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Essentials of Regional Anesthesia pp 387–396Cite as

Selective Regional Anesthesia Options in Surgical Subspecialties

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Abstract

Though the anatomy of most nerves is well understood, there are many variations in popularity of different selective nerve blocks in clinical practice despite the implementation of ultrasound technology. In this regard, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve, and penile nerve blocks, though effective, are less often performed when compared with many other selective nerve blocks. Local pain, local anesthetic toxicity, bowel perforation, pelvic hematoma, hypotension, and subcutaneous hematoma are all potential complications, suggesting that precise technique and use of ultrasound are critical for consistent success without these type of side effects when providing these selective nerve blocks. Collectively, these blocks are valuable for a wide range of indications; however, an appreciation of anatomy and proper technique with ultrasound can improve efficacy and reduce potential side effects. In this regard, many groups have moved away from bupivacaine because of its potential toxicity with intravascular injection, while other groups still utilize bupivacaine, making good technique that is much more significant for ensuring best outcomes and patient safety.

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References

  1. NYSORA-II/IH continuous Block: http://www.nysora.com/peripheral_nerve_blocks/classic_block_tecniques/3066-ilioinguinal_and_iliohypogastric_blocks.html.

  2. Wang H. Is ilioinguinal-iliohypogastric nerve block an underused anesthetic technique for inguinal herniorrhaphy? South Med J. 2006;99(1):15.

    Article  PubMed  Google Scholar 

  3. Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy. South Med J. 2006;99(1):48–51.

    Article  PubMed  Google Scholar 

  4. Stav A, Reytman L, Stav MY, Troitsa A, Kirshon M, Alfici R, Dudkiewicz M, Sternberg A. Transversus abdominis plane versus ilioinguinal and iliohypogastric nerve blocks for analgesia following open inguinal herniorrhaphy. Rambam Maimonides Med J. 2016;7(3):e0021. https://doi.org/10.5041/RMMJ.10248. PMID: 27487311.

    Article  PubMed Central  Google Scholar 

  5. Liu H, Fox CJ, Yarborough MJ, Kaye AD. Selective regional anesthesia options in surgical subspecialties. In: Kaye D, Urman RD, Vadivelu N, editors. Essentials of regional anesthesia. New York: Springer; 2012. p. 525–39. https://doi.org/10.1007/978-1-4614-1013-3. ISBN 978-1-4614-1012-6. Chapter 20.

    Chapter  Google Scholar 

  6. Katz G. Ilioinguinal and iliohypogastric nerves. In:Atlas of regional anesthesia. Connecticut: Appleton-Century-Crofts/Norwalk; 1985. p. 114–5.

    Google Scholar 

  7. Ford S, Dosani M, Robinson AJ, Campbell GC, Ansermino JM, Lim J, et al. Defining the reliability of sonoanatomy identification by novices in ultrasound-guided pediatric ilioinguinal and iliohypogastric nerve blockade. Anesth Analg. 2009;109(6):1793–8.

    Article  PubMed  Google Scholar 

  8. Beaussier M, Weickmans H, Abdelhalim Z, Lienhart A. Inguinal herniorrhaphy under monitored anesthesia care with ilioinguinal-iliohypogastric block: the impact of adding clonidine to ropivacaine. Anesth Analg. 2005;101(6):1659–62.

    Article  CAS  PubMed  Google Scholar 

  9. Pöpping DM, Elia N, Marret E, Wenk M, Tramèr MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology. 2009;111(2):406–15.

    Article  PubMed  Google Scholar 

  10. Disma N, Tuo P, Pellegrino S, Astuto M. Three concentrations of levobupivacaine for ilioinguinal/iliohypogastric nerve block in ambulatory pediatric surgery. J Clin Anesth. 2009;21(6):389–93.

    Article  CAS  PubMed  Google Scholar 

  11. Gucev G, Yasui GM, Chang TY, Lee J. Bilateral ultrasound-guided continuous ilioinguinal-iliohypogastric block for pain relief after cesarean delivery. Anesth Analg. 2008;106(4):1220–2.

    Article  PubMed  Google Scholar 

  12. Frigon C, Mai R, Valois-Gomez T, Desparmet J. Bowel hematoma following an iliohypogastric-ilioinguinal nerve block. Paediatr Anaesth. 2006;16(9):993–6. https://doi.org/10.1111/j.1460-9592.2006.01909.x. PMID: 16918666.

    Article  PubMed  Google Scholar 

  13. Tani M, Sato M, Son I, Tanabe H, Hirota K, Shirakami G, Fukuda K. Transient femoral nerve palsy after ilioinguinal-iliohypogastric nerve block: comparison of ultrasound-guided and landmark-based techniques in adult inguinal hernia surgery. Masui. 2015;64(6):603–9. PMID: 26437548.

    PubMed  Google Scholar 

  14. Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain—a description of techniques and review of literature. Pain Physician. 2008;11(2):215–24. PMID: 18354713.

    PubMed  Google Scholar 

  15. Pankhania M, Ali S. The genitofemoral nerve block: a method for hemiscrotal anaesthesia at the bedside. Ann R Coll Surg Engl. 2012;94(4):272. https://doi.org/10.1308/003588412X13171221591259a. PMID: 22613308.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Long RM, McCartan D, Cullen I, Harmon D, Flood HD. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision. BJU Int. 2010;105(11):1576–8.

    Article  PubMed  Google Scholar 

  17. Metzelder ML, Kuebler JF, Glueer S, Suempelmann R, Ure BM. World J Urol. 2010;28(1):87–91.

    Article  PubMed  Google Scholar 

  18. Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H. Evaluation of genito- femoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. Br J Anaesth. 2005;94(2):243–6.

