Abstract
Purpose
To examine if ilioinguinal-iliohypogastric nerve block could reduce the need for post-Cesarean delivery morphine analgesia and thus reduce the incidence of opioid related adverseeffects.
Methods
A multi-level technique for performing the nerve block with bupivacaine was developed and then utilized in this two-part study. Part one was a retrospective assessment of Cesarean delivery patients with and without ilioinguinal-iliohypogastric blocks to determine if the technique reduced patient controlled analgesia morphine use and thus would warrant further study. The second phase was a randomized double-blind placebo-controlled trial to compare post-Cesarean morphine use and the appearance of opioid-related side effects between the anesthetic and placebo-injected groups.
Results
Both phases demonstrated that our method of ilioinguinaliliohypogastric nerve block significantly reduced the amount ofiv morphine used by patients during the 24 hr following Cesarean delivery. In the retrospective assessment, morphine use was 49 ± 30 mg in the block groupvs 79 ± 25 mg in the no block group (P = 0.0063). For the prospective trial, patients who received nerve blocks with bupivacaine had a similar result, self-administering 48 ± 27 mg of morphine over 24 hr compared to 67 ± 28 mg administered by patients who received infiltrations of saline. However, despite the significant decrease in morphine use, there was no reduction in opioid-related adverse effects: the incidences of nausea were 41 % and 46% (P = 0.70) and for itching were 79% and 63% (P = 0.25) in the placebo and nerve block groups, respectively.
Conclusion
A multi-level ilioinguinal-iliohypogastric nerve block technique can reduce the amount of systemic morphine required to control post-Cesarean delivery pain but this reduction was not associated with a reduction of opioid related adverse effects in our study group.
Résumé
Objectif
Vérifier si l’anesthésie par blocage nerveux ilioinguinal et iliohypogastrique peut réduire ies besoins postcésarienne de morphine et l’incidence des effets indésirables des opioïdes.
Méthode
Une technique de blocage nerveux multiniveau, avec de la bupivacaïne, a été mise au point et utilisée pour une étude en deux phases. La première consistait en une évaluation rétrospective des accouchements par césarienne avec et sans biocages ilioinguinal et iliohypogastrique dans le but de déterminer si la technique réduit l’usage de morphine autoadministrée, ce qui pourrait justifier des études plus poussées. La seconde phase était un essai, randomisé et contrôlé en double aveugle contre placebo, réalisé pour comparer l’usage intergroupe de morphine postcésarienne et l’apparition d’effets secondaires reliés aux opioïdes.
Résultats
Pour les deux phases de l’étude, l’anesthésie par blocage nerveux ilioinguinal et iliohypogastrique a permis de réduire significativement la quantité de morphine iv utilisée pendant les 24 premières heures suivant la césarienne. Dans l’évaluation rétrospective, la morphine utilisée a été de 49 ± 30 mg chez les patientes qui ont reçu un bloc vs 79 ± 25 mg, sans bloc (P = 0,0063). Les résultats de l’essai prospectif sont comparables, l’autoadministration de morphine pendant 24 h étant de 48 ± 21 mg et de 67 ± 28 mg avec et sans bupivacaïne, respectivement. Cependant, il n’y a pas eu de réduction des effets indésirables reliés aux opioïdes: les incidences de nausée ont été de 41 % et de 46 % (P = 0,70) et de prurit, 79 % et 63 % (P = 0,25) chez les patientes avec placebo et bloc nerveux, respectivement.
Conclusion
Un blocage nerveux ilioinguinal et iliohypogastrique a permis de réduire la quantité de morphine à action générale utilisée pour soulager la douleur postcésarienne, mais cette réduction n’a pas été associée à une baisse des effets secondaires reliés aux opioïdes.
Article PDF
Similar content being viewed by others
References
Sinatra RS, Lodge K, Sibert K, et al. A comparison of morphine, meperidine, and oxymorphone as utilized in patient-controlled analgesia following cesarean delivery. Anesthesiology 1989; 70: 585–90.
Moore KL. Clinically Oriented Anatomy, 3rd ed. Baltimore, MD: Williams & Wilkins, 1985.
Trotter TN, Hayes-Gregson P, Robinson S, Cole L, Coley S, Fell D. Wound infiltration of local anaesthetic after lower segment caesarean section. Anaesthesia 1991; 46: 404–7.
Cervero F, Laird JMA. Visceral pain. Lancet 1999; 353: 2145–8.
Nehra D, Gemmell L, Pye JK. Pain relief after inguinal hernia repair: a randomized double-blind study. Br J Surg 1995; 82: 1245–7.
Bunting P, McConachie I. Ilioinguinal nerve blockade for analgesia after caesarean section. Br J Anaesth 1988; 61: 773–5.
Kuppuvelumani P, Jaradi H, Delilkan A. Abdominal nerve blockade for postoperative analgesia after caesarean section. Asia-Oceania J Obstet Gynaecol 1993; 19: 165–9.
Ganta R, Samra SK, Maddineni VR, Furness G. Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section. Br J Anaesth 1994; 72: 229–30.
Huffnagle HJ, Norris MC, Leighton BL, Arkoosh VA. Ilioinguinal iliohypogastric nerve blocks-before or after cesarean delivery under spinal anesthesia? Anesth Analg 1996; 82: 8–12.
Ludington E, Dexter F. Statistical analysis of total labor pain using the visual analog scale and application to studies of analgesic effectiveness during childbirth. Anesth Analg 1998; 87: 723–7.
Rayburn WF, Geranis BJ, Ramadei CA, Woods RE, Patil KD. Patient-controlled analgesia for postcesarean section pain. Obstet Gynecol 1988; 72: 136–9.
Sia ATH, Thomas E, Chong JL, Loo CC. Combination of suppository diclofenac and intravenous morphine infusion in post-caesarean section pain relief — a step towards balanced analgesia? Singapore Med J 1997; 38: 68–70
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Supported by the Duke Anesthesiology Research Fund.
Rights and permissions
About this article
Cite this article
Bell, E.A., Jones, B.P., Olufolabi, A.J. et al. Iliohypogastric-ilioinguinal peripheral nerve block for post-Cesarean delivery analgesia decreases morphine use but not opioid-related side effects. Can J Anesth 49, 694–700 (2002). https://doi.org/10.1007/BF03017448
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03017448