Comparison of Ultrasound-Guided Ilioinguinal and Iliohypogastric Nerve Block with and without Tramadol for Postoperative Pain in Patients Undergoing Caesarean Delivery

Ultrasound Ilioinguinal and Iliohypogastric Nerve Block: Tramadol for Caesarean Delivery

Authors

  • Saad Salman Safir Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan
  • Muhammad Yahya Bakhtiar Khan Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan
  • Amber Ali Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan
  • Mohammad Shafiq Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan
  • Fahad Khan Department of Anesthesia, Northwest General Hospital and Research Center, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i4.3800

Keywords:

Caesarean Section, Postoperative Pain, Ropivacaine, Tramadol

Abstract

Maternal relief, early mobilization, and breastfeeding are dependent on the effective postoperative pain management following caesarean section. Objectives: To compare the analgesic effect of ultrasound-guided ilioinguinal-iliohypogastric nerve block with ropivacaine only versus ropivacaine with tramadol in patients who underwent elective cesarean delivery. Methods: A retrospective study was performed on a sample of 100 individuals, and the study was performed in two groups. Group A was given ropivacaine, and Group B was given ropivacaine and tramadol to relieve postoperative pain. Median [IQR] and mean ± SD were estimated, and comparisons between them were done by Fisher's Exact test, Mann-Whitney U-test, and independent t-test, with p≤0.05 taken as significant. Results: The combination of Ropivacaine and Tramadol gave better analgesia in patients who had a caesarean than when Ropivacaine was used. The combination group had a much longer pain-free period (20 vs. 14 hours, p=0.002), and the overall pain scores were lower (1.0 ± 0.7 vs. 1.8 ± 1.0, p=0.001). The patients needed fewer rescue analgesics, and there was no difference in opioid side effects.  Conclusions: The combination of Tramadol and Ropivacaine has a significant positive effect on postoperative analgesia in patients undergoing a caesarean section, extending pain-free periods and decreasing the intensity of pain, with minimal adverse effects, which makes it an effective and safe approach to enhancing patient comfort and satisfaction.

Author Biographies

Muhammad Yahya Bakhtiar Khan, Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan

   

Amber Ali, Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan

   

Mohammad Shafiq, Department of Anesthesia, Rehman Medical Institute, Peshawar, Pakistan

   

Fahad Khan, Department of Anesthesia, Northwest General Hospital and Research Center, Peshawar, Pakistan

   

References

Angolile CM, Max BL, Mushemba J, Mashauri HL. Global Increased Cesarean Section Rates and Public Health Implications: A Call to Action. Health Science Reports. 2023 May; 6(5): e1274. doi: 10.1002/hsr2.1274. DOI: https://doi.org/10.1002/hsr2.1274

Dowell D. CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022. Morbidity and Mortality Weekly Report. Recommendations and Reports. 2022; 71. doi: 10.15585/mmwr.rr7103a1. DOI: https://doi.org/10.15585/mmwr.rr7103a1

Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. Current Anesthesiology Reports. 2021 Mar; 11(1): 18-27. doi: 10.1007/s40140-021-00437-6. DOI: https://doi.org/10.1007/s40140-021-00437-6

Azanu WK, Osarfo J, Larsen-Reindorf RE, Agbeno EK, Dassah E, Amanfo AO et al. Assessment and Determinants of Acute Post-Caesarean Section Pain in a Tertiary Facility in Ghana. PLoS One. 2022 May; 17(5): e0268947. doi: 10.1371/journal.pone.0268947. DOI: https://doi.org/10.1371/journal.pone.0268947

Gerbershagen MU and Baagil H. Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept. Medicina. 2024 Feb; 60(3): 358. doi: 10.3390/medicina60030358. DOI: https://doi.org/10.3390/medicina60030358

Alhazmi FM, Albalawi OM, Alhazmi SA, Alanazi HA, Alenazi AM, Alrawali AG et al. Nursing Care and Management Post-Cesarean Section: Enhancing Recovery and Patient Outcomes. Gland Surgery. 2024 Dec; 9(2).

Demelash G, Berhe YW, Gebregzi AH, Chekol WB. Prevalence and Factors Associated with Postoperative Pain After Cesarean Section at a Comprehensive Specialized Hospital in Northwest Ethiopia: Prospective Observational Study. Open Access Surgery. 2022 Dec: 1-8. doi: 10.2147/OAS.S347920. DOI: https://doi.org/10.2147/OAS.S347920

Mogahed MM, Darweesh JM, Elkahwagy MS, Brnieh OM, Moharan FM, Easa WS. Ultrasound Guided Ilioinguinal, Iliohypogastric Nerve Block, Transversus Abdominis Plane Block and Quadratus Lumborum Block for Scheduled Cesarean Delivery: A Randomized Clinical Trial. Perioperative Care and Operating Room Management. 2025 Sep :100561. doi: 10.1016/j.pcorm.2025.100561. DOI: https://doi.org/10.1016/j.pcorm.2025.100561

Poojinya T, Suthiyuth P, Raksuan A, Homhuan W, Malaithong W. Comparison of Analgesic Efficacy Between Ultrasound-Guided Iliohypogastric/Ilioinguinal Nerve Block and Wound Infiltration Among Patients Undergoing Gynecologic Surgery: A Randomized Controlled Trial. Journal of Southeast Asian Medical Research. 2023 Mar; 7: e0140-. doi: 10.55374/jseamed.v7.140 DOI: https://doi.org/10.55374/jseamed.v7.140

Yang J, Zhang JW. Review of Benefits and Adverse Effects of the Most Commonly Used Local Anesthetic Adjuvants in Peripheral Nerve Blocks. Journal of Physiology & Pharmacology. 2022 Jun; 73(3). doi: 10.3390/healthcare11040498.

