Ilioinguinal and Iliohypogastric Nerve Block for Acute and Chronic Pain Relief After Caesarean Section: A Randomized Controlled Trial

Abstract

Background: There is an increasing cesarean section (CS) rate in Egypt. Multiple methods are used to manage pain after CS. Objectives: This study aimed to assess the effect of ultrasound-guided bilateral ilioinguinal and iliohypogastric nerve block on pain reduction after CS. Methods: We classified 64 cases of elective CS into two equal groups. The block group underwent the nerve block, and the control group did not. Postoperative pain, morphine consumption, time to analgesic request, and complications were compared between the two groups. Results: No significant difference was detected between the two groups regarding patient characteristics or operation duration. However, pain scores during rest and movement were significantly lower in the block group than in controls, especially within the first 12 hours following the operation. Morphine consumption was significantly lower in the block group (4.53 ± 1.456) in group B vs. (8.87 ± 2.013) in group C with P-value < 0.001. Time to the first rescue analgesia was significantly longer in the intervention group than in the other group (12.25 vs. 3.81 hours). Pruritis and nausea incidence was significantly higher in controls than in the block group. The incidence of chronic postoperative pain was significantly lower in the block group. Conclusions: The ilioinguinal and iliohypogastric nerve block is efficient and safe for managing postoperative pain following CS. It is associated with significant improvement of acute and chronic pain after such operations.

Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023

“…The ilioinguinal and iliohypogastric nerve block has primarily been studied in the context of Caesarean section in two RCTs, 128 , 129 whereas one RCT mentioned the ilioinguinal nerve block only. 130 Additionally, one study investigated the effectiveness of pain management in patients undergoing surgery for cervical cancer.…”

“…Two RCTs ( n =230) used the landmark technique for nerve identification, 129 , 130 whereas another two RCTs ( n =126) used ultrasound guidance. 128 , 131 …”

“… 129 Notably, for Caesarean delivery, the incidence of chronic postsurgical pain appears to be lower in patients receiving ilioinguinal/iliohypogastric nerve block than in those receiving spinal anaesthesia alone. 128 …”

Comparison of Analgesic Efficacy Between Ultrasound-Guided Iliohypogastric/Ilioinguinal Nerve Block and Wound Infiltration Among Patients Undergoing Gynecologic Surgery: A Randomized Controlled Trial

“…This technique can reduce pain up to 12 hours postoperative. (8) Local anesthetic wound infiltration is a common and easy technique to decrease postoperative pain in real-world practice. It involves injecting local anesthesia in the skin, subcutaneous tissue layer, and the surgical incision area, which can reduce pain up to 6 hours after surgery.…”

Evaluation of Analgesic Effect of Bupivacaine Injection into Both Angles of the Rectus Sheath Incision after an Elective Caesarean Section

“…The pain has somatic and visceral components, with a significant portion arising from the abdominal wall incision (5) . Somatic pain at the incision site is carried by the ilioinguinal and ilio-hypogastric nerves (6) , which are at risk of injury due to their superficial course during the Pfannenstiel incision (7) . The ilioinguinal and ilio-hypogastric (IIIH) block is a valuable part of multimodal analgesic strategies for postoperative pain, including in caesarean deliveries (8) .…”