Ultrasound-guided transverse abdominis plane and ilioinguinal-iliohypogastric nerve block versus illioinguinal- illiohypogastric nerve block for inguinal hernia repair in patients with liver cirrhosis

Abstract

ABSTRACTBackground: Patients with chronic liver disease and liver cirrhosis have many anesthetic considerations with general anesthesia and limitation of ability to receive regional anesthesia due to coagulopathy and low platelets count.Our study aims to compare the combination of the Ilioinguinal-iliohypogastric (ILIH) nerve block with the Transverse Abdominis Plane block (TAB) versus the Ilioinguinal-iliohypogastric (ILIH) nerve block alone as a sole anesthetic technique in hepatic patients with liver cirrhosis for surgical repair of inguinal hernia.Methods: Sixty patients known to have chronic liver disease and liver cirrhosis undergoing unilateral repair of inguinal hernia were randomly assigned to two equal groups:Group (T) received ipsilateral transverse abdominis plane block (TAB) ultrasound-guided (US) in combination with Ilioinguinal-iliohypogastric (ILIH) nerve block intraoperatively.Group (I) received US-guided ipsilateral Ilioinguinal-iliohypogastric nerve block only intraoperatively.The degree of pain was evaluated using the VAS score for pain hourly for the first 6 h and at 12, 18, and 24 h postoperatively. Need for LA infiltration into surgical field or the conversion to GA was assessed. Onset of sensory block, duration of analgesia, the use of rescue analgesia and its total dose in 24 hours, the patient’s and surgeon’s satisfaction and any adverse events were recorded. Liver functions were measured 24 h postoperatively.Results: The duration of analgesia was significantly longer in group (T) (14.27 ± 2.5 hours) than in group (I) (11.81 ± 2.9 hours; p = 0.039). The total required dose of acetaminophen in first 24 hours was higher in group (I) (1.1 ± 0.81 gm) than in group (T) (0.6 ± 0.94 gm; p = 0.021).There was no significant difference between groups in onset of sensory block, need for LA infiltration, need for GA, or incidence of postoperative side effects. Patients’ satisfaction was statistically better in group T compared to group I whereas there was no statistical significant difference between both groups regarding surgeon’s satisfaction.Conclusion: Combined Transverse Abdominis plane block (TAB) with Ilioinguinal-iliohypogastric (ILIH) nerve block has longer duration of analgesia and less dose of rescue analgesia with more patient satisfaction than the use of Ilioinguinal-iliohypogastric (ILIH) nerve block in surgical repair of inguinal hernia in chronic hepatic patients with liver cirrhosis.

Keywords

• US-guided nerve block
• transversus abdominis plane
• iliohypogastric nerve
• ilioinguinal nerve
• inguinal hernia surgery
• liver cirrhosis