Title: RCT of Ilio-Inguinal Nerve Block for Post-Laparoscopy Pain
Authors: Anwar V Morgan MD*, Jennifer A Yee BScN*, Stephen H Halpern MD*, Jean Kronberg MD*, Y Brill MD**, Sabrina Lee, MD**, Pamela J Angle MD*.

Affiliation: Departments of Anesthesia* and Gynecology**, Sunnybrook and Women’s College Health Sciences Centre. 76 Grenville St., Toronto, ON, Canada M5S1B2.
INTRODUCTION: Laparoscopic surgery is a common approach to gynecologic surgery. Advantages of laparoscopic techniques include less postoperative pain and decreased length of hospital stay. Nevertheless, postoperative pain remains a major cause of morbidity following laparoscopic surgery and is the most common reason for unplanned readmissions (1). The purpose of this study is to evaluate the efficacy of ilio-inguinal nerve blocks (IINBs) for laparoscopic postoperative pain relief.
METHODS: After obtaining ethical approval, patients undergoing retropubic bladder suspension via the laparoscopic approach were randomly assigned to 2 treatment groups in a blinded fashion. One group received 4ml of 0.5% bupivacaine with 1:200,000 epinephrine and the second received 4ml of NS for the perineural infiltration of the ilio-inguinal nerve bilaterally. The block was performed by an experienced anesthesiologist after completion of the case. Supplemental analgesia, given to all patients, included naprosyn 500mg q12 hours and PCA morphine. As this is an ongoing study, the treatment code has not yet been broken. Postoperative pain scores at rest and on movement, and PCA requirements were compared at 15min, 1hr, 2hrs, 6hrs and 24hours. Demographics were compared using descriptive statistics. Pain and PCA morphine requirements were compared using repeated students t-tests with correction. A p value of 0.05 was considered statistically significant.
RESULTS: There were 18 patients in one group and 19 in the second group (total recruitment will be 25/group). The demographics were similar between groups. Although there were no statistical differences in the pain scores or PCA requirements, there was a trend towards a reduction in pain on movement at all time measurements in one of the groups (Figure 1). The same group required 21% less PCA morphine in 24hrs (Figure 2).
CONCLUSION: If the group that received IINBs was the group that had reduced pain scores and reduced PCA morphine use, this may prove to be an important adjuvant. The difference in pain on movement persisted for 24hrs. There are 13 more patients yet to be recruited. We conclude that there is enough evidence to support the completion of the study and potentially be a material for a larger similar study.
REFERENCE:
1. Anesth & Analg. 87:816-826.

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