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THE ASSOCIATION OF ULTRASOUND-GUIDED ILIOINGUINAL/ILIOHYPOGASTRIC AND GENITOFEMORAL NERVE BLOCK: A NEW ANESTHETIC APPROACH FOR INGUINAL HERNIORRAPHY IN HIGH RISK PATIENT
ESRA Academy. SCIMIA P. Sep 8, 2016; 138296
Topic: Trunk Blocks
PAOLO SCIMIA
PAOLO SCIMIA

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Abstract
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Background and Aims:

The addition of genitofemoral nerve (GF) block may enhance ilioinguinal/iliohypogastric nerve (II/IH) block to achieve complete anesthesia and improve the quality of postoperative analgesia in inguinal herniorraphy, avoiding general and neuraxial anesthesia in high risk patient.

Methods:

A 81-year-old man, ASAIII, underwent inguinal herniorraphy. In  history, moderate aortic stenosis and congestive heart failure with ejection fraction of 30%. Written informed consent was obtained. Ultrasound-guided II/IH and GF nerve blocks were performed. For II/IH block, the probe was placed in oblique fashion at the line joining the umbilicus and the anterior superior iliac spine and Levobupivacaine 0,5% 20ml was injected between transverse abdominis and internal oblique muscles, adjacent to the deep circumflex iliac artery. For GF block, the probe was placed parallel 1.25 cm above the inguinal ligament and Mepivacaina 2% 10ml was injected lateral to the inferior epigastric artery. Intravenous sedation was given using propofol 3mg/kg/h. Supplemental oxygen (4L/min) was administered. Towards the end of surgery sedation was discontinued and patient was transferred to the recovery room.

Results:

Patient felt no pain postoperatively and received only 1g intravenous paracetamol before he was discharged home next day.

Conclusions:

In our experience, genital branch of GF nerve block had the  advantages to decrease pain induced by traction of the hernia sac, enhancing the anesthesia of II/IH block in inguinal hernia surgery. This new anesthetic approach could be represent a viable alternative to general and neuraxial anesthesia, avoiding hypotension and sympathetic block in high risk patient with low cardiac output.

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