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Ilioinguinal-Iliohypogastric Nerve Block
Rafael Vazquez, MD; Nicole Z. Spence, MD
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KEY FACTS

  • Terminology

    • Preprocedure

      • Procedure

        • Post Procedure

          • Outcomes

            TERMINOLOGY

            • Abbreviations

              • Ilioinguinal nerve (II-N)
              • Iliohypogastric nerve (IH-N)
              • External oblique muscle (EOM)
              • Internal oblique muscle (IOM)
              • Transversus abdominis muscle (TAM)
              • Transversus abdominis plane (TAP)
              • Anterior superior iliac spine (ASIS)
              • Iliac crest (IC)
            • Synonyms

              • Ilioinguinal-Iliohypogastric nerve block
            • Definitions

              • IH-N and II-N arise from anterior division of ventral rami of T12-L1 and L1, respectively
                • Pierce psoas muscle medially and emerge from its lateral border
                • They travel anterior to quadratus lumborum (QL) muscle, deep to transversalis fascia, then in deep aspect of TAM
                  • IH-N is larger and located cephalad to II-N as they course abdominal wall
              • Both nerves pierce TAM posterior to anterior IC (ASIS) to enter TAP
              • TAP is fascial plane between TAM and IOM
                • TAP blocks can block these nerves
                • Ascending branch of deep circumflex iliac artery travels in this plane and is used as landmark for plane
              • II-N and IH-N provide sensory innervation to skin of lower abdominal wall, upper hip, and upper thigh
                • Note: Fascial plane between TAM and transversalis fascia is in continuity with space around femoral nerve (FN)

            PREPROCEDURE

            • Indications

              • Contraindications

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Expected Outcome

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      Selected References

                                      1. Bhatia N et al: Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: a prospective, randomised trial. Anaesth Crit Care Pain Med. 38(1):41-5, 2019
                                      2. Lee KS et al: Ultrasound-guided microwave ablation for the management of inguinal neuralgia: a preliminary study with 1-year follow-up. J Vasc Interv Radiol. 30(2):242-8, 2019
                                      3. Choudhary J et al: Transversalis fascia plane block for the treatment of chronic postherniorrhaphy inguinal pain: a case report. A A Pract. 11(3):57-9, 2018
                                      4. Kale A et al: Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia. Turk Neurosurg. 29(4):530-237, 2018
                                      5. Chin KJ et al: Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med. 42(2):133-83, 2017
                                      6. Abrahams M et al: Update on ultrasound for truncal blocks: a review of the evidence. Reg Anesth Pain Med. 41(2):275-88, 2016
                                      7. Wadhwa V et al: CT-guided perineural injections for chronic pelvic pain. Radiographics. 36(5):1408-25, 2016
                                      8. Tagliafico A et al: Anatomical study of the iliohypogastric, ilioinguinal, and genitofemoral nerves using high-resolution ultrasound. Muscle Nerve. 51(1):42-8, 2015
                                      9. Klaassen Z et al: Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. 24(4):454-61, 2011
                                      10. Ndiaye A et al: Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections). Surg Radiol Anat. 32(1):55-62, 2010
                                      11. Eichenberger U et al: Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection. Br J Anaesth. 97(2):238-43, 2006
                                      12. Bell EA et al: Iliohypogastric-ilioinguinal peripheral nerve block for post-cesarean delivery analgesia decreases morphine use but not opioid-related side effects. Can J Anaesth. 49(7):694-700, 2002
                                      13. Vaisman J: Pelvic hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg. 92(4):1048-9, 2001
                                      14. Jöhr M et al: Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg. 88(5):1051-2, 1999
                                      15. Reed RA et al: Effect of chain unsaturation on the structure and thermotropic properties of galactocerebrosides. Biophys J. 55(2):281-92, 1989
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Preprocedure

                                          • Procedure

                                            • Post Procedure

                                              • Outcomes

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Ilioinguinal nerve (II-N)
                                                  • Iliohypogastric nerve (IH-N)
                                                  • External oblique muscle (EOM)
                                                  • Internal oblique muscle (IOM)
                                                  • Transversus abdominis muscle (TAM)
                                                  • Transversus abdominis plane (TAP)
                                                  • Anterior superior iliac spine (ASIS)
                                                  • Iliac crest (IC)
                                                • Synonyms

