Bilateral multi-injection iliohypogastric-ilioinguinal nerve block in conjunction with neuraxial morphine is superior to neuraxial morphine alone for postcesarean analgesia

Alexander Wolfson, Allison J Lee, Robert P Wong, Kristopher L Arheart, Donald H Penning
Journal of Clinical Anesthesia 2012, 24 (4): 298-303

STUDY OBJECTIVE: To determine whether bilateral iliohypogastric and ilioinguinal (IHII) peripheral nerve blocks, given in conjunction with neuraxial morphine, reduce postcesarean analgesic requirements and side effects, resulting in improved maternal satisfaction.

DESIGN: Randomized, prospective, double-blinded, placebo-controlled study.

SETTING: Labor and delivery suite at Johns Hopkins Hospital.

PATIENTS: 34 women scheduled for elective cesarean delivery.

INTERVENTIONS: Patients were randomized to receive IHII nerve blocks bilaterally, with either total 24 mL of 0.5% bupivacaine or normal saline, following cesarean delivery via Pfannensteil incision with a standard intrathecal dose of 12 mg of 0.75% bupivacaine with 10 µg of fentanyl and 200 µg of preservative-free morphine.

MEASUREMENTS: Patients were assessed at 0, 6, 12, 18, and 24 hours postoperatively. Visual analog scale (VAS) pain scores at rest were recorded at each time period. Analgesic use, patients' perception of nausea, vomiting, pruritus, and their overall satisfaction with their analgesia were recorded for the first 24 hours.

MAIN RESULTS: Lower VAS pain scores were seen in the bupivacaine group at 6, 12, 18, and 24 hours postoperatively (P = 0.01, P < 0.01, 0.02, and 0.04, respectively). A longer mean time to first rescue dose of ketorolac was noted in the bupivacaine group (14.3 ± 1.8 hrs) than the saline group (mean 5.6 ±1.1 hrs), (P < 0.01). Fewer patients in the bupivacaine group made requests for acetaminophen 500 mg/oxycodone 5 mg in the first 24 hours. Satisfaction was greater in the bupivacaine group. No difference in side effects was noted between groups.

CONCLUSIONS: Bilateral multilevel injection IHII nerve blocks result in lower resting VAS pain scores, lower analgesic requirements, and greater satisfaction following cesarean delivery in patients who received neuraxial morphine.

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