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Anatomical bases of prolonged ilio-inguinal-hypogastric regional anesthesia

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Abstract

Although anesthesia and post-operative analgesia are associated with specific morbidity, regional anesthesia is not systematically given during groin hernia surgery. The goals of this work were to determine the anatomical bases of safe ilio-inguinal (II)-hypogastric anesthesia that can be prolonged into the post-operative period and to validate this technique on anatomical preparations and in clinical situations. We studied the courses of the ilio-hypogastric (IH) and II nerves in 33 halves of 20 embalmed adult cadavers. The intermediate portion of the IH and II nerves, located between the transverse and the internal oblique muscles, were found to be suitable for a simultaneous block with a single injection. We assessed the feasibility of injecting a percutaneous infiltration into this space by injecting a dye before dissection. In 75% of cases, we observed percutaneous coloring of the nerves, confirming that this site was suitable. To guide the infiltration, the points where the nerves passed through the transverse and the internal oblique muscles were located from the iliac crest and anterior and superior iliac spine, respectively. The nerve trunks were grouped for over 5 cm in a cell-fat layer running between these two deep muscles. It was possible to position a micro-catheter in this anatomical space to allow repeated injections. The results of this anatomical study were used to modify the technique so that it could be used to provide regional anesthesia in five patients operated on for hernia. Post-operative pain was very effectively controlled in four cases with no complications.

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Acknowledgments

We would acknowledge the Research Association: Association Recherche Oncologie Digestive (A.R.O.L.D Boulogne) for their grant support.

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Authors and Affiliations

  1. Service de Chirurgie Générale et Oncologique, Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100 , Boulogne, France

    Frédérique Peschaud, Robert Malafosse & Bernard Nordlinger

  2. Laboratoire d’Anatomie Paris—Ile de France Ouest, Université de Versailles Saint Quentin en Yvelines, Versailles, France

    Frédérique Peschaud & Patrice Le Floch-Prigent

  3. Institut d’Anatomie, Centre Universitaire des Saint-Pères, Université Paris V René Descartes, 45 rue des Saint-Pères, 75270, Paris Cedex 06, France

    Frédérique Peschaud, Patrice Le Floch-Prigent & Vincent Delmas

  4. Service d’Anesthésie et de Réanimation Chirurgicale, Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100, Boulogne, France

    Carole Coste-See

Authors
  1. Frédérique Peschaud
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  2. Robert Malafosse
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  3. Patrice Le Floch-Prigent
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  4. Carole Coste-See
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  5. Bernard Nordlinger
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  6. Vincent Delmas
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Corresponding author

Correspondence to Frédérique Peschaud.

Additional information

This study was supported by grants from the AROLD association (Boulogne France).

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Peschaud, F., Malafosse, R., Floch-Prigent, P.L. et al. Anatomical bases of prolonged ilio-inguinal-hypogastric regional anesthesia. Surg Radiol Anat 28, 511–517 (2006). https://doi.org/10.1007/s00276-006-0132-x

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  • DOI: https://doi.org/10.1007/s00276-006-0132-x

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