الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Postoperative analgesia is an integral part of successful surgical outcome. Uncontrolled postoperative pain increases the incidence of postoperative complication.
Open inguinal hernia surgery is one of the commonly performed surgical procedures which are associated with postoperative pain. The reported incidence of pain after inguinal hernia repair varies from 0% to 43%.
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 block have been applied to alleviate pain due to abdominal wall incision.
First defined in 2001 by Rafi, TAP block is successfully used in many abdominal procedures including appendectomy, inguinal hernia repair, cesarean section, total abdominal hysterectomy, radical gastrectomy, renal transplantation, prostatectomy, and laparoscopic surgeries.
On the other hand, II/IH nerve block is mainly administered for inguinal herniorrhaphy in addition to procedures such as orchidopexy, hydrocelectomy, cesarean section, circumcision, and varicocelectomy.
Although both techniques target similar anatomical structures, TAP block is a field block, while II/IH block is a truncal block.
Ultrasound guidance can be used for all anterior abdominal wall blocks, allowing direct observation of the correct needle placement and spread of local anesthetic drugs.
The aim of this work was to evaluate ultrasound guided (USG) II/IH nerve block versus USG TAP block as analgesia for inguinal hernia repair.
A prospective randomized study was conducted on 60 adult patients who undergoing elective open unilateral inguinal hernia repair. The patients were randomized by use of sealed envelopes technique into two equal groups:
group A: included 30 patients who received USG TAP block with bupivacaine 25% in plane approach with posterior approach.
group B: included 30 patients who received USG II/IH nerve block with bupivacaine 25% in plane approach.
Inclusion criteria were that all patients within the age ≥18 and ≤70 years old, body mass index (BMI) ≤ 35 kg/ m2, and American Society of Anesthesiologists (ASA) classification ≥ I and ≤ III undergoing elective primary unilateral non-complicated inguinal hernia repair (reducible & not strangulated).
Exclusion criteria were that refusal of the patients to give informed consent, skin infection at the puncture site, preexisting coagulation disorders, contraindication to anesthetic drugs, established chronic hepatic failure (Child class B and C), chronic kidney disease stages IV and V, preoperative intake of analgesics within 24 hours before surgery, neurological, psychological diseases, and alcohol or drug abuse.
Results of the present study could be summaries as follow:
- Patients’ demographic data were comparable between groups as regards age, sex, and BMI with no significant differences with P value >0.05.
- Intraoperative heart rate (HR) showed no significant difference at baseline before the induction of anesthesia, 5, 15 minutes after induction, 60, 75, 90 and 105 minutes (P value >0.05).
- Intraoperative HR was significantly lower in TAP block group than II/IH block group at 30 and 45 minutes after induction with P value = 0.015*, <0.001*, respectively).