COMPARISON OF PERCUTANEOUS AND INTRAABDOMINAL BLOCKADES OF ILIOHYPOGASTRIC AND ILIOINGUINAL NERVES FOR POSTOPERATIVE PAIN MANAGEMENT OF TOTAL ABDOMINAL HYSTERECTOMY PATIENTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Study Objective: In this study we aimed to determine whether iliohypogastric and ilioinguinal nerve blockade from intraabdominal approach for the postoperative pain management of total abdominal hysterectomy patients could be a reliable and effective alternative compared to percutaneous block of IHII nerves. 
Design: This study is a randomised controlled double blind prospective clinical trial. 
Setting: This study was conducted in operating room, and recordings were performed in postoperative recovery unit and gynaecology clinic. 
Patients: Eighty seven women undergoing total abdominal hysterectomy were enrolled in this study but 82 completed the study. Patients were divided into three groups (n=29 in each), as control group (group C), percutaneous IHII block group (group PB) and intraabdominal IHII block group (group IB). 
Interventions: Group C patients received no block procedure. The percutaneous bilateral IHII nerves block was performed after abdominal closure to group PB and intraabdominal IHII block was performed before abdominal closure to group IB. 
Measurements: Mean arterial pressure, heart rate, pain scores, satisfaction scores, morphine consumptions and side effects were recorded at the 2nd, 6th, 12th and 24th postoperative hours. 
Main Results: Postoperative MAP, HR results of control group were found similar in all groups. VAS scores at all postoperative hours were found to be significantly lower in the block groups PB an IB than control group. There were no significant differences in pain scores between group PB and IB at any time point. Morphine consumption data were found to be significantly lower in the PB and IB groups than in the control group. 
Conclusions: Intraabdominal IHII blockade just before closure of the abdomen for relieving postoperative pain in total abdominal hysterectomy patients is as effective and safe method as conventional percutaneous IHII blockade without adverse effects.