Prospective Randomized Study Comparing Analgesic Effect of Ultrasound-Guided Ilioinguinal/Ilio hypo gastric Nerve Block with Ultrasound-Guided TAP Block for Inguinal Hernia Repair

Document Type : Original Article


The Department of Anesthesiology and Surgical Intensive Care, Faculty of Medicine, Tanta University


Abstract Background: Both transversus abdominis plane (TAP) block and ilioinguinal-iliohypogastric (IIN/IHN) blocks are used regularly, under ultrasound (USG) guidance for reliving postoperative pain in patients planned for inguinal hernia surgery. Aim of Study: Was to compare post-operative analgesic efficacy of USG guided TAP Vs. IIN/IHN block in adults scheduled for inguinal hernia surgery. Patients and Methods: Seventy male patients aged 18 to 50 with American Society of Anesthesiologists' grade I and II were involved. After end of surgery, patients in Group I received USG guided unilateral TAP block using 20mL bupi-vacaine 0. 5% and those in Group II received IIN/IHN block using 20mL bupivacaine 0.5%, intravenous (IV) morphine was used as a rescue analgesic postoperatively. Assessment of postoperative pain was the primary outcome, total analgesic consumption in the first 24h, first time of analgesic request, post-operative hemodynamics and any complications related to technique or to rescue analgesia were also recorded. Results: Comparison of the median values of NRS at rest and at movement among the studied groups revealed that there was a significant increase in its values in group I compared to group II at 2 and 4 hours post-operatively, time to first analgesic request was statistically prolonged in group II than group I with the median time of 8 and 4 hours postop-eratively respectively. Morphine consumption which was statistically reduced in group II in comparison with group I with the median value of 6mg and 9mg respectively. Significant hemodynamic stabilization (mean arterial blood pressure and heart rate) was recorded with TAP group compared with II/IH group. Neither complications due to the block (as hematoma and local anesthetic toxicity) nor due to the rescue morphine analgesia (as respiratory depression nausea and vomiting) occurred in both groups. Conclusions: Ultrasound guided transversus abdominis plane (TAP) block reduces the postoperative pain and analgesic consumption compared to ultrasound guided ilioinguinal and iliohypogastric nerve (IL/IH) block in patients undergoing inguinal hernia repair.