                                                  • Ilioinguinal-Iliohypogastric nerve block
                                                • Definitions

                                                  • IH-N and II-N arise from anterior division of ventral rami of T12-L1 and L1, respectively
                                                    • Pierce psoas muscle medially and emerge from its lateral border
                                                    • They travel anterior to quadratus lumborum (QL) muscle, deep to transversalis fascia, then in deep aspect of TAM
                                                      • IH-N is larger and located cephalad to II-N as they course abdominal wall
                                                  • Both nerves pierce TAM posterior to anterior IC (ASIS) to enter TAP
                                                  • TAP is fascial plane between TAM and IOM
                                                    • TAP blocks can block these nerves
                                                    • Ascending branch of deep circumflex iliac artery travels in this plane and is used as landmark for plane
                                                  • II-N and IH-N provide sensory innervation to skin of lower abdominal wall, upper hip, and upper thigh
                                                    • Note: Fascial plane between TAM and transversalis fascia is in continuity with space around femoral nerve (FN)

                                                PREPROCEDURE

                                                • Indications

                                                  • Contraindications

                                                    • Getting Started

                                                      PROCEDURE

                                                      • Patient Position/Location

                                                        • Equipment Preparation

                                                          • Procedure Steps

                                                            • Findings and Reporting

                                                              • Alternative Procedures/Therapies

                                                                POST PROCEDURE

                                                                • Expected Outcome

                                                                  • Things to Do

                                                                    • Things to Avoid

                                                                      OUTCOMES

                                                                      • Problems

                                                                        • Complications

                                                                          Selected References

                                                                          1. Bhatia N et al: Postoperative analgesic efficacy of ultrasound-guided ilioinguinal-iliohypogastric nerve block compared with medial transverse abdominis plane block in inguinal hernia repair: a prospective, randomised trial. Anaesth Crit Care Pain Med. 38(1):41-5, 2019
                                                                          2. Lee KS et al: Ultrasound-guided microwave ablation for the management of inguinal neuralgia: a preliminary study with 1-year follow-up. J Vasc Interv Radiol. 30(2):242-8, 2019
                                                                          3. Choudhary J et al: Transversalis fascia plane block for the treatment of chronic postherniorrhaphy inguinal pain: a case report. A A Pract. 11(3):57-9, 2018
                                                                          4. Kale A et al: Selective spinal nerve block in ilioinguinal, iliohypogastric and genitofemoral neuralgia. Turk Neurosurg. 29(4):530-237, 2018
                                                                          5. Chin KJ et al: Essentials of our current understanding: abdominal wall blocks. Reg Anesth Pain Med. 42(2):133-83, 2017
                                                                          6. Abrahams M et al: Update on ultrasound for truncal blocks: a review of the evidence. Reg Anesth Pain Med. 41(2):275-88, 2016
                                                                          7. Wadhwa V et al: CT-guided perineural injections for chronic pelvic pain. Radiographics. 36(5):1408-25, 2016
                                                                          8. Tagliafico A et al: Anatomical study of the iliohypogastric, ilioinguinal, and genitofemoral nerves using high-resolution ultrasound. Muscle Nerve. 51(1):42-8, 2015
                                                                          9. Klaassen Z et al: Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. 24(4):454-61, 2011
                                                                          10. Ndiaye A et al: Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections). Surg Radiol Anat. 32(1):55-62, 2010
                                                                          11. Eichenberger U et al: Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection. Br J Anaesth. 97(2):238-43, 2006
                                                                          12. Bell EA et al: Iliohypogastric-ilioinguinal peripheral nerve block for post-cesarean delivery analgesia decreases morphine use but not opioid-related side effects. Can J Anaesth. 49(7):694-700, 2002
                                                                          13. Vaisman J: Pelvic hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg. 92(4):1048-9, 2001
                                                                          14. Jöhr M et al: Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg. 88(5):1051-2, 1999
                                                                          15. Reed RA et al: Effect of chain unsaturation on the structure and thermotropic properties of galactocerebrosides. Biophys J. 55(2):281-92, 1989