Go Home FasterRichard K. Baumgarten, MD, Grosse Pointe Farms, Mich.
A B. Braun 22G Epidural Needle used for a U/S guided II/IH block.
IN INGUINAL HERNIA REPAIR, past is prologue.
Despite its “state of the art” cachet, enthusiasm for draped and fully anesthetized. The anesthesiologist can laparoscopic hernia surgery has waned. Lap hernias take perform II/IH block right after surgery in the recovery longer, pose a higher risk of bladder and vascular area in less than five minutes, provided the ultrasound complications, and incur much higher supply costs. The problem with open inguinal hernia repair, though, is thatit’s more painful. This hinders recovery and makes it Ultrasound guidance is important because it improves much harder for patients to void, significantly prolonging block accuracy. Traditionally, practitioners performed discharge. Patients typically say: “As soon as I try and these blocks using the iliac crest as a landmark, with press down, it hurts, and I have to stop.” The good tactile feedback to advance the needle through the news is that a new approach to pain management— fascial planes. These “pops and plops” are a little short-acting spinal anesthesia with an ilioinguinal unreliable, and blocks are incomplete in 20 to 30 iliohypogastric(II/IH) nerve block performed in the percent of patients. With ultrasound, the recovery room—is an excellent way to manage the pain, anesthesiologist can visualize the needle entering the promote voiding, and help patients go home sooner. fascial plane between the transverse abdominus andinternal oblique muscles. Even if one can’t see the Here’s how it works. Before the procedure, the small nerves directly, local anesthetic injected in this anesthesiologist administers a short-acting spinal block.
Spinal anesthesia virtually eliminates the PONV seenwith general anesthesia. Lidocaine is an acceptable By performing the block in recovery, after transferring choice; but in many patients, it causes moderate to monitoring responsibility to the recovery nurse, even severe back and buttock pain lasting up to 24 hrs. This the solo anesthesia provider doing consecutive cases symptom constellation is called TNS. I prefer can take advantage of II/IH blocks. This block also preservative-free 2-chloroprocaine (2-CP) since it works well for patients who prefer general anesthesia.
provides rapid, intense muscle relaxation with no TNS.
The practitioner can also perform these blocks pre- My usual 2-CP dose is 35-50 mg for hernia surgery. It operatively. In each scenario, the improved analgesia lasts 30-60 minutes, and motor recovery is quick. To will help patients recover more quickly, void faster, and prevent or minimize spinal headache, I use small-gauge go home sooner—keeping your patients happier and References supplied upon request. administers an ultrasound-guided II/IH nerve block.
Even though paravertebral block offers a perfect triad of segmental anesthesia, muscle relaxation and prolonged post-op analgesia, the II/IH block is more practical.
Paravertebral blocks have a “soak time” of 20 to 30 Medical Center in Lapeer, MI.
Email him at
minutes, and in our center, pre-op beds are at a premium, hernia patients often arrive late, and surgeonsprefer to enter the room with the patient prepped, The views expressed in this advertorial are those of the author only. Providers and clinicians are obligated to make their own determination of the appropriate medical treatment for each of their patients.
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