J Korean Surg Soc.  2011 Dec;81(6):408-413. 10.4174/jkss.2011.81.6.408.

Percutaneous ilioinguinal-iliohypogastric nerve block or step-by-step local infiltration anesthesia for inguinal hernia repair: what cadaveric dissection says?

• Kulacoglu
• Ergul Z
• Esmer AF
• Sen T
• Akkaya T
• Elhan A

• KMID: 1445770
• DOI: http://doi.org/10.4174/jkss.2011.81.6.408

Abstract

PURPOSE
The repair of groin hernias with local anesthesia has gained popularity. Two main methods have been described for local anesthesia. This study was aimed at comparing percutaneous truncular ilioinguinal-iliohypogastric block and step-by-step infiltration technique by using cadaver dissections.
METHODS
The study was performed on an adult male cadaver by using blue dye injection. A percutaneous nerve block simulation was done on right side and the dye was given in between the internal oblique and transversus muscles. On the left side, a skin incision was deepened and the dye was injected under the external oblique aponeurosis. Following the injections, stained areas were investigated superficially and within the deeper tissues with dissection.
RESULTS
There was a complete superficial staining covering the iliohypogastric and ilioinguinal nerves in the inguinal floor at both sides. On the right side, intraabdominal observation showed a wide and intense peritoneal staining, while almost no staining was seen on the left side. Preperitoneal dissection displayed a massive staining including testicular vascular pedicule and vas deferens on the right side. The dye solution also infiltrated the area of the femoral nerve prominently. On the contrary, a very limited staining was seen on the left.
CONCLUSION
It may not always be easy to keep the percutaneous block within optimum anatomical limits without causing adverse events. A step-by-step infiltration technique under direct surgical vision seems to be safer than percutaneous inguinal block for patients undergoing inguinal hernia repair.

Keyword

Inguinal hernia; Local anesthesia; Infiltration anesthesia; Nerve block; Femoral nerve

MeSH Terms

Adult
Anesthesia, Local
Cadaver
Femoral Nerve
Floors and Floorcoverings
Groin
Hernia
Hernia, Inguinal
Humans
Male
Muscles
Nerve Block
Skin
Vas Deferens
Vision, Ocular

Figure

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  Fig. 1 A view from abdomen shows a wide and intense peritoneal staining at right side, where percutaneous block attempted, while almost no staining is seen at left side.

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  Fig. 2 Preperitoneal dissection displayed a massive staining including testicular vascular pedicule and vas deferens at right side. On the contrary, a very limited staining was seen at left side.

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  Fig. 3 The dye solution infiltrated the left femoral nerve area prominently at right side after percutaneous block.

• 

  Fig. 4 A cross-sectional diagram shows both sides. Dye solution can infiltrate the tissues down to the femoral nerve after percutaneous injection between the internal oblique muscle and transversus abdominis at right side. The dye travels along with the transversalis fascia. A dye injection under the external oblique aponeurosis seems to be limited with the more superficial tissues.

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  Fig. 5 (A) The red dye was given beneath the external oblique aponeurosis after the skin was lifting. (B) The whole inguinal regions was involved. Both iliohypogastric and ilioinguinal nerves were found to be infiltrated by the red dye.

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