Kirubakara Raj, S (2006) A Comparative Study of Bilateral Ilioinguinal and Hypogastric Nerve Block with Wound Infiltration for Post Operative Analgesia in Caesarean Section Done Under Spinal Anaesthesia. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: “For all happiness mankind can gain is not a pleasure but in rest from pain” - JOHN DRYDEN. Pain is perhaps the most feared symptom of disease and trauma. PAIN IS AGONY WHILE ITS RELIEF IS ECTACY. International association for study of pain (1979) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Post operative pain is caused by 1. Direct trauma to operated tissues. 2. Reflex muscle spasm and visceral distension. 3. Patient’s anxiety and previous painful experience. However post-operative pain is transitory1 and self limiting, being most severe during the first postoperative day and diminishing over the next 24 hours and therefore more amenable to therapy than chronic pain. Objective for relieving post-operative pain: 1. To alleviate discomfort and distress of the patient. 2. To reduce neuro-endocrine stress response. 3. To reduce oxygen demand. 4. Humanitarian aspect. Post-operative pain has three components: 1. Emotional. 2. Rational. 3. Physical. Emotional component may vary according to patient’s psychological aspect; the rational component varies with the patient’s previous experience, insight and motivation while the physical component depends on the extent of direct tissue injury. The use of specific nerve blocks and wound infiltration alone or in combination with general/spinal anaesthesia provides analgesia into the early and late recovery periods. This is the ideal pain relief modality: a fairly simple technique to eliminate the need for opioids or additional drug treatments thereby minimizing the potential for undesirable interactions and adverse effects. Even though appropriate needle sizes and anaesthetic drugs needs to be tailored to the patient, regional anaesthesia provides advantage over general anaesthesia in reducing nausea and vomiting and providing prolonged post operative analgesia. The obstetric department standard protocol for postoperative analgesia in our hospital is inj. diclofenac sodium on first complain of pain and there after every 12 hours. Therefore we wanted to see if other techniques such as wound infiltration and/or ilioinguinal and hypogastric nerve block could be introduced as a method of postoperative analgesia. Since spinal anaesthesia is safer than general anaesthesia especially in caesarean we preferred the spinal anaesthesia. AIM OF THE STUDY: Comparison of the effectiveness of the bilateral ilioinguinal and hypogastric nerve block with wound infiltration for post-operative analgesia in caesarean section done under spinal anaesthesia. MATERIALS AND METHODS: This prospective, randomized, clinical study was conducted at the Govt. RSRM Hospital, attached to Govt. Stanley Medical College & Hospital, Chennai -1, in 40 patients undergoing emergency and elective caesarean section. The Hospital Committee approved this study and informed consent was obtained from each patient. Study Design: An open, randomized, comparative parallel group design was employed. Inclusion Criteria: 1. ASA I & II, 2. Age : 18-35 years, 3. Pfannenstiel incision. Exclusion Criteria: 1. ASA III & IV, 2. Age >18<35 years, 3. All contraindications to central neuraxial blockade, 4. Progressive neurological disease, 5. Local anesthetic & NSAID sensitivity, 6. Para median incision, 7. Obese patients, 8. Peptic ulcer disease, 9. Renal disease, 10. Infection at the site of ilioinguinal & hypogastric nerve block, 11. Patient refusal. Anaesthetic Technique for Caesarean Section: Spinal anaesthesia. METHODOLOGY: 40 parturients undergoing Caesarean section with Pfannenstiel incision under Spinal anaesthesia were recruited. Once written consent was obtained, patients were randomized into two groups. Before skin closure, Group I: Received Wound infiltration with 20ml of 0.5% bupivacaine + adrenaline 1 in 200,000 solution. Group II: Received Ilioinguinal and Hypogastric nerve block with 20ml of 0.5% bupivacaine + adrenaline 1 in 200,000 solution. RESULTS: The study was conducted in 40 parturients undergoing caesarean section. The patients were divided into two groups with 20 patients in each group. Group I - patients received Wound infiltration. Group II - patients received Ilioinguinal and Hypogastric nerve block. The statistical method used for analysis was students “t” test. The demographic data for age and weight was comparable between Group I and Group II and statistically not significant. The mean (SD) duration of analgesia for Group I and Group II was 421.75 (121.80) and 427.75 (140.30) minutes respectively. The difference between the two groups were clinically and statistically not significant (p=0.9).The mean (SD) of VAS pain scores at time of first dose administration of NSAID analgesic( inj. diclofenac sodium) for Group I and Group II was 6.25 (0.94) and 6.25 (0.99) respectively. This was clinically and statistically not significant. CONCLUSION: In our study we found that both the wound infiltration (Group I) and ilioinguinal and hypogastric nerve block (Group II) had an appreciable duration of analgesia. Both the techniques were simple and take little time to perform. However, we do feel that wound infiltration which gives the same duration of analgesia as ilioinguinal and hypogastric nerve block is superior in that: 1. It is easier to perform and does not require any special training or expertise- since the surgeon can provide the service. 2. It is less expensive as no special equipment is needed. 3. Side effects like motor blockade or partial paralysis of the lower limb may be avoided.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Bilateral Ilioinguinal ; Hypogastric Nerve Block ; Wound Infiltration ; Post Operative Analgesia ; Caesarean Section ; Spinal Anaesthesia ; Comparative Study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 15:21 |
| Last Modified: | 28 Apr 2018 02:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7224 |
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