Is ilioinguinal-iliohypogastric nerve block an underused anesthetic technique for inguinal herniorrhaphy?The common anesthetic techniques for inguinal hernia inguinal hernia n. A hernia into the inguinal canal. inguinal hernia Surgery The prolapse of a loop of intestine into a patent inguinal canal herniorrhaphy in adult patients are general anesthesia Anesthesia, General Definition General anesthesia is the induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anesthetic drugs. , spinal anesthesia spinal anesthesia n. 1. Anesthesia produced by injection of a local anesthetic solution into the spinal subarachnoid space. 2. Loss of sensation produced by disease of the spinal cord. , and occasionally epidural anesthesia epidural anesthesia n. Regional anesthesia produced by injection of a local anesthetic into the epidural space of the lumbar or sacral region of the spine. . Ilioinguinal-iliohypogastric nerve block has rarely been used as an anesthetic technique for hernia repair in adult patients, although it is a popular choice in infants and children in many operation centers. The study "Comparison of Ilioinguinal-iliohypogastric Nerve Block versus Spinal Anesthesia for Inguinal inguinal /in·gui·nal/ (in´gwi-n'l) pertaining to the groin. in·gui·nal adj. 1. Of or located in the groin. 2. Herniorrhaphy" has raised a question: Is this anesthetic technique underused for inguinal hernia repair in adults? According to this retrospective study (the author did use randomization randomization (ranˈ·d  ·m to minimize
the chance of bias), the ilioinguinal-iliohypogastric nerve block has
multiple advantages over spinal anesthesia, including shorter
time-to-home readiness, quicker oral intake postsurgery, and no need for
postanesthesia care unit (PACU) or recovery room care. These advantages
are obviously consistent with the current concept of the fast-track
ambulatory anesthesia.
Fast-track anesthesia is a popular concept for ambulatory surgeries. The patients receiving fast-track anesthesia will be fully awake and breathing comfortably with stable vital signs as soon as they leave the operating room. Since they often fulfill the requirements for discharge from PACU, they will be allowed to bypass PACU and be transferred directly to an area designed to assess home-readiness in preparation for home discharge. (1) Regional anesthesia with peripheral nerve blocks has been accepted as an excellent option for fast-tract ambulatory anesthesia. It offers excellent immediate postoperative pain control, minimal side effects such as nausea and vomiting Nausea and Vomiting Definition Nausea is the sensation of being about to vomit. Vomiting, or emesis, is the expelling of undigested food through the mouth. , elimination of the need for emergence from general anesthesia, and often immediate fulfillment of the PACU discharge criteria at the end of surgeries. Traditional spinal or epidural anesthesia is not an ideal anesthetic technique for fast-tract ambulatory surgeries due to the concerns regarding prolonged recovery, residual sympathetic blockade, urinary retention, and postural puncture headache. (1) As a peripheral regional technique, the ilioinguinal-iliohypogastric nerve block obviously meets the criteria for fast-track ambulatory anesthesia, and therefore is a reasonable choice for inguinal herniorrhaphy. As we know, PACU care is not only costly, but also labor-intensive. The anesthetic technique, ilioinguinal-iliohypogastric nerve block, enables the patients to bypass PACU. Elimination of the need for PACU care means significant healthcare cost and labor savings for this very common surgery. A recent prospective randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. study by Song et al. has indicated that this regional block in combination with monitored anesthesia care monitored anesthesia care Anesthesiology A philosophy for administering local anesthesia, which ↑ Pt comfort and safety, through use of formal anesthesiology services–eg, an anesthesiologist or a certified nurse/ registered nurse anesthetist is the most cost-effective anesthetic technique for outpatients undergoing unilateral inguinal herniorrhaphy in comparison with general anesthesia and spinal anesthesia. (2) Why is such a potential technique rarely used for inguinal herniorrhaphy in adults? The reasons are unclear, but the traditional preference for general or spinal anesthesia, as well as the unfamiliarity of this anesthetic technique by anesthetic providers or surgeons may play a role. The anatomic variations in the ilioinguinal-iliohypogastric nerve distribution may also negatively affect the success rate. (3) Ultrasound-guided nerve block has become a popular regional technique in recent years. This new technique could be very helpful, since it makes direct visualization of the target nerve possible. It has successfully been used for improvement of this nerve block in children. (4) Overall, the ilioinguinal-iliohypogastric nerve block deserves more attention. At least, this anesthetic technique should become a more common choice for inguinal herniorrhaphy. References 1. van Vlymen JM, White PF. Fast-track concept for ambulatory anesthesia, Current Opinion in Anaesthesiology an·aes·the·si·ol·o·gy n. Variant of anesthesiology. anesthesiology, anaesthesiology the branch of medical science that studies anesthesia and anesthetics. 1998;11:603-613. 2. Song D, Greilich NB, White PF, et al. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy. Anesthesia & Analgesia analgesia /an·al·ge·sia/ (an?al-je´ze-ah) 1. absence of sensibility to pain. 2. the relief of pain without loss of consciousness. 2000;91:876-881. 3. Al-dabbagh AK. Anatomical variations of inguinal nerves and risks of injury in 110 hernia repairs. Surg Radiol Anat 2002;24:102-107. 4. Willschke H, Marhofer P, Bosenberg A, et al. Ultrasonography ultrasonography /ul·tra·so·nog·ra·phy/ (-so-nog´rah-fe) the imaging of deep structures of the body by recording the echoes of pulses of ultrasonic waves directed into the tissues and reflected by tissue planes where there is a change in for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth 2005;95:226-230. Haibo Wang, MD, PHD From the Department of Anesthesiology, Louisiana State University Louisiana State University and Agricultural and Mechanical College, generally known as Louisiana State University or LSU, is a public, coeducational university located in Baton Rouge, Louisiana and the main campus of the Louisiana State University System. , Health Sciences Center-Shreveport, LA. Reprint requests to Haibo Wang, MD, PhD, Assistant Professor, Department of Anesthesiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, Louisiana 71130. Email: hwang2@lsuhsc.edu Accepted October 25, 2005. |
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