Original Research Article

Study of ilioinguinal, iliohypogastric and

genitofemoral nerve block by blind localization
through anatomical landmark for inguinal hernia
repair at a tertiary hospital
Shreyas Nilkanth Deshmukh1*, Annasaheb Maske2, Shaikh Mohd Mudassir3
1Junior Resident, 2,3Associate Professor, Department of Anaesthesia, Jiiu's Indian Institute of Medical Sciences and Research Centre and
Noor Hospital, Warudi, Aurangabad -Jalna Road, Badnapur, Jalna-431202, INDIA.
Email: [email protected]
Abstract Background: When combined with iliohypogastric and genitofemoral nerve block, ilioinguinal nerve block can also be
utilized to provide surgical anaesthesia for inguinal hernia repair, post operative pain relief and have minimal hemodynamic
effects. Aim of the study was to evaluate the efficacy and safety of the ilioinguinal nerve (IIN) and iliohypogastric
nerve(IIH) and genitofemoral nerve(GFN) block using landmark technique for day care inguinal hernia repair. Material
and Methods: Present study was prospective, observational study, conducted in 18-60 years, male patients, ASA I and II,
listed for elective hernia repair, fit for surgery. Results: 30 patients were considered for study, all were male, mean age
was 48.1 ± 18.51 Years, mean weight was 66.18 ± 12.8 kgs, ASA class I were 70 %, class II were 30 %/ and mean duration
of surgery was 60.5 ± 22.43 min. In present study, Onset of sensory blockade was 11.2 ± 1.07 min and duration of sensory
blockade was 307.8 ± 82.5 min. Mean period taken for ambulation was 317.8 ± 67.5 min. Mean duration of post-operative
analgesia was 439.9 ± 83.7 min. The nerve block was successful in 29 patients and one was converted to GA. Only minor
complication noticed was Transient minimal femoral sensory block (3.33 %). No peritoneal puncture, hematoma due to
needle puncture, nausea and vomiting, urinary retention, LA toxicity and LA allergy was noted in present study.
Conclusion: Landmark technique for ilioinguinal, iliohypogastric and genitofemoral nerve block provides excellent
anaesthesia technique for day care inguinal hernia repair surgery.
Keywords: ilioinguinal, iliohypogastric, genitofemoral, nerve block, day care, inguinal hernia repair surgery.
*
Address for Correspondence:
Dr. Shreyas Deshmukh, ‘Shraddha’, Plot No-241, Lane No-02, Jawaharnagar, Manewada Road, Nagpur -440024, INDIA.
Email: [email protected]
Received Date: 17/07/2022 Revised Date: 23/08/2022 Accepted Date: 06/09/2022
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

produce tachycardia, hypertension, vasoconstriction and

Access this article online splinting of affected part and predispose the patient to
Quick Response Code: develop increased incidence of chest infection, delayed
Website: mobilisation of patient, deep vein thrombosis, muscle
www.medpulse.in wasting and pressure sore in postoperative period.1
Ilioinguinal/iliohypogastric (II/IH) nerve block and
transversus abdominis plane (TAP) block is getting more
DOI: and more attention as viable alternatives to provide
https://doi.org/10.26611 effective perioperative analgesia for inguinal surgery.2,3
/10152331 Ilioinguinal nerve block has shown great utility as a
diagnostic, prognostic, and therapeutic manoeuvre in the
evaluation and treatment of groin and genital pain that is
INTRODUCTION thought to be mediated via the ilioinguinal nerve. When
Repair of inguinal hernia is one of the most commonly combined with iliohypogastric and genitofemoral nerve
performed procedures with most of them being performed block, ilioinguinal nerve block can also be utilized to
on a day surgery center. Unacceptable level of pain will provide surgical anaesthesia for inguinal hernia repair, post

How to site this article: Shreyas Nilkanth Deshmukh, Annasaheb Maske, Shaikh Mohd Mudassir. Study of ilioinguinal, iliohypogastric
and genitofemoral nerve block by blind localization through anatomical landmark for inguinal hernia repair at a tertiary hospital.
MedPulse International Journal of Anesthesiology. September 2022; 23(3): 40-43. http://medpulse.in/Anesthsiology/index.php
 MedPulse International Journal of Anesthesiology, Print ISSN: 2579-0900, Online ISSN: 2636-4654, Volume 23, Issue 3, September 2022 pp 40-43

operative pain relief and have minimal hemodynamic including the scrotum, was sterilized. The spermatic cord
effects.4 Aim of the study was to evaluate the efficacy and was then stabilized and medialized using the non-dominant
safety of the ilioinguinal nerve(IIN) and iliohypogastric hand, and 5 ml of 1% lidocaine was injected, sub dermally,
nerve(IIH) and genitofemoral nerve(GFN) block using immediately lateral to cord, superficial to the bone. The
landmark technique for day care inguinal hernia repair. injection was made at a point 2 cm medial and 2 cm caudad
to the anterior superior iliac spine using a short-beveled
MATERIAL AND METHODS needle advanced perpendicular to the skin
Present study was prospective, observational study, After an initial pop sensation as the needle penetrates the
conducted in Department of Anaesthesia, Jiiu's Indian external oblique aponeurosis, around 5 ml of 1% lidocaine
Institute of Medical Sciences And Research Centre And is injected. The needle was then inserted deeper until a
Noor Hospital, Warudi, India. Study duration was of 1 year second pop is felt penetrating the internal oblique, to lie
(January 2021 to December 2022). Study was approved by between it and the transversus abdominis muscle. A further
institutional ethical committee. 5 ml of 1% lidocaine was injected to block the
Inclusion criteria: 18-60 years, male patients, ASA I and iliohypogastric nerve. A fan-wise subcutaneous injection
II, listed for elective hernia repair, fit for surgery, willing of 3–5 ml used to block any remaining sensory supply from
to participate. the intercostals and subcostal nerve. Negative aspiration
Exclusion criteria: Patients with ASA III---IV class, prior to injection ensures non-penetrance of the peritoneum
Allergy to local anesthetics, hemorrhagic diathesis and or femoral vessels. After injection of the solution, pressure
clotting disorder, Patients who refused to participate. is applied to the injection site to decrease the incidence of
Study was explained and a written informed, valid consent ecchymosis and hematoma formation.
was taken. All patients were familiarized with the Visual Data was obtained for intraoperative pain, discomfort, and
Analogue Score (VAS) preoperatively. To reduce needle conversion to GA. Postoperative pain score was recorded
prick pain, EMLA cream was applied prior at needle using VAS score and postoperative complications were
insertion site. Ilioinguinal, iliohypogastric and also recorded. Data was collected and compiled using
genitofemoral nerve block using landmark technique was Microsoft Excel, analysed using SPSS 23.0 version.
performed. The spermatic cord was identified immediately Statistical analysis was done using descriptive statistics.
lateral to the pubic tubercle. The area for injection,

