title: Bilateral multi-injection iliohypogastric-ilioinguinal nerve block in conjunction with neuraxial morphine is superior to neuraxial morphine alone for postcesarean analgesia.
abstract: OBJECTIVE
  To determine whether bilateral iliohypogastric and ilioinguinal (IHII) peripheral nerve blocks, given in conjunction with neuraxial morphine, reduce postcesarean analgesic requirements and side effects, resulting in improved maternal satisfaction.
  
  
  METHODS
  Randomized, prospective, double-blinded, placebo-controlled study.
  
  
  METHODS
  Labor and delivery suite at Johns Hopkins Hospital.
  
  
  METHODS
  34 women scheduled for elective cesarean delivery.
  
  
  METHODS
  Patients were randomized to receive IHII nerve blocks bilaterally, with either total 24 mL of 0.5% bupivacaine or normal saline, following cesarean delivery via Pfannensteil incision with a standard intrathecal dose of 12 mg of 0.75% bupivacaine with 10 µg of fentanyl and 200 µg of preservative-free morphine.
  
  
  METHODS
  Patients were assessed at 0, 6, 12, 18, and 24 hours postoperatively. Visual analog scale (VAS) pain scores at rest were recorded at each time period. Analgesic use, patients' perception of nausea, vomiting, pruritus, and their overall satisfaction with their analgesia were recorded for the first 24 hours.
  
  
  RESULTS
  Lower VAS pain scores were seen in the bupivacaine group at 6, 12, 18, and 24 hours postoperatively (P = 0.01, P < 0.01, 0.02, and 0.04, respectively). A longer mean time to first rescue dose of ketorolac was noted in the bupivacaine group (14.3 ± 1.8 hrs) than the saline group (mean 5.6 ±1.1 hrs), (P < 0.01). Fewer patients in the bupivacaine group made requests for acetaminophen 500 mg/oxycodone 5 mg in the first 24 hours. Satisfaction was greater in the bupivacaine group. No difference in side effects was noted between groups.
  
  
  CONCLUSIONS
  Bilateral multilevel injection IHII nerve blocks result in lower resting VAS pain scores, lower analgesic requirements, and greater satisfaction following cesarean delivery in patients who received neuraxial morphine.
authors.affiliation: Department of Anesthesiology, University Medical Center at Princeton, Princeton, NJ 08540, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wolfson
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Robert P
authors.initials: RP
authors.lastname: Wong
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.forename: Donald H
authors.initials: DH
authors.lastname: Penning
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002585:Cesarean Section; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011247:Pregnancy; D011537:Pruritus / Q000209:etiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D002045:Bupivacaine