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Evaluation of Ultrasound-guided Genitofemoral Nerve Block Combined with Ilioinguinal/iliohypogastric Nerve Block during Inguinal Hernia Repair in the Elderly

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Summary

To evaluate the anesthetic effect of ultrasound-guided (USG) ilioinguinal/iliohypogastric nerve (II/IHN) block combined with genital branch of genitofemoral nerve (GFN) block in the elderly undergoing inguinal hernia repair, 54 old patients (aged 60–96years, ASA I–III) with indirect hernia were enrolled and scheduled for unilateral tension-free herniorrhaphy. Patients were grouped randomly to receive either USG II/IHN plus GFN block (Group G) or USG II/IHN block alone (Group I). The intraoperative visual analogue scale (VAS) scores were recorded at skin incision, at spermatic cord/round ligament traction and at sac ligation. The resting and dynamic VAS scores were recorded postoperatively. The requirements of extra sedatives and analgesics for intra- and postoperative analgesia were assessed. Occurrence of complications of the block, postoperative nausea and vomiting and femoral nerve palsy was also reported. Both groups showed similar sensory block. When stretching spermatic cord/round ligament, the patients in group G had significantly lower VAS scores than in group I. And group G used much fewer adjuvant sedatives and analgesics to achieve adequate anaesthesia. In addition, group G was presented with better intraoperative anaesthesia and lower postoperative dynamic VAS scores at all time points tested. No significant difference was found in the postoperative requirement of rescue medication. Both groups showed no complications related to the block and group G reported no femoral nerve palsy. The addition of GFN block to II/IHN block improves the quality of perioperative anesthesia and analgesia in the elderly and reduces the consumption of extra sedatives and analgesics during the surgery.

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References

  1. Chlebny T, Zelga P, Pryt M, et al. Safe and uncomplicated inguinal hernia surgery in the elderly-message from anesthesiologists to general surgeons. Pol Przegl Chir, 2017,89(2):5–10

    Article  Google Scholar 

  2. Mei W, Tian YK, Huang YG. Development and prospect of regional anesthesia: complying with the times and develo** the application of visualized technique in local anesthesia. J Clin Anesthesiol (Chinese), 2017,33 (10):941–943

    Google Scholar 

  3. Li Y, Su YL, Yuan Q, et al. Comparison of three nerve block methods in inguinal tension-free hernioplasty of the elders. Chin J Neuromed (Chinese), 2015,14(9):945–949

    Google Scholar 

  4. Stav A, Reytman L, Stav MY, et al. Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy. Rambam Maimonides Med J, 2016,7(3): 1–9

    Article  Google Scholar 

  5. Casati A, Danelli G, Baciarello M, et al. A prospective, randomized comparison between ultrasoundand nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology, 2007,106(5):992–996

    Article  CAS  Google Scholar 

  6. Yang M, Fang H, Zhang FX, et al. Effect of dexmedetomidine combined with ropivacaine forilioinguinal and iliohypogastric nerve block under sevoflurane anesthesia. J Clin Anesthesiol (Chinese), 2017,33(9):872–874

    Google Scholar 

  7. Yaster M, Maxwell LG. Pediatric regional anesthesia. Anesthesiology, 1989,70(2):324–338

    Article  CAS  Google Scholar 

  8. Dario B, Philip P. In: Dnnilo J, Philip P, eds. Regional Nerve Blocks in Anesthesia and Pain Therapy: Traditional and Ultrasound-Guided Techniques. 4 ed. Heidelberg New York Dordrecht London: Springer, 2015:707–715

  9. Sasaoka N, Kawaquchi M, Yoshitani K, et al. Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. Br J Anaesth, 2005,94(2):243–246

    Article  CAS  Google Scholar 

  10. Rosemar A, Angeras U, Rosengren A. Body mass index and groin hernia: a 34-year follow-up study in Swedish men. Ann Surg, 2008,247(6):1064–1068

