Comparison of Ultrasound Guided Bilateral Ilioinguinal and Iliohypogastric Nerve Blocks Versus Local Infiltration for Post Cesarean Section Analgesia

Abstract

Background: The World Health Organization (WHO) reports > 20% of childbirth is via cesarean section (CS). Most CS deliveries are performed under spinal anesthesia (SA) combined with other multimodal analgesia like epidural analgesia, local anesthetic (LA) wound infiltration, abdominal nerve blocks, and systemic analgesics. These combinations are safer and offer better maternal analgesia as compared to general anesthesia (GA). Study Objective: To compare ultrasound guided ilioinguinal iliohypogastric nerve block (IINB) versus local infiltration of the incision site (LIIS); for postoperative analgesia in CS patients under SA. Methodology: This is a comparative Quasi-experimental study. Participants were divided into two arms. Bupivacaine, dexamethasone and adrenalin were used in both the ultrasound guided IINB arm and the LIIS arm. Participants were patients in Kenyatta National Hospital (KNH) maternity theatres undergoing CS under SA meeting eligibility criteria. Convenience sampling was used; participants in an alternating manner fell into either arm until the desired sample size was achieved. Participants were followed up to determine time to ambulation, time to first analgesia (TFA) request and numerical rating scale (NRS) scores for pain assessment at postnatal wards. A questionnaire was used for data collection. Data was analyzed using statistical package for the social sciences (SPSS) 23.0. Comparison of pain was done between the two groups using Chi square test of association. TFA was measured with comparison done using Student’s t test and association done using Chi square test. Time to ambulation was summarized into median minutes and compared using the Mann Whitney U test. Statistical significance was tested at 5% (p-value <= 0.05). Findings were presented using tables and graphs. Results: Lower pain scores on activity, longer duration of analgesia and early ambulation time were noted in the IINB group as compared to the LIIS group; this was not statistically but was clinically significant