Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 06 01 1580 1580 Maha El Derh Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Aya Salem Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Samar Abdel Twab Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2026 02 23 2026 03 30 Background: An increasingly common minimally invasive treatment for aortic valve dysfunction is transcatheter aortic valve replacement. Our study aimed to compare the efficacy and safety of ilioinguinal/iliohypogastric (IH/II) nerve block and local infiltration intraoperatively. Sufficient pain control is essential for improving recovery and lowering complications following transcatheter aortic valve replacement (TAVR) in such a frail group of patients. Methods: In this prospective, double-blinded, randomized controlled study, 60 patients scheduled for TAVR were divided into two groups. Group A received blind local infiltration with 20 ml of lidocaine 1%, while Group B received a US-guided IH/II nerve block with 20 ml of bupivacaine 25%. The primary outcome, intraoperative pain scores, was assessed using the Numerical Rating Scale (NRS) at predefined procedural time points. Hemodynamics, oxygen saturation, level of consciousness, and required analgesia were recorded at 5 time points as secondary outcomes. Results: The block group experienced significantly lower NRS levels than the Local Group during puncture (1.1±0.8 vs. 3.1±0.8, p < 0.001), balloon insufflation (0.6±0.8 vs. 2.8±0.7, p<0.001), and sheath removal (1.5±1.4 vs. 3.5±0.5, p < 0.001). Patients in the block group also required considerably fewer analgesics (16.3% vs. 53.3%, p = 0.003). MAP and heart rate decreased considerably (p < 0.05) in the Block Group during sheath removal, balloon insufflation, and piercing. SpO2 values were significantly higher in the Block Group during puncture and balloon insufflation (p < 0.01). Conclusion: An IH/II nerve block offered superior analgesia and hemodynamic stability in TAVR-TF patients compared to local infiltration, resulting in considerably lower pain scores and analgesic use. This method provides better pain control for TAVR operations. https://aacc.tums.ac.ir/index.php/aacc/article/view/1580