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IntroductionAmong the different anesthetic techniques used toattend hernioplasty current evidence supports the use oflocal anesthesia by infiltration because it determines ashorter post-operative recovery, fewer complications andlower overall costs 1,. However, despite these advantagesthe local anesthesia by infiltration is rarely used 2. Inorder to improve intraoperative analgesia ilioinguinalblock combined with an infiltration of local anestheticcan represent the rational, but there are no data fromrandomized trials to support this approach in elderlypatients. The aim of our study conducted in double-blind, randomized, and is toverify if the additionalilioinguinal blockade could improve the intra-operativeanalgesia in the intervention of inguinal hernia repairperformed under local anesthesia by infiltration.Materials and methods64 patients who underwent elective surgery for inguinalhernia repair with gradual infiltration of local anestheticwere randomized in 2 groups, in double-blind. In thefirst group the patients were subjected to an additionalilioinguinal block with 10 ml of bupivacaine 0.25%, andothers patients were subjected with isotonic saline toplacebo effect. All operations of hernia repair were per-formed by an experienced team of surgeons. The criteriafor inclusion in the study were: first intervention ofinguinal hernia repair, age over 70 years, ASA class andcomorbidities homogeneous . Were excluded patientswith bilateral hernias, with chronic preoperative pain,dementia, and BMI greater than 29. It has not been usedpremedication. The intraoperative sedation with midazo-lam (1-2 mg) was administered when necessary. Twentyminutes before the intervention an ilioinguinal blockwith 10 ml of bupivacaine 0.25% was performed by injec-tion to 3-4 cm medially from the anterior superior iliacspine in a group of patients, while the other group wastreated with placebo . Immediately after surgery wasassessed intra-operative pain with a visual analogue painscale (VAS) and again 24 and 48 hours after surgery. Andthen was evaluated the use of analgesics (paracetamol,ketorolac and tramadol) For the post-operative pain wereused paracetamol lg every 6 hours, ketorolac 30 mg every8 hours, tramadol 50 mg, if needed.ResultsBetween the two groups there were no differences in age,use of sedation and amount of bupivacaine infiltrationanesthesia. The intra-operative dose of midazolam forsedation was low (l.0 mg) and similar in both groups.The median VAS score intra-operative was 9 in thegroup treated with additional ilioinguinal block while itwas 13 in the group treated with placebo ilioinguinalblock (P = 0.02) (Figure 1). There was no difference inpain scores or analgesic requirements at 24 and 48 hoursafter surgery (Figure 1). The distribution of intra-operative VAS scores showed a greater number (P <0.05)of patients with VAS score≥ 30 intra-operative in theplacebo group compared to patients treated with ilioin-guinal block (Figure 2).

bmc surgery

What is the benefit of associating a blockade ilioinguinal and local anesthetic infiltration in elderly patients undergoing hernia repair surgery: a double-blind randomized study