Research Article

The 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

Abstract

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.

[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.
[2] Hayashi H, Shimoda T, Kishi K, Kitagawa K, Yamaguchi A, Suzuki A, et al. [Ilioinguinal nerve block during general anesthesia for inguinal herniorrhaphy in adult anticoagulated patients]. Masui. 2006; 55(1):82-4.
[3] Joshi GP, Rawal N, Kehlet H; PROSPECT collaboration; Bonnet F, Camu F, et al. Evidence‑based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012; 99:168‑85.
[4] Reid MF, Harris R, Phillips PD, Barker I, Pereira NH, Bennett NR. Day‑case herniotomy in children. A comparison of ilio‑inguinal nerve block and wound infiltration for postoperative analgesia. Anaesthesia. 1987; 42:658‑61.
[5] McCartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med. 2007; 32:330-8.
[6] Deshpande JP, Ghodki PS, Sardesai SP. The Analgesic Efficacy of Dexamethasone Added to Ropivacaine in Transversus Abdominis Plane Block for Transabdominal Hysterectomy under Subarachnoid Block. Anesthesia Essays & Researches. 2017; 11:499-502.
[7] Sparks CJ, Rudkin GE, Agiomea K, Fa'arondo JR. Inguinal field block for adult inguinal hernia repair using a short-bevel needle. Description and clinical experience in Solomon Islands and an Australian teaching hospital. Anaesth Intensive Care. 1995; 23(2):143-8.
[8] Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. J Ultrasound Med. 2006; 25:1571–5.
[9] Demirci A, Efe E M, Türker G, Gurbet A, Kaya F N, 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. Brazilian Journal of Anesthesiology (English Edition). 2014; 64(5): 350-356.
[10] Collins SL, Moore RA, Magueys HJ. The Visual analog pain intensity scale. What is moderate pain in millimetres. Pain. 1997; 72: 95-97.
[11] Rebecca S Twersky. New modalities in outpatient postoperative pain measurement. J Clin Anaesth. 1993; 5:57-6
[12] Bunting P, Mc Conachie I. Ilioinguinal nerve blockade for analgesia after caesarean section. Br J Anesth. 1988; 61: 773-5.
[13] Khedkar SM, Bhalerao PM, Yemul-Golhar SR, Kelkar KV. Ultrasound-guided ilioinguinal and iliohypogastric nerve block, a comparison with the conventional technique: An observational study. Saudi J Anaesth. 2015; 9(3):293-297.
[14] Akkaya A, Yildiz I, Tekelioglu UY, Demirhan A, Bayir H, Ozlu T, et al. Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: A randomized, double blind, controlled trial. Eur Rev Med Pharmacol Sci. 2014; 18:717–22.
[15] Pehora C, Pearson AM, Kaushal A, Crawford MW, Johnston B. “Dexamethasone as an adjuvant to peripheral nerve block.” Cochrane Database Syst Rev. 2017; 11(11):CD011770.
[16] Ammar AS, Mahmoud KM. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial. Saudi J Anaesth. 2012; 6:229–33.
[17] Karan D, Swaro S, Mahapatra PR, Banerjee A. Effect of dexmedetomidine as an adjuvant to ropivacaine in ilioinguinal-iliohypogastric nerve blocks for inguinal hernia repair in pediatric patients: A randomized, double-blind, control trial. Anesth Essays Res. 2018; 12:924-9.
[18] Ivani G, Conio A, De Negri P, Eksborg S, Lönnqvist PA. Spinal versus peripheral effects of adjunct clonidine: comparison of the analgesic effect of a ropivacaine-clonidine mixture when administered as a caudal or ilioinguinal-iliohypogastric nerve blockade for inguinal surgery in children. Paediatr Anaesth. 2002; 12(8):680-4.
[19] Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: a review of its use in regional anaesthesia and acute pain management. Drugs. 2005; 65:2675.
[20] Ahlgren SC, Wang JF, Levine JD. C-fiber mechanical stimulus-response functions are different in inflammatory versus neuropathic hyperalgesia in the rat. Neuroscience. 1997; 76:285–90.
[21] Williams BA, Butt MT, Zeller JR, Coffee S, Pippi MA. Multimodal perineural analgesia with combined bupivacaine-clonidine-buprenorphine-dexamethasone: Safe in vivo and chemically compatible in solution. Pain Med. 2015; 16:186–98.
[22] Santos Gde C, Braga GM, Queiroz FL, Navarro TP, Gomez RS. Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study. Rev Assoc Med Bras (1992). 2011; 57(5):545-9. English, Portuguese.
Files
IssueVol 9 No 3 (2023): Summer QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/aacc.v9i3.13118
Keywords
Dexamethasone Ilioinguinal and Iliohypogastric Ropivacaine Ilinguinal hernioplasty Subarachnoid block.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Deshpande J, Jadhao P. The 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. Arch Anesth & Crit Care. 2023;9(3):227-231.