Advertisement

Selective Regional Anesthesia Options in Surgical Subspecialties

  • Hong Yan
  • Alan David Kaye
  • Henry Liu
Chapter

Abstract

Though the anatomy of most nerves is well understood, there are many variations in popularity of different selective nerve blocks in clinical practice despite the implementation of ultrasound technology. In this regard, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve, and penile nerve blocks, though effective, are less often performed when compared with many other selective nerve blocks. Local pain, local anesthetic toxicity, bowel perforation, pelvic hematoma, hypotension, and subcutaneous hematoma are all potential complications, suggesting that precise technique and use of ultrasound are critical for consistent success without these type of side effects when providing these selective nerve blocks. Collectively, these blocks are valuable for a wide range of indications; however, an appreciation of anatomy and proper technique with ultrasound can improve efficacy and reduce potential side effects. In this regard, many groups have moved away from bupivacaine because of its potential toxicity with intravascular injection, while other groups still utilize bupivacaine, making good technique that is much more significant for ensuring best outcomes and patient safety.

Keywords

Iliohypogastric nerve block Ilioinguinal nerve block Genitofemoral nerve block Penile nerve block 

References

  1. 1.
  2. 2.
    Wang H. Is ilioinguinal-iliohypogastric nerve block an underused anesthetic technique for inguinal herniorrhaphy? South Med J. 2006;99(1):15.CrossRefPubMedGoogle Scholar
  3. 3.
    Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy. South Med J. 2006;99(1):48–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Stav A, Reytman L, Stav MY, Troitsa A, Kirshon M, Alfici R, Dudkiewicz M, Sternberg A. Transversus abdominis plane versus ilioinguinal and iliohypogastric nerve blocks for analgesia following open inguinal herniorrhaphy. Rambam Maimonides Med J. 2016;7(3):e0021.  https://doi.org/10.5041/RMMJ.10248. PMID: 27487311.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Liu H, Fox CJ, Yarborough MJ, Kaye AD. Selective regional anesthesia options in surgical subspecialties. In: Kaye D, Urman RD, Vadivelu N, editors. Essentials of regional anesthesia. New York: Springer; 2012. p. 525–39.  https://doi.org/10.1007/978-1-4614-1013-3. ISBN 978-1-4614-1012-6. Chapter 20.CrossRefGoogle Scholar
  6. 6.
    Katz G. Ilioinguinal and iliohypogastric nerves. In:Atlas of regional anesthesia. Connecticut: Appleton-Century-Crofts/Norwalk; 1985. p. 114–5.Google Scholar
  7. 7.
    Ford S, Dosani M, Robinson AJ, Campbell GC, Ansermino JM, Lim J, et al. Defining the reliability of sonoanatomy identification by novices in ultrasound-guided pediatric ilioinguinal and iliohypogastric nerve blockade. Anesth Analg. 2009;109(6):1793–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Beaussier M, Weickmans H, Abdelhalim Z, Lienhart A. Inguinal herniorrhaphy under monitored anesthesia care with ilioinguinal-iliohypogastric block: the impact of adding clonidine to ropivacaine. Anesth Analg. 2005;101(6):1659–62.CrossRefPubMedGoogle Scholar
  9. 9.
    Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology. 2009;111(2):406–15.CrossRefPubMedGoogle Scholar
  10. 10.
    Disma N, Tuo P, Pellegrino S, Astuto M. Three concentrations of levobupivacaine for ilioinguinal/iliohypogastric nerve block in ambulatory pediatric surgery. J Clin Anesth. 2009;21(6):389–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Gucev G, Yasui GM, Chang TY, Lee J. Bilateral ultrasound-guided continuous ilioinguinal-iliohypogastric block for pain relief after cesarean delivery. Anesth Analg. 2008;106(4):1220–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Frigon C, Mai R, Valois-Gomez T, Desparmet J. Bowel hematoma following an iliohypogastric-ilioinguinal nerve block. Paediatr Anaesth. 2006;16(9):993–6.  https://doi.org/10.1111/j.1460-9592.2006.01909.x. PMID: 16918666.CrossRefPubMedGoogle Scholar
  13. 13.
    Tani M, Sato M, Son I, Tanabe H, Hirota K, Shirakami G, Fukuda K. Transient femoral nerve palsy after ilioinguinal-iliohypogastric nerve block: comparison of ultrasound-guided and landmark-based techniques in adult inguinal hernia surgery. Masui. 2015;64(6):603–9. PMID: 26437548.PubMedGoogle Scholar
  14. 14.
    Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain—a description of techniques and review of literature. Pain Physician. 2008;11(2):215–24. PMID: 18354713.PubMedGoogle Scholar
  15. 15.
    Pankhania M, Ali S. The genitofemoral nerve block: a method for hemiscrotal anaesthesia at the bedside. Ann R Coll Surg Engl. 2012;94(4):272.  https://doi.org/10.1308/003588412X13171221591259a. PMID: 22613308.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Long RM, McCartan D, Cullen I, Harmon D, Flood HD. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int. 2010;105(11):1576–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Metzelder ML, Kuebler JF, Glueer S, Suempelmann R, Ure BM. World J Urol. 2010;28(1):87–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H. Evaluation of genito- femoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. Br J Anaesth. 2005;94(2):243–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Sandeman DJ, Dilley AV. Ultrasound guided dorsal penile nerve block in children. Anaesth Intensive Care. 2007;35(2):266–9. PMID: 17444318.PubMedGoogle Scholar
  20. 20.
    Gürkan Y, Kus A, Aksu C, Çiftçi S, Çulha M, Pandin P. Ultrasonography-guided penile block for adult penile surgery. Can J Anesth. 2016;63(6):780–1.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hong Yan
    • 1
  • Alan David Kaye
    • 2
  • Henry Liu
    • 3
  1. 1.Department of AnesthesiologyWuhan Central HospitalWuhanChina
  2. 2.Department of AnesthesiologyLouisiana State University School of MedicineNew OrleansUSA
  3. 3.Department of Anesthesiology and Perioperative MedicineHahnemann University Hospital, Drexel University College of MedicinePhiladelphiaUSA

Personalised recommendations