Comparison of ultrasound‑guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section: A retrospective propensity match study

Abstract

Effective and adequate post-operative analgesia for cesarean section is in demand due to increasing rates of cesarean deliveries, and may help promote recovery, ambulation and breastfeeding. Local nerve block has been applied as post-operative analgesia for maternal patients receiving cesarean section; specifically, lateral abdominal transversus abdominis plane block (TAPB) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance have been proven to be effective. The present study aimed to compare the analgesic effect of TAPB and IHINB in maternal females undergoing cesarean section. Propensity-matched females who received cesarean section (n=124) were retrospectively enrolled and divided into the TAPB group (n=62) and the IHINB group (n=62) according to their post-operative analgesia treatment. All of the patients have been given spinal-epidural anesthesia during the operation, while they received either TAPB or IHINB for post-operative analgesia. Demographic and clinical data were collected and compared, including time to first morphine request, cumulative morphine consumption, visual analogue scale (VAS) score and adverse events. Due to propensity matching, there was no significant difference between the two groups in their baseline characteristics (all P>0.05). The log-rank test indicated no significant difference in the Kaplan-Meier curves for the time to first morphine request between the two groups (P=0.575). The VAS score and cumulative morphine consumption at 6 and 12 h was similar between the two groups (all P>0.05). However, these two parameters were significantly lower in the IHINB group at 24 and 48 h (P<0.001). Uni- and multivariate logistic regression analysis indicated that the method of block was not an independent influencing factor regarding postoperative pain relief (P=0.628). There was also no difference between the two groups in adverse events of analgesia (all P>0.05). In conclusion, the present study demonstrated that TAPB and IHINB achieved a comparably satisfactory analgesic effect after cesarean section. However, the analgesic effect of IHINB was better than that of TAPB at the later stages.

Transversus abdominis plane block versus wound site infiltration using 0.25% bupivacaine for post-operative analgesia after caesarean delivery performed under subarachnoid block

“…However, the analgesic effect of IHINB was better than that of TAP block at the later stages. 16 In our study no complications were found in either of the two groups. However, some studies have reported complications like block failure, vascular injury, abdominal viscera and nerve injuries with TAP block.…”

Comparison of Bilateral Ilioinguinal-Ilioihypogastric Nerve Block Versus Transverses Abdominis Nerve Block for Post-Operative Pain Management for Parturient Undergoing Elective Cesarean Section in Dilla University Referral Hospital, Ethiopia, A Randomized Controlled Trial

“…Yet, at 24 & 48 hour II/IH group consumed less morphine than their counter parts with p < 0.05 and P < 0.001 respectively. Study design (non-randomized, retrospective), the use of intrathecal morphine & blocks done with ultrasound guided technique could have contributed for the difference seen to our nding [18]. Similarly a cohort by Seid et al, in a study done in Gondar, Ethiopia found that 24 hour total tramadol consumption was lower in II/IH group compared to TAP group (P = 0.009) [19].…”

“…Regarding time to rst analgesic request there is no statistically signi cant difference between between TAP and II/IH groups with median time of 1200.0 (95% CI, 861.9 to 1538.1) & 1285.0 (95% CI, 1245.31 to 1324.69) minutes respectively (χ 2 (1) = 0.467, p = .494). Similarly Yulu Jin et al [18] didn't nd statistically different result in terms of time to rst analgesic request between groups. In contrast to our nding Seid et al and Bessmertnyj AE et al, found that time to rst analgesic request were longer in II/IH group compared to TAP group for post cesarean delivery patients with P < 0.05.…”

The efficacy of TAP block versus ilioinguinal block for post-cesarean section pain management: A systematic review and meta-analysis

“…In this systematic review and meta-analysis, a total of 390 parturient were included from five studies with a sample size ranging from 32 [ 19 ] to 124 [ 17 ]. The time to first analgesic request among the included studies varied from 409 ± 206 min [ 18 ] to 1327 ± 960 min [ 17 ] in the TAP group while it varied from 300 ± 204.44 min [ 19 ]to 1504 ± 834 min [ 17 ] in IL/IH group. Regarding study design, three studies employed an RCT [ 15 , 18 , 19 ] and the remaining two were cohort studies [ 16 , 17 ] ( Table 1 ).…”

“…Controversy still exists regarding the analgesic efficacy of transverse abdominis plane (TAP) block versus ilioinguinal or iliohypogastric (IL/IH) nerve block for postoperative pain management following cesarean section [ 15 , 16 , 17 , 18 , 19 , 20 ].…”