Abstract
ObjectivesWe hypothesized that preoperative (pre-op) ultrasound (US)-guided posterior transversus abdominis plane block (TAP) and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG) will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately.MethodsThis is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups.ResultsA total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two “block” groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each “block” group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar.ConclusionUltrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.)
Highlights
The Lichtenstein patch tension-free method of open inguinal hernia repair[1] is commonly used under general anesthesia with the facilitation of ilioinguinal and iliohypogastric nerve blocks (ILI+IHG) to improve postoperative analgesia.[2]The PROSPECT Working Group published a procedure-specific review and guideline for analgesia following inguinal hernia repair in 2012, in which ILI+IHG were strongly recommended preoperatively and during surgery.[3]
According to the new guideline published in February 2016, the use of peripheral regional anesthetic techniques is strongly recommended as a component of multimodal analgesia for pain management following open inguinal hernia repair.[4]
Wang et al conducted a meta-analysis to evaluate the clinical efficacy of US-guided ILI+IHG and USguided transversus abdominis plane block (TAP) for perioperative analgesia in patients undergoing open inguinal surgery; only four articles were included in the meta-analysis:[10] two randomized controlled trials were performed in pediatric patients,[11,12] and two trials were conducted in adults.[8,13]
Summary
The Lichtenstein patch tension-free method of open inguinal hernia repair[1] is commonly used under general anesthesia with the facilitation of ilioinguinal and iliohypogastric nerve blocks (ILI+IHG) to improve postoperative (post-op) analgesia.[2]The PROSPECT Working Group (http://www. postoppain.org/working-group/) published a procedure-specific review and guideline for analgesia following inguinal hernia repair in 2012, in which ILI+IHG were strongly recommended preoperatively (pre-op) and during surgery (grade A recommendation based on randomized clinical trials).[3]. The Lichtenstein patch tension-free method of open inguinal hernia repair[1] is commonly used under general anesthesia with the facilitation of ilioinguinal and iliohypogastric nerve blocks (ILI+IHG) to improve postoperative (post-op) analgesia.[2]. Postoppain.org/working-group/) published a procedure-specific review and guideline for analgesia following inguinal hernia repair in 2012, in which ILI+IHG were strongly recommended preoperatively (pre-op) and during surgery (grade A recommendation based on randomized clinical trials).[3] According to the new guideline published in February 2016, the use of peripheral regional anesthetic techniques is strongly recommended as a component of multimodal analgesia for pain management following open inguinal hernia repair.[4]. Wang et al conducted a meta-analysis to evaluate the clinical efficacy of US-guided ILI+IHG and USguided TAP for perioperative analgesia in patients undergoing open inguinal surgery; only four articles were included in the meta-analysis:[10] two randomized controlled trials were performed in pediatric patients,[11,12] and two trials were conducted in adults.[8,13] The authors concluded that US-guided ILI+IHG or TAP is associated with improved perioperative analgesia compared with the landmarkbased technique
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