RESULTS
30 patients were considered for study, all were male, mean age was 48.1 ± 18.51 Years, mean weight was 66.18 ± 12.8
kgs, ASA class I were 70 %, class II were 30 %/ and mean duration of surgery was 60.5 ± 22.43 min.
Table 1: Demographic Profile
Parameters Value (No. of cases/ Mean ±SD)
Age 48.1 ± 18.51 Years
Weight 66.18 ± 12.8 kgs
Gender (M/F) 30/00
ASA (I/II) 21/09
Duration of surgery 60.5 ± 22.43 min

In present study, Onset of sensory blockade was 11.2 ± 1.07 min and duration of sensory blockade was 307.8 ± 82.5 min.
Mean period taken for ambulation was 317.8 ± 67.5 min. Mean duration of post-operative analgesia was 439.9 ± 83.7 min.
The nerve block was successful in 29 patients and one was converted to GA. Only minor complication noticed was
Transient minimal femoral sensory block (3.33 %). No peritoneal puncture, hematoma due to needle puncture, nausea and
vomiting, urinary retention, LA toxicity and LA allergy was noted in present study.
Table 2: Anaesthesia characteristics
Parameters Value (No. of cases/ Mean ±SD)
Onset of sensory blockade 11.2 ± 1.07 min
Duration of sensory blockade 307.8 ± 82.5 min
Ambulation Time 317.8 ± 67.5 min
Post-operative analgesia 439.9 ± 83.7 min
Conversion to GA 1 (3.33%)
Complication
Transient minimal femoral sensory block 1 (3.33%)

Copyright © 2022, Medpulse Publishing Corporation, MedPulse International Journal of Anesthesiology, Volume 23, Issue 3 September 2022
 Shreyas Nilkanth Deshmukh, Annasaheb Maske, Shaikh Mohd Mudassir

DISCUSSION result in complications such as peritoneal puncture, small

All anesthetic methods have been used for inguinal hernia or large bowel perforations, and femoral nerve palsy even
repair surgeries. The choice of the anesthetic technique in experienced hands.10 Combined iliohypogastric and
depends on its acceptability by the patient and surgeon, the ilioinguinal nerve blocks significantly reduce pain scores
feasibility and safety of the procedure, surgical method, and supplemental analgesia after discharge following
medical history, comorbidities, and the cost. An inguinal herniorrhaphy. When compared with spinal
ilioinguinal and iliohypogastric nerve block seems to be a anaesthesia, these blocks are associated with a shorter time
simple and straight forward technique based on surface to discharge home, lower pain scores at discharge, higher
anatomy and visible skin landmarks. Anatomically, the satisfaction scores at 24-hour follow-up, and lower cost.10
sensory nerve supply of the inguinal region is from the These blocks have been suggested as an alternative
T12–L2 nerves. The ilioinguinal and iliohypogastric anaesthetic technique for repair of strangulated hernia in
nerves (branches of T12 and L1) are located between the high-risk patients who are not suitable candidates for
internal abdominal oblique and transverse abdominis general or neuraxial anaesthesia. This technique can
muscles just superior to the anterior superior iliac spine.6 successfully be utilised in patients who are not suitable for
In study by Elwany AF et al.,7 mean duration (in minutes) other modes of anaesthesia like neuraxial anaesthesia and
to require rescue analgesia was found to be 1003.2 ± 99.6 general anaesthesia.
(min) in group A and 1317 ± 69 (min) in group B. In a
comparison of these two values the difference in the CONCLUSION
meantime to rescue analgesic requirement was statistically Landmark technique for ilioinguinal, iliohypogastric and
significant (p < 0.001). IIN/IHN block delays the need for genitofemoral nerve block provides excellent anaesthesia
rescue analgesia and reduces the postoperative analgesic technique for day care inguinal hernia repair surgery. This
requirement compared to USG-guided TAP block. technique is really helpful in setup where PNS and USG
In study by Singh SK, nerve block was deemed to be are not available. The potential benefits are lack of
successful in 92% of the patients. In 8% of patients, dependency on availability of hospital beds, greater
conversion to GA was required. There was excellent flexibility of scheduling surgeries, reduced hospital
analgesia postoperatively up to 12 h. All of the 92 patients infection, shorter waiting list, overall reduced procedural
were ambulatory within 4–6 h without any discomfort. IIN cost, recovery in a familiar environment and contribution
and IHN block in the TAP plane, supplemented with GFN to the economic growth of the nation.
block provides excellent anaesthesia technique for day
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Conflict of Interest: None Declared

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