The Effect of Adding Ketamine to Bupivacaine in Ultrasound Guided Ilioinguinal and Iliohypogastric Nerve Block for Inguinal Hernia Operations

Abstract
Background: Chronic pain occurs in 5-10% after the inguinal hernia repair that creates an important problem. Peripheral nerve blocks with local anesthetics are a method that may be used in inguinal hernia surgeries. Iliohypogastric (IH) and Ilioinguinal (II) nerve blocks are used for this purpose.
Aim: Our aim is to evaluate the effect of adding ketamine to bupivacainein ultrasound guided ilioinguinal and iliohy-pogastric nerve block in patients scheduled for inguinal hernia repair.
Patients and Methods: This study was carried out on 90 patient, 18-60 years, ASA I-II, scheduled for elective inguinal hernia repair under general anesthesia with ilioinguinal and iliohypogastric nerve block. Patients were randomized into two equal groups (45 patients in each group): Group 1: Received given 2mg/kg of 0.5% bupivacaine in the block) and Group II (given 2mg/kg of 0.5% bupivacaine with ketamine 2mg/kg in the block) 45 patients the following parameters were compared between the 2 groups: Vital signs (heart rate, mean arterial pressure), Visual Analogue Scale (VAS), the first time for resuce analgesia, dose of rescue analgesia (morphine), incidence of Post-Operative Nausea and Vomiting (PONV) using neumeric rank score and undesirable side effect.
Results: There were no significant difference between the two studied groups regarding demographic data, vital signs, Post-Operative Nausea and Vomiting (PONV) and undesirable side effects. The visual analogue scale showed that pain began earlier and more sever in group 1than in Group II. Total dose of rescue analgesia (morphine) was significantly higher in Group I than Group II. The first time for resuce analgesia was earlier in Group I than Group II.
Conclusion: Patients undergoing inguinal hernia repair surgery, addition of ketamine 2mg/kg to bupivacaine in ultrasound guided ilioinguinal and iliohypogastric nerve block produce more effective postoperative analgesia as indicated by lower VAS scale and the prolonged duration of sensory block compared to bupivacaine alone.