Ultrasound-guided ipsilateral transverse abdominis plane and ilioinguinal-iliohypogastric nerve block for inguinal hernia repair in patients with liver cirrhosis

Background Patients with liver cirrhosis have a limited hepatic reserve and are vulnerable to surgical and anesthetic stress. The purpose of the present study was to observe the effect of combining ultrasound-guided ipsilateral transverse abdominis plane block with ilioinguinal-iliohypogastric block as a sole anesthetic technique for inguinal hernial repair in a series of chronic liver patients with cirrhosis. Materials and methods Twenty-nine male patients having chronic liver disease with cirrhosis underwent elective inguinal hernia repair, with inclusion criteria of American Society of Anesthesiologists physical status classification groups II or III and age between 40–75 years. All patients were with chronic liver disease and liver cirrhosis, having a Child–Pugh class B or Moemen modified classification of liver disease class B and an international normalized ratio not exceeding 1.5. Results No patients necessitated the conversion to general anesthesia and only three patients (10%) needed local anesthetic infiltration. Cardiorespiratory parameters were stable throughout the study period. Patients had a significantly low visual analog scale for pain in the first 6 h postoperatively (P 0.001). Mean duration of postoperative analgesia was 13.16 ± 4.5 h. No patients (0%) required rescue analgesia in the first 6 h postoperatively, whereas 16 patients (55.17%) required rescue analgesia in the following next 6 h postoperatively and 11 patients (37.9%) required rescue analgesia between 18 and 24 h postoperatively. Patients reported a high median satisfaction score of 6 (5–7). Conclusion This study showed the feasibility of combined ultrasound-guided transverse abdominis plane and ilioinguinal-iliohypogastric nerve block as a sole anesthetic technique for inguinal hernia repair in patients with liver cirrhosis as well as for providing postoperative analgesia and early ambulation.