Single-point ultrasound-guided iliohypogastric-ilioinguinal-genitofemoral nerve block for inguinal hernia surgery in older adult patients: a randomized controlled trial.

BACKGROUND

Ultrasound-guided nerve block can be used for perioperative analgesia and can potentially improve the course of recovery. Although iliohypogastric-ilioinguinal nerve block has been successfully used for inguinal hernia surgery, the poor blocking effect of intraoperative traction reflex remains a major drawback of this technique. The main objective of this study was to investigate the feasibility of single-point ultrasound-guided iliohypogastric-ilioinguinal-genitofemoral nerve (GFN) blockage for open anterior inguinal hernia repair in older adults.

METHODS

A total of 40 older adult patients [categorized as American Society of Anesthesiologists (ASA) I-III, body mass index (BMI) ≤28 kg/m, age ≥60 years] undergoing open anterior inguinal hernia repair (the Lichtenstein technique) from June 2018 to December 2019 were recruited and randomly separated into an iliohypogastric-ilioinguinal nerve block group (group A; n=20) and an iliohypogastric-ilioinguinal-GFN block group (group B; n=20). The numerical rating scale (NRS) score in the post-anesthesia care unit (PACU) was the primary endpoint. Moreover, the following secondary indicators were recorded: the NRS score at 4 and 12 h after surgery and the duration of the nerve block; the total consumption of anesthetics; the occurrence of perioperative complications; and the mean arterial pressure (MAP), heart rate (HR), and respiration rate (RR), and oxygen saturation (SpO) at baseline (T0), before skin incision (T1), 1 min after skin incision (T2), after dissection of the hernial sac (T3), at mesh placement (T4), and at the end of surgery (T5).

RESULTS

Patients in Group B had lower NRS scores in the PACU (0.9±0.7 2.1±0.9), at 4 hours post-operation (1.9±1 2.7±0.7), lower intraoperative traction response scores (0.6±0.8 1.7±1.2), and fewer postoperative complication scores (0.1±0.3 vs. 0.8±0.9) compared to group A (P<0.05). In addition, the MAP in group A was significantly higher than that in group B (P<0.01) at T2 (89.3±6.7 . 83.8±4.9), T3 (92.4±6.9 . 86.6±4.8), and T4 (87.8±5.2 . 83.1±4.6). The HR in group A was also higher than that in group B (P<0.05) at T2 (73.3±8.4 . 68.4±5.4) and T3 (77.0±14.7 . 68.7±6.9). Finally, compared to group B, group A showed a higher consumption of sufentanil (5.5±3.9 . 2.4±2.8) and lidocaine (3.4±2.3 . 1.0±2.0) (P<0.05).

CONCLUSIONS

Performing an ultrasound-guided iliohypogastric-ilioinguinal-GFN block through a single puncture point is a feasible clinical approach. This strategy provides appropriate intraoperative and postoperative analgesia in older adult patients undergoing open anterior inguinal hernia repair and significantly reduces postoperative complications and thus has the potential to emerge as a novel analgesic option for inguinal hernia surgery.

TRIAL REGISTRATION

Chinese Clinical Trial Registry identifier: ChiCTR2200066573.