A comparative study to evaluate ultrasound-guided transversus abdominis plane block versus ilioinguinal iliohypogastric nerve block for post-operative analgesia in adult patients undergoing inguinal hernia repair

Kirti Kamal, Parul Jain, Teena Bansal, Geeta Ahlawat, Kirti Kamal, Parul Jain, Teena Bansal, Geeta Ahlawat

Abstract

Background and aims: Both transversus abdominis plane (TAP) block and combined ilioinguinal-iliohypogastric (IIN/IHN) blocks are used routinely under ultrasound (USG) guidance for postoperative pain relief in patients undergoing inguinal hernia surgery. This study compares USG guided TAP Vs IIN/IHN block for post-operative analgesic efficacy in adults undergoing inguinal hernia surgery.

Methods: Sixty adults aged 18 to 60 with American Society of Anesthesiologsts' grade I or II were included. After general anaesthesia, patients in Group I received USG guided unilateral TAP block using 0.75% ropivacaine 3 mg/kg (maximum 25 mL) and those in Group II received IIN/IHN block using 10 mL 0.75% ropivacaine. Postoperative rescue analgesia was with tramadol (intravenous) IV ± diclofenac IV in the first 4 h followed by oral diclofenac subsequently. Total analgesic consumption in the first 24 h was the primary objective, intraoperative haemodynamics, number of attempts and time required for performing the block as well as the postoperative pain scores were also evaluated.

Results: Time to first analgesic request was 319.8 ± 115.2 min in Group I and 408 ± 116.4 min in Group II (P = 0.005). Seven patients (23.33%) in Group I and two (6.67%) in Group II required tramadol in first four hours. No patient in either groups received diclofenac IV. The average dose of tablet diclofenac was 200 ± 35.96 mg in Group I and 172.5 ± 34.96 mg in Group II (P = 0. 004).

Conclusion: USG guided IIN/IHN block reduces the postoperative analgesic requirement compared to USG guided TAP block.

Keywords: Iliohypogastric nerve block; ilioinguinal nerve block; inguinal hernia; ultrasound guided.

Conflict of interest statement

There are no conflicts of interest.

References

    1. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15:239–49.
    1. PROSPECT collaboration. Joshi GP, Rawal N, Kehlet H, Bonnet F, Camu F, Fischer HB, et al. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012;99:168–85.
    1. Ding Y, White PF. Post-herniorrhaphy pain in outpatients after preincision ilioinguinal-iliohypogastric nerve block during monitored anaesthesia care. Can J Anesth. 1995;42:12–5.
    1. Bugedo GJ, Cárcamo CR, Mertens RA, Dagnino JA, Muñoz HR. Preoperative percutaneous ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine for post-herniorrhaphy pain management in adults. Reg Anesth. 1990;15:130–3.
    1. Toivonen J, Permi J, Rosenberg PH. Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia. Acta Anaesthesiol Scand. 2001;45:603–7.
    1. Demirci A, Efe EM, Türker G, Gurbet A, Kaya FN, Anil A, et al. Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: Comparison of the anatomical landmark and ultrasound guided techniques. Rev Bras Anestesiol. 2014;64:350–6.
    1. Bærentzen F, Maschmann C, Jensen K, Belhage B, Hensler M, Børglum J, et al. Ultrasound-guided nerve block for inguinal hernia repair: A randomized, controlled, double-blind study. Reg Anesth Pain Med. 2012;37:502–7.
    1. Venkatraman R, Abhinaya RJ, Sakthivel A, Sivarajan G. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair. Local Reg Anesth. 2016;9:7–12.
    1. Frassanito L, Pitoni S, Gonnella G, Alfieri S, Del Vicario M, Catarci S, et al. Utility of ultrasound-guided transversus abdominis plane block for day-case inguinal hernia repair. Korean J Anesthesiol. 2017;70:46–51.
    1. Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, et al. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011;106:380–6.
    1. Petersen PL, Mathiesen O, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: A randomised clinical trial. Eur J Anaesthesiol. 2013;30:415–21.
    1. Pyati S, Gan TJ. Perioperative pain management. CNS Drugs. 2007;21:185–211.
    1. Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Cox SG, et al. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005;95:226–30.
    1. Willschke H, Bösenberg A, Marhofer P, Johnston S, Kettner S, Eichenberger U, et al. Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: What is the optimal volume? Anesth Analg. 2006;102:1680–4.

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