    Article  Google Scholar 

  11. Wirtschafter ZT, Bentley JP. Hernias as a Collagen Maturation Defect. Ann Surg, 1964,160(5):852–859

    Article  CAS  Google Scholar 

  12. Read RC. Attenuation of the rectus sheath in inguinal herniation. Am J Surg, 1970,120(5):610–614

    Article  CAS  Google Scholar 

  13. Strom C, Rasmussen LS, Sieber FE. Should general anaesthesia be avoided in the elderly? Anaesthesia, 2014,69(Suppl 1):35–44

    Article  Google Scholar 

  14. van Schoor AN, Boon JM, Bosenberg AT, et al. Anatomical considerations of the pediatric ilioinguinal/iliohypogastric nerve block. Paediatr Anaesth, 2005,15(5):371–377

    Article  CAS  Google Scholar 

  15. Weintraud M, Marhofer P, Bosenberg A, et al. Ilioinguinal/iliohypogastric blocks in children: where do we administer the local anesthetic without direct visualization? Anesth Analg, 2008,106(1):89–93

    Article  CAS  Google Scholar 

  16. Starling JR, Harms BA. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg, 1989,13(5):586–591

    Article  CAS  Google Scholar 

  17. Starling JR, Harms BA, Schroeder ME, et al. Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery, 1987,102(4):581–586

    CAS  PubMed  Google Scholar 

  18. Peng PW, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures. Reg Anesth Pain Med, 2009,34(5):458–474

    Article  Google Scholar 

  19. Rab M, Ebmer AJ, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg, 2001,108(6):1618–1623

    Article  CAS  Google Scholar 

  20. Shandling B, Steward DJ. Regional analgesia for postoperative pain in pediatric outpatient surgery. J Pediatr Surg, 1980,15(4):477–480

    Article  CAS  Google Scholar 

  21. Frassanito L, Zanfini BA, Pitoni S, et al. Ultrasound-guided genitofemoral nerve block for inguinal hernia repair in the male adult: a randomized controlled pilot study. Minerva Anestesiol, 2018,84(2):189–195

    Article  Google Scholar 

  22. Wipfli M, Birkhauser F, Luyet C, et al, Ultrasound-guided spermatic cord block for scrotal surgery. BrJ Anaesth, 2011,106(2):255–259

    Article  CAS  Google Scholar 

  23. Shanthanna H. Successful treatment of genitofemoral neuralgia using ultrasound guided injection: a case report and short review of literature. Case Rep Anesthesiol, 2014,4:e371703

    Google Scholar 

  24. Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature. Pain Physician, 2008,11(2):215–224

    Article  Google Scholar 

  25. Terkawi AS, Romdhane K. Ultrasound-guided pulsed radiofrequency ablation of the genital branch of the genitofemoral nerve for treatment of intractable orchalgia. Saudi J Anaesth, 2014,8(2):294–298

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Wuhan Fourth Hospital & Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430033, China

    Zhi Huang, **ao-hong Peng & **-yuan Ke

  2. Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Wei **a

  3. Department of Physiology, Basic Medicine School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Wei Wang

Authors
  1. Zhi Huang
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  2. Wei **a
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  3. **ao-hong Peng
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  4. **-yuan Ke
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  5. Wei Wang
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Corresponding authors

Correspondence to **-yuan Ke or Wei Wang.

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Conflict of Interest Statement

The authors declare no conflicts of interest in this study.

This work is supported by grants from Hubei Province Health and Family Planning Scientific Research Project (No. WJ2019F01).

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Huang, Z., **a, W., Peng, Xh. et al. Evaluation of Ultrasound-guided Genitofemoral Nerve Block Combined with Ilioinguinal/iliohypogastric Nerve Block during Inguinal Hernia Repair in the Elderly. CURR MED SCI 39, 794–799 (2019). https://doi.org/10.1007/s11596-019-2107-2

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  • DOI: https://doi.org/10.1007/s11596-019-2107-2

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