الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Open inguinal hernia surgery is one of the commonly performed surgical procedures which is associated with substantial postoperative pain and distress. The reported incidence of pain after inguinal hernia repair varies from 0% to 37%. These procedures can be performed under regional anesthesia or general anesthesia and postoperative analgesia can be provided by various analgesic modalities.
The use of local anesthetic for blocks/infiltration is associated with a shorter intra-hospital recovery, lesser morbidity, and overall cost Infiltration of local anesthetic also improves acute postoperative pain management by decreasing postoperative pain, opioid demand with its resultant complications such as nausea, vomiting, and respiratory depression. It also delays the time to rescue analgesic administration.
Pain and discomfort are important components which are expected after abdominal wall incision. Peripheral nerve blocks such as transversus abdominis plane (TAP) block, abdominal field blocks, and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described in the literature as means to alleviate pain due to abdominal wall incision.
First defined in 2001 by Rafi, transversus abdominis plane block (TAP block) is successfully used in many of the abdominal procedures including appendectomy, inguinal hernia repair, cesarean section, total abdominal hysterectomy, radical gastrectomy, renal transplantation, prostatectomy and laparoscopic surgeries. On the other hand, iliohypogastric/ilioinguinal nerve block (II/IHN block) is mainly administered for inguinal herniorrhaphy in addition to procedures such as orchiopexy, hydrocelectomy, cesarean section, circumcision, varicocelectomy alone or in combination with other blocks such as genitofemoral nerve block. Although both techniques target similar anatomical structures, TAP block is a field block while II/IHN block is a truncal block. In this regard, II/IHN block is generally performed with a smaller volume than TAP block. Recently, many studies concluded the superiorty of US-guided ilioinguinal block provided over TAP block. The reason stated for this was the anatomical variability encountered in the course of the ilioinguinal/iliohypogastric nerves, we thus decided to administer ultrasound-guided TAP block medially, close to the origin of the transverse abdominis muscle (medial TAP block) and compare its postoperative analgesic effect with that of ultrasound-guided II/IHN block.
More recently, Ultrasound-guided techniques can be used with all anterior abdominal wall blocks, allowing direct observation of the correct needle placement and spread of local anaesthetic.
Of various local anaesthetics used for abdominal wall block, bupivacaine is an amide local anaesthetic with long duration of action. Its mechanism of action is by preventing the generation and conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold.
The aim of the work was to compare between the efficiency of ultrasound guided transversus abdominis plane block and iliohypogastric/ ilioinguinal nerve block in patients undergoing inguinal hernia repair under general anaesthesia as regards the intensity and duration of analgesia, analgesic requirements, the block performance time, the incidence of adverse events.
After receiving Institutional Ethical Committee approval and written informed consent, 40 patients, aged 20 to 60 years, with American Society of Anesthesiologists (ASA) physical status scores of I and II, planned for inguinal hernia repair under general anaesthesia.: Preoperative evaluation was done by complete history taking, clinical examination and necessary laboratory investigations. All patients were informed about the procedure and taught how to use the VAS for assessing pain. Patients will be randomly assigned into two equal groups 20 each using closed envelope technique:
• group (I): patients received TAP block on the side of the surgery with 20 ml of 0.25% isobaric bupivacaine with ultrasound guidance.
• group (II): patients received II/IH block on the side of the surgery with 20 ml of 0.25% isobaric bupivacaine with ultrasound guidance
The following data were recorded in all patients:
Demographic data
Age, height, weight and body mass index.
a. Intensity of postoperative analgesia (Pain scoring)
Pain was assessed by direct marking on the visual analogue scale (VAS) Patients was interviewed after recovery at 30 minutes, 2, 4, 6, 12 and 24 hours postoperative and VAS was assessed and recorded.
b. Duration of analgesia (minutes)
Total dose of rescue analgesia in 24 hours
The total analgesic dose of both diclofenac sodium and pethidine taken within the first 24 hours was recorded.
c. Post-operative complications
• Haemodynamic instability
Bradycardia (decrease in heart rate below 50 beats per minute)
• Haematoma at the site of injection.
d. Number of attempts taken to administer the block:
e. The time consumed to administer the block
Results showed that the demographic data were comparable in both groups. There were no statistical significant differences between the two groups as regards age, gender, weight in kilograms.
group I: At 0.5 hour postoperatively VAS ranged from 1-3 with a mean of 1.80 ± 0.77. In the first 6 hours there was mild or no pain with VAS score ranged from 2-4 with a mean 3.10 ± 0.85.At12 hours postoperatively VAS ranged from 2-5 with a mean 3.65 ± 0.88.At 24 hours postoperatively VAS ranged from 2-5 with a mean 2.90 ± 0.97.