Comparison of Spinal Anesthesia Versus Ilioinguinal-Iliohypogastric Nerve Block Applied for Single-Sided Inguinal Hernia
DOI:
https://doi.org/10.54112/bcsrj.v6i3.2328Keywords:
Inguinal Hernia; Herniorrhaphy; Spinal Anesthesia; Nerve Block; Ilioinguinal Nerve; Iliohypogastric NerveAbstract
Inguinal hernia repair is commonly performed under spinal anesthesia; however, spinal anesthesia may be associated with delayed ambulation, urinary retention, and prolonged discharge readiness. Ilioinguinal–iliohypogastric nerve block may provide effective regional anesthesia with faster postoperative recovery. Objective: To compare spinal anesthesia with ilioinguinal–iliohypogastric nerve block in patients undergoing elective single-sided inguinal hernia repair. Methods: This randomized controlled trial was conducted in the Department of Anaesthesia, and ICU, Benazir Bhutto Hospital, Rawalpindi, from September 2023 to August 2024. A total of 70 adult patients undergoing elective unilateral open inguinal hernia repair were equally allocated into two groups. Group A received spinal anesthesia, while Group B received ilioinguinal–iliohypogastric nerve block with local anesthetic infiltration. Postoperative pain was assessed using the visual analogue scale at different time intervals. Secondary outcomes included rescue analgesic requirement, time to ambulation, oral intake, discharge readiness, same-day discharge, patient satisfaction, and postoperative complications. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Ilioinguinal–iliohypogastric nerve block required longer preparation and sensory onset time than spinal anesthesia. However, postoperative pain scores were significantly lower in the nerve block group at 2, 4, 6, and 12 hours after surgery. Rescue analgesia was required less frequently in the nerve block group compared with the spinal anesthesia group (40.0% vs. 68.6%, p=0.031), and the time to first rescue analgesia was significantly longer (289 ± 92 vs. 178 ± 73 minutes, p<0.001). Patients in the nerve block group had earlier ambulation, earlier oral intake, shorter discharge readiness time, higher same-day discharge rate, and better satisfaction scores. Urinary retention was significantly more common after spinal anesthesia (17.1% vs. 0.0%, p=0.025). No major anesthesia-related complication, local anesthetic toxicity, reoperation, or mortality was observed. Conclusion: Ilioinguinal–iliohypogastric nerve block provided better early postoperative analgesia, reduced rescue analgesic requirement, improved recovery profile, and lowered urinary retention compared with spinal anesthesia in patients undergoing unilateral inguinal hernia repair. It may be considered a safe and effective alternative to spinal anesthesia, particularly in day-care and resource-limited surgical settings.
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