Preemptive ilioinguinal-iliohypogastric nerve block versus morphine for unilateral varicocoelectomy

ABSTRACT

The surgical approach for varicocelectomy is similar to that of herniorraphy. Iliohypogastric-ilioinguinal [IHII] nerve block reduces postoperative pain after herniorrhaphy. The effect of preemptive intramuscular injection of 0.1 mg/kg of morphine was studied in ambulatory surgery for patients undergoing unilateral varicocoelectomy and the results were compared with those of IHII nerve block. This study was performed at Jordan University Hospital, Amman, Jordan, between August 2005 and December 2006. After obtaining the approval of the ethical committee, an informed consent was taken from 68 adult male patients in ASA [American Society of Anesthesiologist] who are I-II scheduled for unilateral varicocoelectomy. Those patients were included in a prospective, randomized, double blind study. 34 patients have received IHII nerve block 10 minutes before the incision with 20 mls of bupivacaine 0.5% [B group], and 34 patients received 0.1 mg/kg of morphine 10 minutes also before the incision [M group]. All patients have received standardized anesthesia, pain was assessed by 0-10 [VAS] Visual Analogue Score at 0, 30 minutes, 1, 2, 3, post operative hours. The incidences of nausea, vomiting, sedation, itching and additional analgesic requirement were assessed. P < 0.05 was considered significant. Iliohypogastric-ilioinguinal nerve block group reported lower postoperative pain scores at 30 minutes P=0.00255, 1 hour P=0.0001, 2 hours P=0.0103.No significant differences were present between the two groups at 3 and 4 hours postoperatively. The incidence of sedation, nausea, vomiting and itching was similar in both groups [p=NS]. Iliohypogastric-ilioinguinal nerve block for unilateral ambulatory varicocoelectomy can reduce pain more than morphine in the immediate postoperative period, but this reduction was not associated with a reduction in opioid related side effects