Preliminary study of ultrasound-guided ilioinguinal-iliohypogastric nerve block in performing low ligation of the spermatic vein.

Background: Varicocele is the most prevalent condition in andrology. Current microscopic surgical techniques have demonstrated precise efficacy and are associated with numerous advantages. However, anesthesia protocols vary considerably across institutions, and achieving rapid recovery has become a major focus of research. Precision nerve block anesthesia represents a growing trend in the evolution of anesthetic techniques for varicocele surgery. The application of ultrasound (US)-guided ilioinguinal and iliohypogastric nerve blocks during low ligation of the spermatic vein, along with innovative anesthetic strategies, facilitates the performance of this procedure as ambulatory surgery-marking a novel advancement in the field. This paper aimed to evaluate the safety, convenience and efficacy of US-guided ilioinguinal-iliohypogastric nerve block (ILNB) in performing low ligation of the spermatic vein, and the novel anesthetic approach for low ligation of the spermatic vein as an ambulatory surgery was introduced. Methods: Sixty-nine patients diagnosed with varicocele were enrolled in this study from March 2021 to August 2021, and all patients underwent low ligation of the spermatic vein. The patients were randomly divided into the conventional anesthesia group (CA: spinal anesthesia) or ILNB group. The ILNB group underwent real-time US guidance to examine the area around the ilioinguinal nerve (deep iliac circumflex artery) and the transverse abdominal muscle plane. When the effects of anesthesia were insufficient, sufentanil was administered intravenously as a supplementary anaesthesia. All surgeries were performed under a microscope by the same surgical group. The demographic characteristics, visual analogue scale (VAS) scores, recovery speed (duration until discharge postoperative period), postoperative adverse events, and medical costs in each group were recorded. Results: Twenty-one patients received conventional anesthesia, while Forty-eight patients received the novel anesthesia method. There was no significant difference in demographic characteristics between the two groups. All patients achieved full recovery, and no postoperative adverse events, including bleeding, haematoma, or surgical site infection, were observed in any of the groups. Compared with those in the CA group, patients in the ILNB group had comparable postsurgical VAS scores, and the hospital expenses were lower. Conclusions: Patients in the ILNB group under US guidance were successfully anesthetized according to the requirements for undergoing microscopic low ligation during varicocele surgery. This novel method was proven to be both safe and effective and merits widespread application. US-guided ILNB for low ligation of the spermatic vein was considered "ambulatory surgery". Compared with previous "ambulatory surgeries" under spinal anesthesia, the length of hospital stay was shorter for patients undergoing low ligation of the spermatic vein under ILNB: it was also safe and reliable and more precise, and the cost was lower. In addition to the advantages of significantly lower medical costs, this approach can shorten the hospitalization duration and save medical resources.