Routine preoperative care at Shouldice Hospital has not classically included the use of an ilioinguinal-iliohypogastric nerve block. However, with the purchase of an ultrasound machine and growing reports in the literature to the benefit of nerve blocks for inguinal hernia surgery1-5, it is now being trialed in patients at Shouldice Hospital.
There is limited research on the outcomes of ilioinguinal-iliohypogastric nerve block for inguinal hernia patients undergoing a Shouldice Repair, and none from the Shouldice Hospital, founder of the repair. One of the few reports evaluated patients who underwent a modified Shouldice Technique and not the actual repair2. Beaussier et al (2005), reported on 40 patients, 20 received local anesthesia with an ilioinguinal-iliohypogastric nerve block and 20 just received local anesthesia, and measured time to first analgesic request, pain intensity, and adverse events2. Their findings showed that the ilioinguinal-iliohypogastric nerve block with local anesthesia group had less pain during movement on postoperative day 3 but had an increased risk for orthostatic hypotension2. An even earlier study by Nehra et al (1995), divided 200 male inguinal hernia patients, who underwent a Shouldice Technique or modified Bassini repair, into 4 different treatment groups for comparison1. The groups included bupivacaine ilioinguinal field block with oral aspirin, bupivacaine ilioinguinal field block with oral placebo, saline with oral aspirin, and saline with oral placebo1. They measured pain scores, mobility, complications, patient experience, as well as opioid use1. The authors found that the bupivacaine ilioinguinal field block with oral aspirin group had decreased pain and opioid use, as well as increased mobility compared to groups that had saline with oral aspirin and saline with oral placebo1.
More recent research, focusing exclusively on the Lichtenstein repair for inguinal hernias, found that treatment groups had improved outcomes4,5. Kacmaz and Bolat (2020), compared 35 patients who received spinal anesthesia with 35 who received an ilioinguinal-iliohypogastric nerve block with tumescent anesthesia4. They measured sensory block onset time, patient satisfaction, postoperative opioid consumption, duration of surgery and first mobilization, length of hospital stay due to complications related to anesthetic method, and intraoperative hemodynamic values4. The authors found that in the nerve block group there was an increased duration of sensory block, intraoperative pain scores, and patient satisfaction, as well as lower postoperative pain scores, need for analgesics, and urinary retention, there was also early mobilization and discharge4. A 2023 study comparing 30 patients who received an ilioinguinal-iliohypogastric nerve block with added dexamethasone to 30 who just received a nerve block, found that the combination group had decreased rebound pain scores and opioid use5.
The purpose of this study is to evaluate the use of ilioinguinal-iliohypogastric nerve block for hernia patients at Shouldice Hospital. The results are expected to be useful in implementing the ilioinguinal-iliohypogastric nerve block within the patient population at Shouldice Hospital. Concurrently, aiding in understanding and potentially improving the current practices regarding pain management. This could enhance patient care and satisfaction, as well as provide valuable information about the utility of an ilioinguinal-iliohypogastric nerve block to the anesthetists and surgeons.
