Ilioinguinal and Iliohypogastric Nerve Block for Acute and Chronic Pain Relief After Caesarean Section: A Randomized Controlled Trial

Laila Elahwal, Shimaa Elrahwan, Amr Arafa Elbadry, Laila Elahwal, Shimaa Elrahwan, Amr Arafa Elbadry

Abstract

Background: There is an increasing cesarean section (CS) rate in Egypt. Multiple methods are used to manage pain after CS.

Objectives: This study aimed to assess the effect of ultrasound-guided bilateral ilioinguinal and iliohypogastric nerve block on pain reduction after CS.

Methods: We classified 64 cases of elective CS into two equal groups. The block group underwent the nerve block, and the control group did not. Postoperative pain, morphine consumption, time to analgesic request, and complications were compared between the two groups.

Results: No significant difference was detected between the two groups regarding patient characteristics or operation duration. However, pain scores during rest and movement were significantly lower in the block group than in controls, especially within the first 12 hours following the operation. Morphine consumption was significantly lower in the block group (4.53 ± 1.456) in group B vs. (8.87 ± 2.013) in group C with P-value < 0.001. Time to the first rescue analgesia was significantly longer in the intervention group than in the other group (12.25 vs. 3.81 hours). Pruritis and nausea incidence was significantly higher in controls than in the block group. The incidence of chronic postoperative pain was significantly lower in the block group.

Conclusions: The ilioinguinal and iliohypogastric nerve block is efficient and safe for managing postoperative pain following CS. It is associated with significant improvement of acute and chronic pain after such operations.

Keywords: Acute Pain; Caesarean Section; Chronic Pain; Iliohypogastric; Ilioinguinal.

Conflict of interest statement

Conflict of Interests: There is no conflict of interest.

Copyright © 2022, Author(s).

Figures

Figure 1.. Randomized trial flow diagram, including…
Figure 1.. Randomized trial flow diagram, including enrollment, intervention allocation, and analysis
Figure 2.. The VAS scores during rest…
Figure 2.. The VAS scores during rest in studied groups
Figure 3.. The VAS scores during movement…
Figure 3.. The VAS scores during movement in studied groups

