Inguinal Block

36 Inguinal Block



Perspective


Inguinal block is primarily a technique of peripheral block for inguinal herniorrhaphy.




Patient Selection


Increasing numbers of patients are undergoing inguinal herniorrhaphy as outpatients; thus, this block may be incorporated in most practices.



Pharmacologic Choice


As with many of the peripheral regional blocks, motor blockade is not essential for success with inguinal block. Therefore, lower concentrations of intermediate- to long-acting local anesthetics can be chosen. For example, 1% lidocaine or mepivacaine is appropriate, as is 0.25% bupivacaine or 0.2% ropivacaine. Often the surgeon must supplement inguinal block intraoperatively by injecting near the spermatic cord, so the volume of local anesthetic used during the initial block should not preclude additional intraoperative injection.



Placement




Anatomy


Innervation of the inguinal region arises from the distal extensions of the more cephalad lumbar plexus nerves: the iliohypogastric and ilioinguinal nerves, which have their origin from the first lumbar nerve, and the genitofemoral nerve, which has its origin from the first and second lumbar nerves (Fig. 36-1). These peripheral extensions of the lumbar plexus and the 12th thoracic nerve follow a circular course that is influenced by the bowl-like shape of the ilium. As these nerves course anteriorly, as illustrated in Figure 36-2

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May 31, 2016 | Posted by in ANESTHESIA | Comments Off on Inguinal Block

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