TY - JOUR
T1 - Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Blocks for Persistent Inguinal Postherniorrhaphy Pain
T2 - A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial
AU - Bischoff, Joakim Mutahi
AU - Koscielniak-Nielsen, Zbigniew J
AU - Kehlet, Henrik
AU - Werner, Mads U
PY - 2012/6
Y1 - 2012/6
N2 - Background:Ilioinguinal and iliohypogastric nerve blocks are used in the clinical management of persistent inguinal postherniorrhaphy pain, but no controlled studies have been published on the subject. In this controlled study, we investigated the analgesic and sensory effects of ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves with lidocaine.Methods:A randomized, double-blind, placebo-controlled, crossover trial in 12 patients with severe persistent inguinal postherniorrhaphy pain, including a control group of 12 healthy controls, was performed. Assessments included pain ratings under standardized conditions with numerical rating scale (0-10), sensory mapping to a cool roller, and quantitative sensory testing (QST), in the groin regions, before and after each ultrasound-guided block. A needle approach of 1 to 2 cm superior and medial to the anterior superior iliac spine was used. Outcomes were changes in pain ratings, sensory mapping, and QST compared with preblock values. Lidocaine responders were a priori defined by a pain reduction of =80% after lidocaine block and =25% after placebo block, nonresponders by pain reduction of 25% after placebo block.Results:One of 12 pain patients was a lidocaine responder, 6 patients were nonresponders, and 5 patients were placebo responders. No consistent QST changes were observed in patients after the lidocaine block. In 10 of 12 healthy controls, a cool hypoesthesia area developed in the groin after the lidocaine block. Furthermore, QST assessments demonstrated significantly decreased suprathreshold heat pain perception in the groin after lidocaine versus placebo blocks (95% confidence interval = -3.5 to -0.5, P = 0.008).Conclusion:Ultrasound-guided lidocaine blocks of the ilioinguinal and iliohypogastric nerves, at the level of the anterior superior iliac spine, are not useful in diagnosis and management of persistent inguinal postherniorrhaphy pain.
AB - Background:Ilioinguinal and iliohypogastric nerve blocks are used in the clinical management of persistent inguinal postherniorrhaphy pain, but no controlled studies have been published on the subject. In this controlled study, we investigated the analgesic and sensory effects of ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves with lidocaine.Methods:A randomized, double-blind, placebo-controlled, crossover trial in 12 patients with severe persistent inguinal postherniorrhaphy pain, including a control group of 12 healthy controls, was performed. Assessments included pain ratings under standardized conditions with numerical rating scale (0-10), sensory mapping to a cool roller, and quantitative sensory testing (QST), in the groin regions, before and after each ultrasound-guided block. A needle approach of 1 to 2 cm superior and medial to the anterior superior iliac spine was used. Outcomes were changes in pain ratings, sensory mapping, and QST compared with preblock values. Lidocaine responders were a priori defined by a pain reduction of =80% after lidocaine block and =25% after placebo block, nonresponders by pain reduction of 25% after placebo block.Results:One of 12 pain patients was a lidocaine responder, 6 patients were nonresponders, and 5 patients were placebo responders. No consistent QST changes were observed in patients after the lidocaine block. In 10 of 12 healthy controls, a cool hypoesthesia area developed in the groin after the lidocaine block. Furthermore, QST assessments demonstrated significantly decreased suprathreshold heat pain perception in the groin after lidocaine versus placebo blocks (95% confidence interval = -3.5 to -0.5, P = 0.008).Conclusion:Ultrasound-guided lidocaine blocks of the ilioinguinal and iliohypogastric nerves, at the level of the anterior superior iliac spine, are not useful in diagnosis and management of persistent inguinal postherniorrhaphy pain.
U2 - 10.1213/ANE.0b013e31824d6168
DO - 10.1213/ANE.0b013e31824d6168
M3 - Journal article
C2 - 22467891
SN - 0003-2999
VL - 114
SP - 1323
EP - 1329
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
IS - 6
ER -