Janiak M, Gorniewski G, Kowalczyk R, Wasilewski P, Nowakowski P, Trzebicki J. Effect of Intramuscular Tramadol on the Duration of Clinically Relevant Sciatic Nerve Blockade in Patients Undergoing Calcaneal Fracture Fixation: A Randomized Controlled Trial. In Healthcare. 2023 Feb; 11(4): 498. doi: 10.3390/healthcare11040498. DOI: https://doi.org/10.3390/healthcare11040498

Tadesse H, Sintayhu A, Dendir G, Tila M, Habtu E, Alemu A, Alemayehu M. The Role of Adjuvants in Regional Anesthesia: The Postoperative Analgesic Effectiveness of Dexamethasone Vs. Tramadol Given as Adjuvants to Bupivacaine for Ultrasound-Guided Supraclavicular Block for Upper Extremity Surgery—A Prospective Cohort Study. Frontiers in Anesthesiology. 2024 Oct; 3: 1423919. doi: 10.3389/fanes.2024.1423919. DOI: https://doi.org/10.3389/fanes.2024.1423919

Shin HW, Ju BJ, Jang YK, You HS, Kang H, Park JY. Effect of Tramadol as an Adjuvant to Local Anesthetics for Brachial Plexus Block: A Systematic Review and Meta-Analysis. Plos One. 2017 Sep; 12(9): e0184649. doi: 10.1371/journal.pone.0184649. DOI: https://doi.org/10.1371/journal.pone.0184649

Elahwal L, Elrahwan S, Elbadry AA. Ilioinguinal and Iliohypogastric Nerve Block for Acute and Chronic Pain Relief After Caesarean Section: A Randomized Controlled Trial. Anesthesiology and Pain Medicine. 2022 Mar; 12(2): e121837. doi: 10.5812/aapm.121837. DOI: https://doi.org/10.5812/aapm.121837

Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients After Microdiscectomy? Pain Research and Management. 2022; 2022(1): 5337483. doi: 10.1155/2022/5337483. DOI: https://doi.org/10.1155/2022/5337483

Singh NP, Makkar JK, Bhatia N, Singh PM. The Analgesic Effectiveness of Ilioinguinal-Iliohypogastric Block for Caesarean Delivery: A Meta-Analysis and Trial Sequential Analysis. European Journal of Anesthesiology. 2021 Aug; 38: S87-96. doi: 10.1097/EJA.0000000000001379. DOI: https://doi.org/10.1097/EJA.0000000000001379

Shaon AH and Dey CK. A Comparative Study of Bilateral Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Analgesia in Lower Segment Cesarean Section: Bilateral Ilioinguinal and Iliohypogastric Nerve Block for Postoperative Analgesia. Journal of the Medical College for Women and Hospital. 2025 Jun; 21(1): 23-31. doi: 10.3329/jmcwh.v21i1.80073. DOI: https://doi.org/10.3329/jmcwh.v21i1.80073

Ryu C, Choi GJ, Jung YH, Baek CW, Cho CK, Kang H. Postoperative Analgesic Effectiveness of Peripheral Nerve Blocks in Cesarean Delivery: A Systematic Review and Network Meta-Analysis. Journal of Personalized Medicine. 2022 Apr; 12(4): 634. doi: 10.3390/jpm12040634. DOI: https://doi.org/10.3390/jpm12040634

Li F, Guo L, Huang Z, Lin F, Pan L. Effects of Dexmedetomidine as an Adjuvant to Ropivacaine or Ropivacaine Alone on Duration of Postoperative Analgesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Plos One. 2023 Oct; 18(10): e0287296. doi: 10.1371/journal.pone.0287296. DOI: https://doi.org/10.1371/journal.pone.0287296

Xuan C, Yan W, Wang D, Li C, Ma H, Mueller A et al. The Facilitatory Effects of Adjuvant Pharmaceutics to Prolong the Duration of Local Anesthetic for Peripheral Nerve Block: A Systematic Review and Network Meta-Analysis. Anesthesia and Analgesia. 2021 Sep; 133(3): 620-9. doi: 10.1213/ANE.0000000000005640. DOI: https://doi.org/10.1213/ANE.0000000000005640

Yetneberk T, Chekol B, Teshome D. The Efficacy of TAP Block Versus Ilioinguinal Block for Post-Cesarean Section Pain Management: A Systematic Review and Meta-Analysis. Heliyon. 2021 Aug; 7(8). doi: 10.1016/j.heliyon.2021.e07774. DOI: https://doi.org/10.1016/j.heliyon.2021.e07774

Bessmertnyj AE, Antipin EE, Uvarov DN, Sedyh SV, Nedashkovsky EV. Comparison of the Effectiveness of Ilioinguinal-Iliohypogastric Blockade and Transversus Abdominis Plane Block for Analgesia After Cesarean Section. Anesteziologiia i Reanimatologiia. 2015 Mar; 60(2): 51-4.

Downloads

Published

2026-04-30
CITATION
DOI: 10.54393/pjhs.v7i4.3800
Published: 2026-04-30

How to Cite

Safir, S. S., Khan, M. Y. B., Ali, A., Shafiq, M., & Khan, F. (2026). Comparison of Ultrasound-Guided Ilioinguinal and Iliohypogastric Nerve Block with and without Tramadol for Postoperative Pain in Patients Undergoing Caesarean Delivery: Ultrasound Ilioinguinal and Iliohypogastric Nerve Block: Tramadol for Caesarean Delivery. Pakistan Journal of Health Sciences, 7(4), 39–45. https://doi.org/10.54393/pjhs.v7i4.3800

Issue

Section

Original Article

Plaudit

Most read articles by the same author(s)