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

## Authors

- Nurettin Kurt ([ORCID](https://orcid.org/0000-0001-7713-5120)) — Department of Anaesthesiology and Reanimation, Van Yuzuncu Yıl University Faculty of Medicine, Van/Turkey
- Nureddin Yuzkat ([ORCID](https://orcid.org/0000-0002-8218-1217)) — Department of Anaesthesiology and Reanimation, Van Yuzuncu Yıl University Faculty of Medicine, Van/Turkey
- Celaleddin Soyalp ([ORCID](https://orcid.org/0000-0002-2687-5329)) — Department of Anaesthesiology and Reanimation, Van Yuzuncu Yıl University Faculty of Medicine, Van/Turkey
- Mehmet Kilic ([ORCID](https://orcid.org/0000-0002-5345-0166)) — Department of Intensive Care, SBU Van Training and Research Hospital, Van/Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 9, Issue 3 (2023), pages 158–164
- **Article type:** Original Article
- **Published online:** 2023-09-13
- **DOI:** [10.5455/umj.20230813123641](https://doi.org/10.5455/umj.20230813123641)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=165131
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/165131.pdf

## Abstract

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.

## Keywords

Ilioinguinal/iliohypogastric nerve block; Inguinal hernia; Unilateral spinal anesthesia; Peripheral nerve block; Postoperative analgesia

## How to cite

Kurt N, Yuzkat N, Soyalp C, Kilic M. Postoperative Analgesic Efficacy Of Ilioinguinal-Iliohypogastric Block In Inguinal Hernia Surgeries: A Prospective Randomized Single-Blind Study. Ulutas Med J. 2023;9(3):158-164. doi:10.5455/umj.20230813123641