References

    1. Al Rifai RH. Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014. BMC Pregnancy Childbirth. 2017;17(1):417. doi: 10.1186/s12884-017-1591-2.
    1. Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol. 2012;206(4):331 e1–19. doi: 10.1016/j.ajog.2012.02.026.
    1. Kerai S, Saxena KN, Taneja B. Post-caesarean analgesia: What is new? Indian J Anaesth. 2017;61(3):200–14. doi: 10.4103/ija.IJA_313_16.
    1. Pekmezci A, Cesur M, Aksoy M, Ince I, Aksoy A. The effect of ilioinguinal-iliohypogastric block with or without intravenous paracetamol for pain relief after caesarean delivery. Acta Med Mediterr. 2014;30(6):1183–8.
    1. Pujari V, Krishnegowda S, Doddagavanahalli SC, Bevinaguddaiah Y, Parate L. A randomized control trial on the efficacy of bilateral ilioinguinal-iliohypogastric nerve block and local infiltration for post-cesarean delivery analgesia. J Obstet Anaesth Crit Care. 2020;10(1):32. doi: 10.4103/joacc.JOACC_30_19.
    1. Edinoff AN, Houk GM, Patil S, Bangalore Siddaiah H, Kaye AJ, Iyengar PS, et al. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugs. Anesth Pain Med. 2021;11(3):e117197. doi: 10.5812/aapm.117197.
    1. Edinoff AN, Fitz-Gerald JS, Holland KAA, Reed JG, Murnane SE, Minter SG, et al. Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate. Anesth Pain Med. 2021;11(3):e117146. doi: 10.5812/aapm.117146.
    1. Bhaskar SB. Case for local infiltration analgesia: Is all the evidence in black and white? Indian J Anaesth. 2015;59(1):1–4. doi: 10.4103/0019-5049.149437.
    1. Joshi G, Gandhi K, Shah N, Gadsden J, Corman SL. Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities. J Clin Anesth. 2016;35:524–9. doi: 10.1016/j.jclinane.2016.08.041.
    1. Rajabi M, Razavizade MR, Hamidi-Shad M, Tabasi Z, Akbari H, Hajian A. Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section. Anesth Pain Med. 2020;10(5):e100563. doi: 10.5812/aapm.100563.
    1. Saranteas T, Kostroglou A, Efstathiou G, Giannoulis D, Moschovaki N, Mavrogenis AF, et al. Peripheral nerve blocks in the cervical region: from anatomy to ultrasound-guided techniques. Dentomaxillofac Radiol. 2020;49(8):20190400. doi: 10.1259/dmfr.20190400.
    1. Chong CCW. Ultrasound in pain management. Ultrasound Med Biol. 2019;45 doi: 10.1016/j.ultrasmedbio.2019.07.621.
    1. Imani F, Rahimzadeh P, Faiz HR, Abdullahzadeh-Baghaei A. An Evaluation of the Adding Magnesium Sulfate to Ropivacaine on Ultrasound-Guided Transverse Abdominis Plane Block After Abdominal Hysterectomy. Anesth Pain Med. 2018;8(4):e74124. doi: 10.5812/aapm.74124.
    1. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain. 2016;13:67–75. doi: 10.1016/j.sjpain.2016.06.012.
    1. Jin J, Peng L, Chen Q, Zhang D, Ren L, Qin P, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol. 2016;16(1):99. doi: 10.1186/s12871-016-0270-6.
    1. Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, et al. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108(3):248–57. doi: 10.1016/j.pain.2003.12.024.
    1. Bell EA, Jones BP, Olufolabi AJ, Dexter F, Phillips-Bute B, Greengrass RA, et al. Iliohypogastric-ilioinguinal peripheral nerve block for post-Cesarean delivery analgesia decreases morphine use but not opioid-related side effects. Can J Anaesth. 2002;49(7):694–700. doi: 10.1007/BF03017448.
    1. Kintu A, Abdulla S, Lubikire A, Nabukenya MT, Igaga E, Bulamba F, et al. Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country. BMC Health Serv Res. 2019;19(1):68. doi: 10.1186/s12913-019-3911-x.
    1. Fusco P, Scimia P, Paladini G, Fiorenzi M, Petrucci E, Pozone T, et al. Transversus abdominis plane block for analgesia after Cesarean delivery. A systematic review. Minerva Anestesiol. 2015;81(2):195–204.
    1. Eshete MT, Baeumler PI, Siebeck M, Tesfaye M, Haileamlak A, Michael GG, et al. Quality of postoperative pain management in Ethiopia: A prospective longitudinal study. PLoS One. 2019;14(5):e0215563. doi: 10.1371/journal.pone.0215563.
