Ilioinguinal or Iliohypogastric Nerve Block - Indications, Procedure, Risk Factors, and Contraindications.

Introduction

The ilioinguinal/iliohypogastric and genitofemoral nerve blocks are used to understand and treat groin pain by blocking the pain signals of these nerves. These nerves go to the lower abdomen, groin, scrotum, labia, and inner thigh. Sometimes, these nerves can get hurt from injuries or get stuck between muscles or scar tissue, causing long-lasting groin pain. Doctors can figure out what is causing the pain by putting numbing medicine around these nerves. If the numbing helps, you might get more shots, sometimes with steroids, to feel better.

What Is the Ilioinguinal Nerve Block?

The ilioinguinal nerve is a nerve that gives feeling to the inner thigh, the base of the penis in men, and parts of the pubic area in women. Ilioinguinal nerve blocks are helpful because they can both check and treat groin pain. These blocks involve numbing the nerve with medication to help manage pain. Doctors use ilioinguinal nerve blocks with numbing medicine and steroids to treat ongoing pain after groin surgery or injury. This is done when they think the pain is due to inflammation or the nerve being stuck or trapped.

What Is the Anatomy of the Ilioinguinal and Iliohypogastric Nerve Block?

Iliohypogastric Nerve:

• Part of the spine's L1 nerve root with a bit from T12 sometimes.

• It follows an angled path from L1 and T12 around the side, going through muscles.

• It divides into two parts after going through muscles.

• One part gives a feeling to the skin on the backside of the hip area.

• The other part gives a feeling to the skin above the pubic area.

• These branches can connect and cause variations in feeling.

Ilioinguinal Nerve:

• Also comes from the L1 nerve root, sometimes with a bit from T12.

• It goes through a muscle near the hip bone.

• It can connect with the iliohypogastric nerve.

• It can get trapped at the side of specific muscles, causing discomfort.

• It gives a feeling to the inner thigh, the base of the penis, the upper part of the scrotum, and certain areas in women.

What Are the Indications of Ilioinguinal Nerve Block?

1. Ilioinguinal Neuralgia: The ilioinguinal nerve, which runs along the lower abdomen and groin, is the source of the pain. Both the discomfort and the problem with the nerve are treated during treatment.

2. Iliohypogastric Neuralgia: Lower abdominal pain brought on by the iliohypogastric nerve. Addressing the nerve-related issue and controlling discomfort is necessary for treating this pain.

3. Groin Pain: A feeling of discomfort where the tummy meets the leg. This discomfort has many possible causes, and it needs to be appropriately managed.

4. Mesh and Staples, Inguinal Pain: Especially after operations requiring mesh or staples, groin pain is common. In order to alleviate this discomfort, the exact reason must be addressed.

5. Pelvic Pain: A variety of conditions can cause pain in the pelvic region. Finding the cause and techniques to relieve it is necessary for managing this discomfort.

6. Postherpetic Neuralgia: Pain that lasts for days or weeks after having shingles (herpes zoster). While treating this illness, the nerve-related discomfort must be addressed and alleviation provided.

7. Lateral Abdominal Wall Pain Following Incision or Placement of a Trocar: Pain on the side of the abdomen following a surgical cut or inserting a medical device is known as lateral abdominal wall pain post incision or trocar placement. The pain from the incision or trocar insertion must be controlled to relieve this discomfort.

What Is the Procedure for Administering Ilioinguinal and Iliohypogastric Nerve Block?

1. Equipment Needed:

• A thin needle with insulation, about 2 inches long

• A syringe with a small needle (0.5 inches) for injecting numbing medicine

• A device to stimulate the nerves

• Wires and connectors for the device

2. For Pain Relief or Surgery:

• A slightly thicker needle, 6 or 8 inches long

• A syringe with a small needle for injecting numbing medicine

3. For Radiofrequency or Cryotherapy:

• A special machine and cables.

• Needles or tubes for treatment.

• A bigger needle or catheter.

• Materials for numbing (bupivacaine, lidocaine).

• Medication (deposteroid).

• Medication for numbing nerves.

• Equipment for nerve stimulation.

• Tools for heat treatment or freezing.

• Equipment for nerve stimulation

• Tools for heat treatment or freezing

• Grounding pad.

4. Procedure Explanation:

• The patient lies on their back with their legs extended and supported.

• The doctor finds points on the abdomen where there might be pain.

• They insert a thin needle and use a device to check nerve response.

• A bit of numbing medicine is injected if the correct nerve is found.

5. Pain Relief or Surgery:

• Same position as before.

• The doctor uses a thicker needle to inject numbing medicine.

• This helps with pain relief or surgery.

6. Radiofrequency or Cryotherapy:

• Same needle positions as before.

• For radiofrequency, a heated probe is used to treat the nerve.

• For cryotherapy, a freezing probe is used in cycles.

• This helps with pain relief.

What Are the Things to be Followed After the Procedure?

• Before the procedure, the patient can have a light meal.

• If the patient needs insulin for diabetes, they take it and eat it.

• The patient can also take their medications for high blood pressure or diabetes.

• If they are taking certain blood thinners like Coumadin, Plavix, Lovenox, Pletal, Efficient, Teclid, or Pradaxa, they should inform the doctor to give them special instructions.

• Let the doctor know if the patient has allergies to things like iodine, contrast, or medical dye.

• The patient will be at the facility for about one and a half hours.

• They should bring someone to drive them home because they would not be allowed to drive on the day of the procedure.

• The patient can return to normal activities, including work, the day after the procedure unless their doctor says otherwise.

What Are the Contraindications of the Ilioinguinal Nerve Block?

1. Infection: It is unsafe to perform surgery with an active infection in the body.

2. Extreme Fear of Needles: It is best to postpone the treatment to prevent upsetting someone with a severe fear of needles.

3. Using Blood Thinners or Similar Drugs: If a patient uses drugs that thin their blood or influence their blood clots, the procedure might not be safe for them.

4. Significant Scarring in the Area: If the area is severely scarred, administering the injection may be more challenging.

5. Blood Clotting Issues: If the body has trouble clotting blood, the procedure may cause difficulties with bleeding.

6. Pain Due to Emotional Causes: The procedure may be effective if the pain is more emotionally motivated than physically motivated, the procedure may not be effective.

What Are the Risk Factors Associated with Ilioinguinal and Iliohypogastric Nerve Block?

• Allergic reaction to the medicine.

• Harm to the nerves.

• Damage to nearby parts.

• Bleeding and bruises where the shot is given.

• Infection.

• Medicine is going into a blood vessel by mistake.

• Sometimes, the pain might not improve or worsen after the shot.

Conclusion

Ilioinguinal and iliohypogastric nerve blocks are simple procedures that can help relieve pain. These injections can diagnose and treat pain. Other treatments like RF, cold therapy, or special injections might help if the diagnostic test works, but the relief does not last. After the injections, gentle pressure can prevent bruising. Some strong treatments like alcohol or phenol injections are only used for severe cancer pain. Success depends on finding the right spot and using the right methods. These treatments can give months of relief. If the injections don't help the pain, there might be a problem with other nearby nerves. It's common to inject both nerves in one shot because they often affect similar areas.