To access the efficacy of transverse abdominis plane block versus ilioinguinal and iliohypogastric nerve block for post operative pain management
- Conditions
- Medical and Surgical,
- Registration Number
- CTRI/2024/02/063086
- Lead Sponsor
- Career institute of medical sciences and hospital
- Brief Summary
A comparative evaluation between ultrasound guided transverse abdominis plane nerve block versus ilioinguinal and iliohypogastric nerve block in hernia repair surgeries for post operative pain management.
A nerve block is the injection of numbing medication (local anesthetic ) near specific nerves to decreasepain in a certain part ofbody during and after surgery and for post operative pain management.Transverse abdominis plane block has a potent analgesic effect after hernia repair surgeries.
Open inguinal hernia surgery is one of the commonly performed surgical procedures which is
associated with substantial postoperative pain and distress.
The use of local anesthetic for blocks/infiltration is associated with a shorter intra-
hospital recovery, lesser morbidity, and overall costs. Due to abdominal wall incision peripheral nerve blocks such as transversus abdominis plane (TAP) block and ilioinguinal & iliohypogastric (II&IH) nerve blocks have been described in the literature as means to
alleviate pain.
Among all drugs and techniques, TAP and II&IH blocks are effective and easy to perform with least complications. Infiltration of local anesthetic also decrease postoperative pain and opioid demand with its resultant complications such as nausea, vomiting, and respiratory
depression. It also delays the time to rescue analgesic administration.
Anatomically, the sensory nerve supply of the inguinal region is from the T12–L2 nerves. The ilioinguinal and iliohypogastric nerves (branches of T12 and L1) are located between the internal abdominal oblique and transverse abdominis muscles just superior to the anterior superior iliac spine. Medially, the ilioinguinal and iliohypogastric nerves penetrate the internal abdominal oblique abdominal muscle to lie between the internal inguinal ring and the external oblique muscle.
Peripheral nerve blocks such as transversus abdominis plane (TAP) block, abdominal field blocks, and ilioinguinal/iliohypogastric (IIIH) nerve blocks have been described in the literature as means to alleviate pain due to abdominal wall incision.
Repair of inguinal hernia is one of the most commonly performed procedures with most of them being performed on a day surgery center. During the first 24 h after surgery, Ultrasound guided Transverse abdominis plane(a compartment block)is purposed to be superior to Ultrasound guided ilinguinal & iliohypogastric (a truncal block)in terms of the opioid-sparing
effect provide significantly better analgesia.
A growing number of studies have compared these 2 techniques in analgesia for inguinal hernia repair with variable outcomes. To reconcile these conclusions, we conducted this meta-analysis and systematic review to summarize the current evidence and compare the analgesic efficacy and side effects of II and IH block versus TAP block in adult patients undergoing abdominal surgeries.
Levobupivacaine is an s-enantiomer of the long-acting local anaesthetic bupivacaine, which, although currently the most widely used agent in surgery and obstetrics, is associated with potentially fatal cardiotoxicity.Levobupivacaine is less arrhythmogenic than the same dose range of bupivacaine in healthy volunteers. The most common adverse event associated with levobupivacaine treatment is hypotension.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- All
- Target Recruitment
- 60
- Patients who were included into the study: ASA grade I&II belonging to American Society of Anesthesiologists (ASA) Age group >18 to <65 years Patient willing to give consent.
- Patients who will be able to follow the study protocols.
Patients who were excluded from the study: Age group >18 to <65 years Patients with Child-Pugh ≥ 8/15, INR≥ 1.5, Grade 3 ascites, Serum sodium ≤120 mcq/l 2 Body mass index (BMI) ≥ 40 kg/m , Known allergy to any of the medicines used Renal or cardiovascular dysfunction Bronchial asthma, Hematological disorders.
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Onset & duration of sensory blockade 18 months Duration of post operative analgesia 18 months Patient satisfaction scores 18 months Visual analogue score 18 months
- Secondary Outcome Measures
Name Time Method Intra operative narcotic/analgesic requirement Side effects or complications
Trial Locations
- Locations (1)
Career institute of medical sciences and hospital
🇮🇳Lucknow, UTTAR PRADESH, India
Career institute of medical sciences and hospital🇮🇳Lucknow, UTTAR PRADESH, IndiaDr Priyesh bhaskarPrincipal investigator7985975077drpriyeshlpsc@gmail.com