## References

1. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. Journal of pain research. 2018; 10: 2287 https://doi.org/10.2147/jpr.s144066
2. Aleem S, Sarwar N, Naseem S, Abbas MA, Hameed S, Aleem A. Effectiveness of Intramuscular Diclofenac Sodium Injection versus Diclofenac Suppositories in Post-Operative Pain Management in Inguinal Hernia. Pakistan Journal of Medical & Health Sciences 2022;16(03):197-97. 164 77 Ilioinguinal-Iliohypogastric Block in Inguinal Hernia Nurettin Kurt et al. https://doi.org/10.53350/pjmhs22163197
3. Bhatia N, Sen IM, Mandal B, Batra A. Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: A prospective, randomised trial. Anaesth Crit Care Pain Med. 2019;38(1):41-5. https://doi.org/10.1016/j.accpm.2018.03.007
4. Raeder J. Best anesthetic method for inguinal hernia repair?. Acta anaesthesiologica scandinavica 2005;49(2):131-32. https://doi.org/10.1111/j.1399-6576.2005.00689.x
5. Callesen T, Bech K, Kehlet H. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Anesthesia & Analgesia 2001;93(6): 1373-76. https://doi.org/10.1097/00000539-200112000-00004
6. Onur T, Karaca Ü, Ökmen K, Terkanlıoğlu S, Onur A. The effects of ilioinguinal nerve block on acute and chronic neuropathic pain in patients following inguinal hernia repair with spinal anesthesia: A prospective cohort study. Journal of Surgery and Medicine 2022;6(2): 120-24 https://doi.org/10.28982/josam.891954
7. Ronald D. Miller: USG guidence for Regional Anesthesia. Miller’s Anesthesia. Ed. 8., San Francisco; Jens K, Andrew TG. 2015; 1752-66
8. Morgan GE, Michael SM, Murray MJ. Peripheral Nerve Blocks. Clinical Anesthesiology. Ed.5., New York; McGray Hill; 2013.
9. Prakash J, Prabhu JP, Kharwar RK, Priye S, Singh D, Saran K. Comparison of epidural levobupivacaine and bupivacaine in lower abdominal and lower limb surgeries. Bali J Anaesthesiol 2020; 4:95-8. https://doi.org/10.4103/bjoa.bjoa_21_20
10. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010;104(5):538-46. https://doi.org/10.1093/bja/aeq069
11. Erdine S. Historical perspective. In: Regional anesthesia. Ed. 1., Istanbul: Nobel Tıp; 2013.
12. Marhofer P, Frickey N. Ultrasonographic Guidance in Pediatric Regional Anesthesia Part 1: Theoretical Background. Pediatric Anesthesia. 2006; 16(10): 1008-18. https://doi.org/10.1111/j.1460-9592.2006.02020.x
13. Suresh S, Chan V W.S. Ultrasound Guided Transverses Abdominis Plane Block in İnfants, Children and Adolescents: a Simple Procedural Guidance for Their Performance. Pediatric Anesthesia 2009;19:296-9. https://doi.org/10.1111/j.1460-9592.2009.02958.x
14. 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 anaesthesiolo gica scandinavica 2001;45(5): 603-07 https://doi.org/10.1034/j.1399-6576.2001.045005603.x
15. Bugedo GJ, Dagnino JA, Cárcamo CR, Muñoz HR, Mertens RA. Preoperative Percutaneous Ilioinguinal and Iliohypogastric Nerve Block with 0.5% Bupivacaine for Post-herniorrhaphy Pain Management in Adults. Regional Anesthesia: The Journal of Neural Blockade in Obstetrics, Surgery, & Pain Control 1990; 15(3): 130-33 https://doi.org/10.1136/rapm-00115550-199015030-00005
16. Toivonen J, Permi J, Rosenberg PH. Analgesia and Discharge Following Preincisional Ilioinguinal and Iliohypogastric Nerve Block Combined with General or Spinal Anaesthesia for Inguinal Herniorrhaphy. Acta anaesthesiologica scandinavica 2004; 48(4): 480-85 https://doi.org/10.1111/j.1399-6576.2004.00346.x
17. Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of Ilioinguinal-iliohypogastric Nerve Block Versus Spinal Anesthesia for Inguinal Herniorrhaphy. Southern Medical Journal, 2006; 99(1): 48-52. https://doi.org/10.1097/01.smj.0000197298.48311.80
18. Bunting P, McConachie I. Ilioinguinal Nerve Blockade for Analgesia After Caesarean Section. British Journal of Anaesthesia 1988; 61(6): 773-75. https://doi.org/10.1093/bja/61.6.773
19. Bessmertny AE, Antipin EE, Uvarov DN, Sedykh SV, Nedashkovsky EV. Comparison of the Effectiveness of Ilioinguinal/iliohypogastric Blockade and Blockade of the Transverse Space of the Abdomen for Pain Relief After Caesarean Section. Anesthesiology and Resuscitation 2015; 60(2):51-54.
20. Yucel E, Kol IO, Duger C, Kaygusuz K, Gursoy S, Mimaroglu C. Ilioinguinal-iliohypogastric Nerve Block with Intravenous Dexketoprofen Improves Postoperative Analgesia in Abdominal Hysterectomies. Revista Brasileira de Anestesiologia 2013; 63(4): 334-39. https://doi.org/10.1016/j.bjane.2012.07.003
21. Aghamir SK, Mojtahedzadeh M, Alizadeh F, Alizadeh F, Khalili H, Sadeghi M, et al. Propacetamol vs. Tramadol for Post-operative Pain Management After Urologic Surgery. The Internet Journal of Pharmacology 2005;4(2): 1-9. https://doi.org/10.5580/19b5
22. Yimyaem PR, Kritsanaprakornkit W, Thienthong S, Horatanaruang D, Palachewa K, Tantanatewin W, et al. Post-operative Pain Management by Acute Pain Service in a University Hospital, Thailand. Acute Pain 2006;8(4): 161-67. https://doi.org/10.1016/j.acpain.2006.08.041