Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

14. Perioperative Pain Management Multi-modalities to Prevent…
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effect. For hernia surgery, local anesthetics may be applied using four
different techniques: inguinal nerve block (discrete nerve block at the
site of the ilioinguinal, iliohypogastric, and/or genitofemoral nerve);
field block (infiltration into the superficial and deeper structures in the
field of surgery, which may result in a block of the ilioinguinal, iliohypogastric,
and/or genitofemoral nerve); infiltration (injection of local
anesthetic into the cutaneous/subcutaneous/deeper structures of the
surgical field); and instillation (local anesthetic application without
needles (e.g., spray) into the surgical site).
Techniques for Administration of Local Anesthetics
Inguinal Nerve Block
The ilioinguinal and iliohypogastric nerves can be blocked by a
directed administration of local anesthetic pre- or intraoperatively.
Beginning two fingerbreadths superior and medial to the anterior superior
iliac spine, a 1.5 inch needle is introduced deep into the abdominal
wall, targeting the layers between the internal and external oblique fascia
(Fig. 14.3 ). Depth is estimated by feeling for the “pop” of the needle
across the external oblique fascial layer and 10 mL of long- acting local
anesthetic (bupivacaine or liposomal bupivacaine) is infiltrated.
Transversus Abdominis Plane Block
This procedure is done under ultrasound or laparoscopic guidance
and used to block T11–L1 cutaneous, myofascial, and peritoneal nerves,
including the iliohypogastric and ilioinguinal nerves. It provides excellent
pain relief for surgeries involving the infra-umbilical abdominal wall.
Fig. 14.3. Landmarks for inguinal nerve block.