Case for local infiltration analgesia: Is all the evidence in black and white?

Ilioinguinal and Iliohypogastric Nerve Block for Acute and Chronic Pain Relief After Caesarean Section: A Randomized Controlled Trial

Background

There is an increasing cesarean section (CS) rate in Egypt. Multiple methods are used to manage pain after CS.

Objectives

This study aimed to assess the effect of ultrasound-guided bilateral ilioinguinal and iliohypogastric nerve block on pain reduction after CS.

Methods

We classified 64 cases of elective CS into two equal groups. The block group underwent the nerve block, and the control group did not. Postoperative pain, morphine consumption, time to analgesic request, and complications were compared between the two groups.

Results

No significant difference was detected between the two groups regarding patient characteristics or operation duration. However, pain scores during rest and movement were significantly lower in the block group than in controls, especially within the first 12 hours following the operation. Morphine consumption was significantly lower in the block group (4.53 ± 1.456) in group B vs. (8.87 ± 2.013) in group C with P-value < 0.001. Time to the first rescue analgesia was significantly longer in the intervention group than in the other group (12.25 vs. 3.81 hours). Pruritis and nausea incidence was significantly higher in controls than in the block group. The incidence of chronic postoperative pain was significantly lower in the block group.

Conclusions

The ilioinguinal and iliohypogastric nerve block is efficient and safe for managing postoperative pain following CS. It is associated with significant improvement of acute and chronic pain after such operations.

Survey of Surgeons Attitude to Local Anesthetics for Postoperative Pain Relief

Background

There is no ideal postoperative pain management. Simple surgeon-delivered local anesthetic (LA) techniques such as wound infiltration and regional nerve blocks can play a significant role in the improvement of postoperative pain relief.

Settings and Design

Administered paper questionnaires to delegates attending surgical society conferences.

Methods

A 15-point questionnaire was administered to surgical delegates attending general surgey, orthopedic and gynecological conferences at different locations.

Results

Response rate was 65.26%. 33% of surgeons used LA regularly, 31% occasionally, and 36% never used LA for postoperative analgesia. 50% of all surgeons used lignocaine for local anesthesia (P < 0.0001) and infiltration (65% of all surgeons) was the most common method (P < 0.0001). Only 30% surgeons knew the correct duration of action of bupivacaine infiltration (P < 0.0001) and only 4% surgeons knew that LAs are antimicrobial (P < 0.0001). 53% of orthopedic surgeons used combination of lignocaine and bupivacaine, while 46% of general and 73% gynecologists surgeons used lignocaine more commonly. Only <5% of all surgeons had used long-acting liposomal bupivacaine and almost 40% more were willing to use the liposomal LA drug only if more evidence is available.

Conclusions

Although majority of surgeons were aware of the benefits of LA use for postoperative pain relief, reluctance, lack of knowledge of LA drugs and methods of LA use and fear of infection and wound healing are barriers for effective use of LA drugs for postoperative pain relief. Attending anesthesiologists must develop methods in the operating room to create awareness about the effectiveness of LA use for postoperative pain relief. Single-use vials or ampules of LA must be encouraged to LA use for postoperative analgesia, especially in the third-world countries.