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Ultrasound guided hernia blocks

Shiv Kumar Singh 1, Hetal B. Vadera 2

1Consultant Anaesthesia, Department of Anaesthesia, Ro al!iverpool "niversit Hospitals, !iverpool,#"K$

2Consultant % Head, Department of Anaesthesia, SterlingHospital, Ra&'ot, #(ndia$

Correspondence: Dr Shiv Kumar Singh, Department ofAnaesthesia, 11 th )loor, Ro al !iverpool "niversit Hospitals,*res+ot Street, !iverpool ! - * #"K$/

0 mail shiv.singh3rl4uht.nhs.u'

ABSTRACT

(nguinal hernia surger is one of the +ommonest da +ase

pro+edure in an surgi+al unit, and one of the pro+edures thathas a ver high in+iden+e of persistent post surgi+al pain.Blo+'s of the ilioinguinal and ilioh pogastri+nerves ma redu+ethe in+iden+e of this +hroni+ pain. Blo+'ing the genital 4ran+hof genitofemoral nerve +ompletes the nerve 4lo+' for inguinalhernia surgeries. All these three nerves +an 4e easil 4lo+'edunder ultrasound guidan+e and this improves the e5e+tivenessof the 4lo+'. )ailures in a+hieving +omplete anesthesia andanalgesia is not al6a s due to te+hni+al reasons, anatomi+alvariations ma 4e the +ause in some of the +ases. 7his arti+le

mailto:shiv.singh@rlbuht.nhs.ukmailto:shiv.singh@rlbuht.nhs.uk

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des+ri4es the anatom , sonoanatom , the variations and the

nerve 4lo+'s under ultrasound guidan+e.

Key words: Hernia, (nguinal8surger / 9erve Variations/ 9erveBlo+'/ 9erve Blo+'ade/ Anesthesia, !o+al/ Spinal 9erves/ A+ute*ain/ *udendal 9euralgia/ "ltrasound/"ltrasonograph / "ltrasound (maging/ "ltrasonograph ,(nterventional

Citation: Singh SK, Vadera HB. "ltrasound guided hernia4lo+'s. Anaesth *ain %(ntensive Care 2:1;/1

INTR !UCTI N(nguinal hernia repair is one of the +ommonest da +ase

surgi+al pro+edures. Signi?+ant part of the pain from herniasurger arises from the a4dominal 6all in+ision, the somati+pain. Despite the e5e+tive perioperative pain managementstrategies, the fre@uen+ of moderate to severe pain from this

lo6er a4dominal surger is seen in appro imatel =:> ; of thepatients. 1 =

(n normal +ir+umstan+es, the a+ute pain asso+iated 6ithinguinal hernia surger diminishes 6ithin several da s to 6ee's

4ut, in a4out 1: of +ases, this pain persists and patiente perien+e 6hat is 'no6 as +hroni+ or persistent post surgi+al

pain #C*S* or **S*$. 7he most +onsistent ris' fa+tor for C*S* isthe presen+e and8or intensit of pain e perien+ed in theperioperative period and hen+e preventive analgesia andoptimal treatment of post operative pain is essential to prevent,mitigate, or treat C*S* in hernia surgeries.

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*eripheral nerve 4lo+'s along 6ith multimodal analgesia are

+ommonl emplo ed for perioperative management of painarising from hernia surgeries. 7hese 4lo+'s are often performed

using 4lind te+hni@ues and, more re+entl under ultra soundguidan+e. 7he failure rates of 4lind te+hni@ue as per thepu4lished literature are appro imatel =: : . - 7his high rateof failure +omes from the la+' of 'no6ledge a4out the anatomof the nerves #anomalies and anatomi+al variations$ and partlfrom the failure to eliminate the E+ushion e5e+tF 6hileperforming the loss of resistan+e #!GR$ 4lo+'s.