A Prospective, Randomized Study Comparing Ultrasound Guided Bilateral Transversus Abdominis Plane Block with Bilateral Ilioinguinal, Iliohypogastric Nerve Blocks in Patients Undergoing Lower Segment Cesarean Section

Abstract

Introduction: Post-operative pain treatment with regional nerve blocks can provide effective pain relief with minimal side effects of systemic analgesics. Transversus abdominis plane block, Ilioinguinal & Iliohypogastric using ultrasound guidance is a ubiquitous, component of multimodal analgesia with the added advantage of providing analgesia post operatively in lower abdomen surgeries. There is a paucity of literature comparing these two regional anesthesia options for post-operative pain in LSCS patients.

Objectives: To compare ultrasound guided B/L transversus abdominis plane block and ultrasound guided ilioinguinal, iliohypogastric nerve blocks for post-operative analgesia lower segment caesarean section.

Methods:   This was a prospective, randomized, double blinded controlled study in which the enrolled 60 participants were randomly divided into two groups (30 in each group). Patients in group I received Ultrasound-guided TAP block using (n=30) 0.375% Ropivacaine 20ml on either side. Patients in group II received Ultrasound-guided IIN and IHN block using (n=30)0.375% Ropivacaine 10ml on either side. Both the blocks were compared . Observations were recorded in terms of visual analogue scale (VAS) (0–10).

Results: Comparison of both treatments showed significant difference in the VAS Dyn score between the I and II group with p =0.042. Both blocks did not have any side effects or misguidance due to USG. However, TAP blocks were relatively easier to perform than IIN/IH. Both groups had similar total additional analgesic consumption in 24 hrs which is not statistically significant.

Conclusion: In patients undergoing elective or emergency caesarean section, USG guiding IIN and IH nerve blocks are equally efficient at providing analgesia like ultrasound-guided transversus abdominis plane blocks. We also conclude that 10 ml Inj ropivacaine 0.375% used to block the ilioinguinal and iliohypogastric nerves, is as effective as 20 ml of injection ropivacaine 0.375% used in TAP block with ultrasound guidance.