Inguinal Nerve Block for Patients Undergoing Inguinal Hernioplasty

Abstract

ABSTRACT:Inguinal hernia repair is the most common elective surgical procedure performed under general, regional or local anesthesia. The advantages of day case surgery include greater patient satisfaction and reduced financial costs to the health service. Inguinal nerve blocks may be particularly helpful for patients with cardiovascular or respiratory disease, for whom there may be advantages in avoiding general anesthesia. The absence of post-operative sedation or drowsiness allows early ambulation and diminishes the requirement for recovery facilities with inguinal nerve block. KEYWORDS: Inguinal nerve block, Inguinal Hernia, Bupivacaine. INTRODUCTION:Inguinal hernia repair is the most common elective surgical procedure performed under general, regional or local anesthesia. According to the guidelines of Royal College of Surgeons of England at least 30% of elective inguinal hernia repairs are performed as day care cases and overall 50% of inguinal hernia repairs are performed on a day care case basis in the U.K. The advantages of day case surgery include greater patient satisfaction and reduced financial costs to the health service. With a careful technique, local anesthesia causes minimal physiological disturbances. The absence of post-operative sedation or drowsiness allows early ambulation and diminishes the requirement for recovery facilities.The nerve supply to inguinal and femoral region comes from the anterior branch of the six lower intercostal nerves, which continue forward on to the anterior abdominal wall accompanied by the last thoracic (subcostal) nerve. The illiohypogastric and illioinguinal nerves (T12 & L1) supply the lower abdomen. They are blocked by an injection of local anesthetic solution deposited in the internal and external oblique muscles just medial to the anterior superior iliac spine. The genitofemoral nerve (L1, L2) supplies inguinal cord structures and the anterior scrotum via its genital branch and supplies the skin and subcutaneous tissues of the femoral triangle via the femoral branch.