Korean J Pain.  2024 Oct;37(4):332-342. 10.3344/kjp.24172.

Effect of ultrasound-guided ilioinguinaliliohypogastric nerve block on chronic pain in patients undergoing open inguinal hernia surgery under spinal anesthesia: a randomized doubleblind study

• Sahoo RK
• Pradhan A
• Samanta P
• Senapati LK
• Satapathy GC

• KMID: 2559695
• DOI: http://doi.org/10.3344/kjp.24172

Abstract

Background
Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia.
Methods
Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests.
Results
The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of –8.43 mg (95% CI –10.54, –6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180–360]) versus (180 min [180–360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups.
Conclusions
Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months.

Keyword

Analgesia; Anesthesia; Spinal; Chronic Pain; Hernia; Inguinal; Nerve Block

Figure

• 

  Fig. 1 CONSORT (Consolidated Standards of Reporting Trials) flow diagram for enrolment, group allocation, follow-up, and analysis. GA: general anesthesia, II/IH: ilioingional iliohypogastric, NRS: numerical rating scale, DN4: Douleur neuropathique 4 questions.

• 

  Fig. 2 Scanning technique for iliohypogastric-ilioinguinal nerve block. (A) The figure shows the sono-anatomy of the block with ilioinguinal/iliohypogastric nerves (the white arrow indicates the fascial plane between IO and TA where the nerves typically travel). (B) The figure shows the local anesthetic (LA) spread around the nerves (marked with a white arrow). ASIS: anterior superior iliac spine, EO: external oblique, IO: internal oblique, TA: transverse abdominis.

• 

  Fig. 3 Numerical rating scale (NRS) pain scores at movement (NRS-M). Values represent the means and standard deviations. Group A: ilioinguinal iliohypogastric nerve block with ropivacaine, Group B: ilioinguinal iliohypogastric nerve block with normal saline.

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