Local Infiltration Anaesthesia for Inguinal Herniorrhaphy: A Comparison of two techniques

Author(s): Alexander Akogwu Ohemu, Felicia Dele Asudo, Ekundayo Stephen Garba, King-David Terna Yawe

Background: Local infiltration anesthesia for inguinal herniorrhaphy has already been established as effective with a good safety profile compared to other anesthesia methods. Adding regional nerve blocks (ilioinguinal, iliohypogastric, and genital branch of genitofemoral) offers peri-operative analgesia with a 60-70% success rate using the anatomic landmark technique. A stepwise infiltration technique may provide adequate perioperative anesthesia without regional nerve blocks. This study compared the efficacy of anatomic landmark peripheral nerve block with stepwise local infiltration in providing anesthesia for inguinal herniorrhaphy.

Methods: Sixty-two consenting patients were randomized into two groups; stepwise local infiltration anesthesia group and anatomic landmark peripheral nerve block. Pain evaluation used the Verbal Numerical Rating Scale (VNRS). Intraoperative and postoperative analgesic requirements, pain score, volume of local anaesthetic used and patient acceptance of technique were compared.

Results: Pain scores at anesthesia infiltration were significantly higher in the regional nerve block group, while pain scores at sac ligation were higher in the stepwise group. Pain scores at other surgery stages showed no significant difference. The volume of Local anaesthetic used for infiltration was noted to be significantly more for patients in the anatomic landmark nerve group. More patients in the stepwise group said they would not want the same anaesthetic technique but this was not statistically significant.

Conclusion: No significant difference was observed in overall intra and post-operative analgesic effect between both groups. Stepwise infiltration anaesthesia for inguinal herniorrhaphy confers no added benefit to local anaesthetic efficacy when compared to anatomic landmark regional nerve block.