Abdominal blockage of iliohypogastric and ilio-inguinal nerves for management of post-caesarean pain: A novel method

Abstract

Objective. The aim of this study was to compare pain relief after caesarean section achieved by an intra-abdominal iliohypogastric and ilio-inguinal (IHII) nerve block with levobupivacaine with that in patients given a placebo. Study design. A total of 60 healthy women scheduled for caesarean delivery under general anaesthesia were enrolled in the study. The patients were randomised to an abdominal IHII nerve block with levobupivacaine (levobupivacaine group) or administration of saline (placebo group). Instead of the classic percutaneous method, the block was administered intra-operatively from the peritoneal aspect. Scores on a visual analogue scale (VAS) at 2, 6, 12 and 24 hours, adverse effects, morphine consumption and success of blockage by a pinprick test were recorded. Results. In the levobupivacaine group, the pinprick test showed there to be successful bilateral block in 22 patients and unilateral block in 5, while the block failed in 3. No block was recorded in the placebo group. When morphine consumption at 12 and 24 hours were compared, consumption was found to be significantly low for both time points in the levobupivacaine group. VAS scores 2, 6 and 12 hours after the operation were also significantly lower in the levobupivacaine group. Conclusion. A block of the IHII nerves from inside the abdomen just before abdominal closure appears to be an effective and safe way of relieving pain after caesarean section.

SAJOG • January 2012, Vol. 18, No. 1