction and any adverse events were recorded. Liver functions were measured 24 h postoperatively.Results: The duration of analgesia was significantly longer in group (T) (14.27 ± 2.5 hours) than in group (I) (11.81 ± 2.9 hours; p = 0.039). The total required dose of acetaminophen in first 24 hours was higher in group (I) (1.1 ± 0.81 gm) than in group (T) (0.6 ± 0.94 gm; p = 0.021).There was no significant difference between groups in onset of sensory block, need for LA infiltration, need for GA, or incidence of postoperative side effects. Patients’ satisfaction was statistically better in group T compared to group I whereas there was no statistical significant difference between both groups regarding surgeon’s satisfaction.Conclusion: Combined Transverse Abdominis plane block (TAB) with Ilioinguinal-iliohypogastric (ILIH) nerve block has longer duration of analgesia and less dose of rescue analgesia with more patient satisfaction than the use of Ilioinguinal-iliohypogastric (ILIH) nerve block in surgical repair of inguinal hernia in chronic hepatic patients with liver cirrhosis.

Ultrasound-guided Ilioinguinal-Iliohypogastric nerve block in inguinal hernia repair surgery under general anesthesia: a randomized controlled study

Ultrasound-guided Ilioinguinal-Iliohypogastric nerve block in inguinal hernia repair surgery under general anesthesia: a randomized controlled study

Comparison of spinal anaesthesia versus ilioinguinal-iliohypogastric nerve block applied with tumescent anaesthesia for single-sided inguinal hernia.

Primary aim of this study is to determine whether the use of local anaesthesia performed with IINB and IHNB against spinal anaesthesia in inguinal hernia repair is accepted as an alternative medicine. 75 cases in the class of American Society of Anesthesia physical status (ASA) I-III between the ages of 18 and 75 diagnosed with single-sided inguinal hernia and hospitalized for surgery in general surgery clinic were prospectively and randomly included in this study. There was statistically significant difference between the groups (30.14 ± 8.2 and 35.51 ± 9.39) in terms of the duration of the surgery. The duration was shorter in Group 1 (p < 0.001). There was statistically significant difference between the groups in terms of the duration of the first mobilization. It was significantly shorter in Group 2 than in Group 1 (5.71 ± 1.7 and 2.70 ± 1.53min) (p < 0.001). Mean duration of length of hospital stay criteria was significantly shorter in Group 2 than in Group 1 (26.00 ± 6.43 and 14.23 ± 5.40h) (p < 0.001). Throughout the follow-up period in postoperative 24h, the number of patients who needed analgesia was significantly higher in Group 1 than in Group 2 (91.4% and 45.7%) There was statistically significant difference between the groups in terms of patient satisfaction and urinary retention development (p < 0.005). Hematoma development or postoperative bleeding was not observed in either group. The time of sensory block onset was significantly higher in Group 2 than in Group 1 (9.66 ± 1.41 and 9.03 ± 0.98min) (p < 0.005) CONCLUSION: The results of our study show that IINB and IHNB applied with local anaesthesia are superior to spinal anaesthesia in unilateral inguinal hernia repairs.

A randomized control trial on the efficacy of bilateral ilioinguinal-iliohypogastric nerve block and local infiltration for post-cesarean delivery analgesia

Background and Aims: The management of post-cesarean delivery pain is of utmost importance to prevent undesirable outcomes. Local anesthetic wound infiltration and bilateral ilioinguinal-iliohypogastric (ILIH) nerve block are two potential techniques to provide better postoperative analgesia. In this study, these two techniques have been compared for the management of postoperative pain in the elective cesarean section. Materials and Methods: After approval from the institutional ethics committee and informed consent from patients, this study was conducted on 150 patients who underwent elective cesarean section under spinal anesthesia. Patients were allotted into three groups: group C (postoperative sham injection), group L (postoperative infiltration of incision site with 20 mL of 0.5% ropivacaine), and the group I (postoperative bilateral ILIH block with 10 mL of 0.5% ropivacaine on each side under ultrasound guidance). The objectives of our study were to evaluate the duration of analgesia, visual analog scale (VAS) score, and the cumulative analgesic requirement for pain relief and a number of analgesic demands. Student t-test and Mann-Whitney U test were used to compare the analgesic parameters among the groups. Results: Group I had a significantly longer duration of analgesia (515.64 ± 82.87 min) compared to group L (280.87 ± 39.47 min), and group C (246.89 ± 37.85 min). Group I had significantly lower VAS scores compared to the groups L and C. Group I (1.72 ± 0.68) had lower analgesic demands compared to group L (3.26 ± 0.64) and group C (4.62 ± 0.65). The cumulative analgesic requirement was significantly lower in group I. Conclusion: ILIH nerve block has a longer duration of postoperative pain relief in cesarean delivery patients compared to local infiltration and placebo.

