Efficacy of Bilateral Ilioinguinal Iliohypogastric Nerve Blocks for Postcesarean Section Analgesia under Spinal Anesthesia in a Nigerian Population: A randomised Controlled Trial

Abstract

Abstract Background: Cesarean section (CS) often produces significant postoperative pain. This pain negatively affects mother–child bonding, maternal ambulation, and satisfaction. No single optimal post-CS analgesia method has been reported. The efficacy of the bilateral ilioinguinal iliohypogastric (IIIH) nerve blocks in managing post-CS pain in Nigerian population is explored. Aims: The purpose of the study was to evaluate the pain relief benefits of the bilateral IIIH nerve blocks in parturients undergoing CS under the subarachnoid block. Materials and Methods: Eighty-four parturients who had nonemergency CS were randomised into two groups of 42 patients each. Patients in Group A had bilateral IIIH nerve block with 40 ml of 0.25% plain bupivacaine. Patients in Group B had the same nerve block with 40 ml of normal saline 0.9%. The postoperative Visual Analog Scale (VAS) pain scores in the recovery room at zero, 2, 4, 6, 12, and 24 h were assessed in resting and with activity. The rescue doses of opioids (50 mg tramadol) and the time to parturient’s first demand for rescue pain relief were also recorded. The mean values were compared. Results: The sociodemographic indices were similar in both groups. The time to patients’ first pain relief demand was statistically longer in Group A compared with Group B (432.2 ± 54.6 min vs. 94.18 ± 84.1 min, respectively), P = 0.001. Opioid use in Group A, 55.25 ± 30.05 mg, was significantly lesser compared to Group B, 110.65 ± 35.15 mg, P = 0.033. Group A had significantly lesser mean VAS pain scores than Group B at resting and with activity, at 4, 6, 12, and 24 h after surgery, with P < 0.05 at each time point. The patients in Group A had better satisfaction scores. Conclusion: The bilateral IIIH nerve block with bupivacaine 100 mg reduced opioid consumption and VAS pain scores and prolonged analgesia duration with increased patients’ satisfaction scores.