    1. Sakalli M, Ceyhan A, Uysal HY, Yazici I, Basar H. The efficacy of ilioinguinal and iliohypogastric nerve block for postoperative pain after caesarean section. J Res Med Sci. 2010;15(1):6–13.
    1. Bunting P, McConachie I. Ilioinguinal nerve blockade for analgesia after caesarean section. Br J Anaesth. 1988;61(6):773–5. doi: 10.1093/bja/61.6.773.
    1. Nigatu YA, Gebremedhn EG, Tawuye HY, Gebreegzi AH. Analgesic Efficacy of Bilateral Ilioinguinal and Iliohypogastric Nerve Block for Post Caesarean Delivery Under Spinal Anaesthesia, 2016. Double blind randomized Study. J Anesth Clin Res. 2017;08(08) doi: 10.4172/2155-6148.1000751.
    1. Jin Y, Li Y, Zhu S, Zhu G, Yu M. Comparison of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section: A retrospective propensity match study. Exp Ther Med. 2019;18(1):289–95. doi: 10.3892/etm.2019.7540.
    1. Talebi G, Moayeri H, Rahmani K, Nasseri K. Comparison of Three Different Doses of Dexmedetomidine Added to Bupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block; A Randomized Clinical Trial. Anesth Pain Med. 2021;11(2):e113778. doi: 10.5812/aapm.113778.
    1. Yucel E, Kol IO, Duger C, Kaygusuz K, Gursoy S, Mimaroglu C. Ilioinguinal-iliohypogastric nerve block within travenous dexketoprofen improves postoperative analgesia in abdominal hysterectomies. Braz J Anesthesiol. 2013;63(4):334–9. doi: 10.1016/j.bjan.2012.07.002.
    1. Splinter WM, Bass J, Komocar L. Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia. Can J Anaesth. 1995;42(3):197–200. doi: 10.1007/BF03010675.
    1. Ganta R, Samra SK, Maddineni VR, Furness G. Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section. Br J Anaesth. 1994;72(2):229–30. doi: 10.1093/bja/72.2.229.
    1. Chabot B, Ferland CE. Inpatient postoperative undesirable side effects of analgesics management: a pediatric patients and parental perspective. Pain Rep. 2020;5(5):e845. doi: 10.1097/PR9.0000000000000845.
    1. Ortner CM, Turk DC, Theodore BR, Siaulys MM, Bollag LA, Landau R. The Short-Form McGill Pain Questionnaire-Revised to evaluate persistent pain and surgery-related symptoms in healthy women undergoing a planned cesarean delivery. Reg Anesth Pain Med. 2014;39(6):478–86. doi: 10.1097/AAP.0000000000000158.
    1. Niklasson B, Georgsson Ohman S, Segerdahl M, Blanck A. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section. Acta Obstet Gynecol Scand. 2015;94(6):622–8. doi: 10.1111/aogs.12613.
    1. Moriyama K, Ohashi Y, Motoyasu A, Ando T, Moriyama K, Yorozu T. Intrathecal Administration of Morphine Decreases Persistent Pain after Cesarean Section: A Prospective Observational Study. PLoS One. 2016;11(5):e0155114. doi: 10.1371/journal.pone.0155114.
    1. Richez B, Ouchchane L, Guttmann A, Mirault F, Bonnin M, Noudem Y, et al. The Role of Psychological Factors in Persistent Pain After Cesarean Delivery. J Pain. 2015;16(11):1136–46. doi: 10.1016/j.jpain.2015.08.001.
    1. Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859–71. doi: 10.1111/j.1526-4637.2010.00983.x.
    1. Rupniewska-Ladyko A, Malec-Milewska M. A High Dose of Fentanyl May Accelerate the Onset of Acute Postoperative Pain. Anesth Pain Med. 2019;9(5):e94498. doi: 10.5812/aapm.94498.
    1. Woolf CJ, Salter MW. Neuronal plasticity: increasing the gain in pain. Science. 2000;288(5472):1765–9. doi: 10.1126/science.288.5472.1765.
    1. Neil MJ, Macrae WA. Post Surgical Pain- The Transition from Acute to Chronic Pain. Rev Pain. 2009;3(2):6–9. doi: 10.1177/204946370900300203.
    1. Lavand'homme P, De Kock M. The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery. Acta Anaesthesiol Belg. 2006;57(4):373–9.
    1. Obata H, Saito S, Fujita N, Fuse Y, Ishizaki K, Goto F. Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain. Can J Anaesth. 1999;46(12):1127–32. doi: 10.1007/BF03015520.
    1. Batoz H, Verdonck O, Pellerin C, Roux G, Maurette P. The analgesic properties of scalp infiltrations with ropivacaine after intracranial tumoral resection. Anesth Analg. 2009;109(1):240–4. doi: 10.1213/ane.0b013e3181a4928d.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj