Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia

Background: By choosing spinal anaesthesia instead of general anaesthesia, and by infiltrating the wound area with local anaesthetic the need for post operative analgesics may be reduced. An ilioinguinal and iliohypogastric ne rve block (IINB) in inguinal herniorrhaphy was, therefore, studied in a day surgery setting in combination with a spinal block. Methods: One hundred ASA I-II adult patients scheduled for inguinal hernior rhaphy were given spinal anaesthesia with hyperbaric 0.5% bupivacaine. In a randomized and blinded fashion half of them received an IINB 5 min before the surgical incision with 10 mi of 0.5% bupivacaine (B-IINB) and the other half with saline (S-IINB). All patients received ketoprofen 100 mg i.v. du ring: surgery and another 100 mg 2-3 h postoperatively. The patients were o bserved for about 6 h in the day surgery unit before discharge. Results: The results showed that in comparison with the S-IINB group, signi ficantly fewer patients in the B-IINB group needed analgesics (P <0.01) and the amount required was also significantly less postoperatively, before di scharge (about 6 h postoperatively) (P <0.05). The latency to the need for the first postoperative analgesic was shorter in the S-IINB patients (P <0. 01). At home the VAS scores and the need for analgesics (oral ketoprofen 10 0 mg) were low with no differences between the groups. No complications occ urred. Conclusion: It is concluded that no long-term analgesia could be demonstrat ed by a preincisional IINB performed during spinal anaesthesia in day-surge ry inguinal herniorrhaphy patients. Thus, reduced analgesic requirement was seen only for about 6 h postoperatively.