Background: Ilioinguinal (IL) and iliohypogastric (IH) nerve blocks are used in patients with chronic postherniorrhaphy pain. The present study tested the hypothesis that our method, previously developed in cadavers, blocks the nerves separately and selectively in human volunteers.
Methods: We blocked the IL and the IH nerves in 16 volunteers in a single-blinded randomized cross-over setting under direct ultrasound visualization, by injecting two times the ED95 volume of 1% mepivacaine needed to block a peripheral nerve. The anaesthetized skin areas were tested by pinprick and marked on the skin. A digital photo was taken. For further analysis, the parameterized picture data were transformed into a standardized and unified coordinate system to compare and calculate the overlap of the anaesthetized skin areas of the two nerves on each side. An overlap <25% was defined as selective block.
Results: Fifty nerve blocks could be analysed. The mean volume injected to block a single nerve was 0.9 ml. Using ultrasound, we observed spread from one nerve to the other in 12% of cases. The overlap of the anaesthetized skin areas of the nerves was 60.3% and did not differ after exclusion of the cases with visible spread of local anaesthetic from one nerve to the other.
Conclusions: The IL and IH nerves cannot be selectively blocked even if volumes below 1 ml are used. The most likely explanation is the spread of local anaesthetic from one nerve to the other, although this could not be directly observed in most cases.
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http://dx.doi.org/10.1093/bja/aet028 | DOI Listing |
Anat Cell Biol
January 2025
Department of Anatomy, College of Medicine, King Khalid University, Abha, Saudi Arabia.
This study aims to determine the level of origin, branching pattern and exits of the iliohypogastric and ilioinguinal nerves in relation to the psoas major muscle. Additionally, this study confirms the presence and retroperitoneal courses of the double nerves. We dissected a total of 24 iliohypogastric and ilioinguinal nerves (6 male and 6 female cadavers).
View Article and Find Full Text PDFMed Ultrason
November 2024
Department of Anesthesiology, Affiliated Hospital of Hebei University, Baoding.
Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.
Material And Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).
Quant Imaging Med Surg
December 2024
Department of Anesthesiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China.
Background: Ultrasound-guided nerve block can be used for perioperative analgesia and can potentially improve the course of recovery. Although iliohypogastric-ilioinguinal nerve block has been successfully used for inguinal hernia surgery, the poor blocking effect of intraoperative traction reflex remains a major drawback of this technique. The main objective of this study was to investigate the feasibility of single-point ultrasound-guided iliohypogastric-ilioinguinal-genitofemoral nerve (GFN) blockage for open anterior inguinal hernia repair in older adults.
View Article and Find Full Text PDFIndian J Anaesth
September 2024
Department of Anaesthesia, Lady Hardinge Medical College and Smt Sucheta Kriplani and Kalawati Saran Children's Hospital, New Delhi, India.
Cureus
September 2024
Department of Anaesthesiology, Vinayaka Mission's Medical College, Vinayaka Mission's Research Foundation, Karaikal, IND.
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