Comparison of bilateral ilioinguinal-iliohypogastric nerve block versus transverses abdominis nerve block for postoperative pain management for parturient undergoing elective cesarean section in Dilla University Referral Hospital, Ethiopia. A randomized controlled trial

BackgroundPain is one of the most common complaints and causes of distress in the perioperative period. The postoperative pain after cesarean section is believed to be of mild to moderate intensity lasting for up to 72 h. Apart from patient preferences, several factors affect choices of analgesia in a resource-limited setting like Ethiopia. Availability of resources, trained manpower, and inter-individual variation in pain threshold was among the factors affecting analgesia choices. Thus, this study aims to compare TAP block versus II/IH block for post-cesarean delivery analgesia in resource-limited areas where the ultrasound-guided block is not practiced. MethodA randomized controlled trial study was conducted in Dilla university referral hospital. Pregnant women scheduled for elective cesarean section were randomized to either TAP block (n = 36) or II/IH block (n = 36) for postoperative pain management. The sample size was calculated using a G-power version 3.1.9.2 getting a total of 72 participants. Pain severity, total tramadol consumption, and time to first analgesic request were assessed during the first 72 h postoperatively. Manny Whitney U-test and independent t-test were used based on the distribution of data. A Kaplan Meier analysis was used to assess' proportion of patients who did not require analgesia for a 48 h follow up period. ResultThe cumulative median tramadol consumption over 48 h were 100 mg for TAP group and 150 mg for II/IH (p = 0.018). The median tramadol consumption at 24hr. and 36 h were also lower in the TAP group compared to II-IH (P < 0.05). There was no statistically significant difference between groups regarding time to first analgesia request (p > 0.05). The median pain score at 36hr. and 48hr. were lower in the TAP group (3 and 4) compared to the II-IH group (4 and 6) respectively (p < 0.05). There is no statistically significant difference between groups regarding the postoperative side effects and complications. ConclusionBoth II-IH and TAP block had comparable analgesic efficacy during the first 24hr. TAP block had longer analgesic effectiveness compared to II-IH with an effect lasting for 48hr.

Comparison of ultrasoundguided ilioinguinal iliohypogastric nerve block with wound infiltration during pediatric herniotomy surgeries

Background and Aims:The purpose of this study was to compare the analgesic efficacy of the ilioinguinal-iliohypogastric nerve block (II/IH) with local wound infiltration in children undergoing herniotomy surgeries.Methods:After ethics committee approval and informed consent, 100 children aged 6 months–7 years posted for herniotomy surgeries were randomly divided into Group B and Group W. Local wound infiltration was performed in Group W by the surgeon at the time of port placement and the end of the surgery with 0.2 mL.kg−1 of 0.25% bupivacaine. Ipsilateral II/IH was performed in Group B at the end of the surgery, under ultrasonographic guidance with a Sonosite portable ultrasound unit and a linear 5–10 MHz probe with a 22G hypodermic needle, and 0.2 mL.kg−1 of 0.25% bupivacaine was used on each side. The parameters recorded were postoperative hemodynamics, paracetamol and opioid requirements, postoperative pain scores, postoperative nausea vomiting, and the need for rescue analgesia in the first 6 h postoperatively.Results:The median pain scores were significantly lower in the II/IH group than the local wound infiltration group at 10 min (2 [0–2.5] compared to 2 [3–4]; P = 0.011), 30 min (1.5 [0–3] compared to 3 [2–5]; P < 0.001), 1 h (1.5 [0–2] compared to 2 [2–3]; P < 0.001) and 2 h (2 [0–2] compared to 2 [1.5–2.5]; P = 0.010) postoperatively. The need for postoperative opioids and rescue analgesia was also significantly lower in the II/IH group (P < 0.001).Conclusion:II/IH is superior to local wound infiltration for postoperative analgesia in pediatric herniotomy surgeries.

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

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.

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.