    Article  CAS  PubMed  Google Scholar 

  19. Sandeman DJ, Dilley AV. Ultrasound guided dorsal penile nerve block in children. Anaesth Intensive Care. 2007;35(2):266–9. PMID: 17444318.

    CAS  PubMed  Google Scholar 

  20. Gürkan Y, Kus A, Aksu C, Çiftçi S, Çulha M, Pandin P. Ultrasonography-guided penile block for adult penile surgery. Can J Anesth. 2016;63(6):780–1.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Wuhan Central Hospital, Wuhan, Hubei, China

    Hong Yan MD

  2. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Alan David Kaye MD, PhD

  3. Department of Anesthesiology and Perioperative Medicine, Hahnemann University Hospital, Drexel University College of Medicine, Philadelphia, PA, USA

    Henry Liu MD

Authors
  1. Hong Yan MD
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  2. Alan David Kaye MD, PhD
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  3. Henry Liu MD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    The primary nerve root supplying the ilioinguinal and iliohypogastric nerves is:

    1. (a)

      L3

    2. (b)

      L2

    3. (c)

      L1

    4. (d)

      T12

  2. 2.

    All the following are advantages of ilioinguinal and iliohypogastric blocks compared to spinal except:

    1. (a)

      Quicker postoperative discharge

    2. (b)

      Faster postoperative oral intake

    3. (c)

      Less need for recovery room

    4. (d)

      Less postoperative surgical complications

  3. 3.

    The ilioinguinal nerve supplies sensation to all the following areas except:

    1. (a)

      Skin covering the base of the penis

    2. (b)

      Skin covering the upper scrotum

    3. (c)

      Skin covering the mons pubis

    4. (d)

      Skin covering the posterior aspect of the upper thigh

  4. 4.

    The ilioinguinal and iliohypogastric nerves are commonly located between:

    1. (a)

      The transverse abdominal muscle and the internal oblique muscle

    2. (b)

      The internal oblique muscle and the external oblique muscle

    3. (c)

      The transverse abdominal muscle and the rectus sheath

    4. (d)

      The rectus sheath and aponeurosis of the external oblique muscle

  5. 5.

    Continuous ilioinguinal and iliohypogastric blocks for Pfannenstiel incisions:

    1. (a)

      Place catheter unilaterally

    2. (b)

      Place bilateral catheters between the transverse abdominal and the internal oblique muscles

    3. (c)

      Place bilateral catheters between the external and the internal oblique muscles

    4. (d)

      Place bilateral catheters between the internal and the external oblique muscles aiming medially

  6. 6.

    Complications to the ilioinguinal and iliohypogastric block include all except:

    1. (a)

      Hemodynamic instability

    2. (b)

      Bowel perforation

    3. (c)

      Subcutaneous hematoma

    4. (d)

      Pelvic hematoma

  7. 7.

    Indications for genitofemoral nerve block include all except:

    1. (a)

      Supplemental block for hernia surgery

    2. (b)

      Aid in diagnosis of genitofemoral neuralgia

    3. (c)

      Treatment of some chronic pelvic pain syndromes

    4. (d)

      Primary block for orchiopexy surgery

  8. 8.

    The genitofemoral nerve originates from:

    1. (a)

      Dorsal rami of T12 and L1

    2. (b)

      Dorsal rami of L1 and L2

    3. (c)

      Ventral rami of L1 and L2

    4. (d)

      Ventral rami of T12 and L1

  9. 9.

    The genital branch of the genitofemoral nerve:

    1. (a)

      Enters the inguinal area through the deep ring

    2. (b)

      Travels with the spermatic cord

    3. (c)

      Supplies the cremaster and dartos muscles

    4. (d)

      All of the above

  10. 10.

    Anatomical landmarks used for ultrasound block of the genital branch include all except:

    1. (a)

      ASIS

    2. (b)

      Umbilical button

    3. (c)

      Inguinal ligament

    4. (d)

      Quadriceps muscle

  11. 11.

    Clinical pearls for genitofemoral block include all except:

    1. (a)

      Use epinephrine mixed with local anesthetic

    2. (b)

      Use multidirectional infiltration

    3. (c)

      Sterile preparation extremely important

    4. (d)

      Use local anesthetic without epinephrine

  12. 12.

    Indications for penile block include:

    1. (a)

      Cystoscopy

    2. (b)

      Retrograde urethrogram

    3. (c)

      Circumcision and distal hypospadias repair

    4. (d)

      Testicular torsion

  13. 13.

    Contraindications for penile block:

    1. (a)

      Dorsal penile skin surgery

    2. (b)

      Postoperative analgesia for penile surgery

    3. (c)

      Penile skin infection

    4. (d)

      Phimosis surgery

  14. 14.

    All of the following concerning the penile nerve are true except:

    1. (a)

      Derived from S2–4

    2. (b)

      Courses under the pubic symphysis

    3. (c)

      Travels under Buck’s fascia

    4. (d)

      Blocked with local anesthetic containing epinephrine

  15. 15.

    Complications from penile block:

    1. (a)

      Inadequate block

    2. (b)

      Penile ischemia is common

    3. (c)

      Hematomas are rare

    4. (d)

      Local anesthetic toxicity from large-volume doses

Answers

  1. 1.

    c

  2. 2.

    d

  3. 3.

    d

  4. 4.

    a

  5. 5.

    b

  6. 6.

    a

  7. 7.

    d

  8. 8.

    c

  9. 9.

    d

  10. 10.

    d

  11. 11.

    a

  12. 12.

    c

  13. 13.

    c

  14. 14.

    d

  15. 15.

    b

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Yan, H., Kaye, A.D., Liu, H. (2018). Selective Regional Anesthesia Options in Surgical Subspecialties. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_20

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

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