The effects of ilioinguinal nerve block on acute and chronic neuropathic pain in patients following inguinal hernia repair with spinal anesthesia: A prospective cohort study

Abstract

Background/Aim: Post-surgical pain is a major factor affecting the quality of life of patients. This study aims to investigate the effectiveness of ilioinguinal block on acute and chronic neuropathic pain after inguinal hernia surgery with spinal anesthesia. Methods: This prospective cohort study included sixty ASA I-III patients aged 18-65 years, who underwent a unilateral inguinal hernia operation. The patients were divided into two groups: Those who received spinal block only (Group 1, n=30), and those who received spinal and ultrasound-guided ilioinguinal nerve block (Group 2, n=30). The perioperative and postoperative complications, Visual Analogue Scale (VAS) scores on rest and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores at the postoperative 2nd, 6th, 12th, and 24th hours, and in the 3rd and 6th months were noted. Results: No significant difference was observed in the time of first analgesic administration among the groups, but tramadol use significantly reduced in Group 2 (P=0.019). Time until mobilization and discharge was significantly shorter among the Group 2 patients (P<0.001, P=0.021, respectively). Visual Analogue Scale scores at rest at the 12th and 24th hours, and in the 3rd and 6th months were significantly less in Group 2 (P=0.032, P=0.005, P=0.022, P=0.008, respectively). Leeds Assessment of Neuropathic Symptoms and Signs scores of the patients at the 24th hour, 3rd, and 6th months were significantly lower in Group 2 (P<0.001, P<0.001, P=0.012, respectively). Conclusion: We think that ilioinguinal nerve block with spinal anesthesia is a successful and reliable technique for acute postoperative and chronic neuropathic pain management in unilateral inguinal hernia repair.

Keywords

• Inguinal hernia
• Spinal anesthesia
• Ilioinguinal nerve block
• Chronic pain
• Neuropathic pain

References

1. 1. Kurmann A, Fischer H, Dell-Kuster S, Rosenthal R, Audigé L, Schüpfer G, et al. Effect of intraoperative infiltration with local anesthesia on the development of chronic pain after inguinal hernia repair: a randomized, triple-blinded, placebo-controlled trial. Surgery. 2015;157(1):144-54.
2. 2. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95:69–76.
3. 3. Aasvang EK, Brandsborg B, Christensen B, Jensen TS, Kehlet H. Neurophysiological characterization of postherniotomy pain. Pain 2008;137:173–81.
4. 4. Macrae W. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77-86.
5. 5. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet. 2006;367(9522):1618-25.
6. 6. Toivonen J, Permi J, Rosenberg PH. Effect of preincisional ilioinguinal and iliohypogastric nerve block on postoperative analgesic requirement in day-surgery patients undergoing herniorrhaphy under spinal anaesthesia. Acta Anaesthesiol Scand. 2001;45:603–7.
7. 7. Gierman L, van der Ham F, Koudijs A, Wielinga P, Kleemann R, Kooistra T, et al. Metabolic stress–induced inflammation plays a major role in the development of osteoarthritis in mice. Arthritis Rheum. 2012;64(4):1172-81.
8. 8. Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073–93.

9. 9. Bennett M. The LANSS Pain Scale: Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92:147-57.
10. 10. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, et al. Predictive risk factors for persistent postherniotomy pain. The Journal of the American Society of Anesthesiologists. 2010;112(4):957-69.
11. 11. Massaron S, Bona S, Fumagalli U, Battafarano F, Elmore U, Rosati R. Analysis of post-surgical pain after inguinal hernia repair: a prospective study. Hernia. 2007;11(6):517-25.
12. 12. Kamal K, Jain P, Bansal T, Ahlawat G. A comparative study to evaluate ultrasound-guided transversus abdominis plane block versus ilioinguinal iliohypogastric nerve block for post-operative analgesia in adult patients undergoing inguinal hernia repair. Indian J Anaesth. 2018;62(4):292-7.
13. 13. Okur O, Tekgul ZT, Erkan N. Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: a prospective randomized controlled open-label study. J Anesth. 2017;31(5):678-85.
14. 14. Gürkan I, Ütebey G, Özlü O. Comparison of ilioinguinal iliohypogastric nerve block versus spinal anesthesia techniques for single sided inguinal herniorrhaphy. Pain. 2013;25:108-14.
15. 15. Toivonen J, Permi J, Rosenberg P. Analgesia and discharge following preincisional ilioinguinal and iliohypogastric nerve block combined with general or spinal anaesthesia for inguinal herniorrhaphy. Acta Anaesthesiol Scand. 2004;48(4):480-5.
16. 16. Yilmazlar A, Bilgel H, Donmez C, Guney A, Yilmazlar T, Tokat O. Comparison of ilioinguinal-iliohypogastric nerve block versus spinal anesthesia for inguinal herniorrhaphy. South Med J. 2006;99(1):48-52.
17. 17. Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, et al. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011;106(3):380-6.
18. 18. Faiz SHR, Nader ND, Niknejadi S, Davari-Farid S, Hobika GG, Rahimzadeh P. A clinical trial comparing ultrasound-guided ilioinguinal/iliohypogastric nerve block to transversus abdominis plane block for analgesia following open inguinal hernia repair. J Pain Res. 2019;12:201.
19. 19. Hosalli V, Ayyanagouda B, Hiremath P, Ambi U, Hulkund S. Comparative efficacy of postoperative analgesia between ultrasound-guided dual transversus abdominis plane and Ilioinguinal/Iliohypogastric nerve blocks for open inguinal hernia repair: An open label prospective randomized comparative clinical trial. Indian J Anaesth. 2019;63(6):450.
20. 20. Santos GdC, Braga GM, Queiroz FL, Navarro TP, Gomez RS. Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study. Rev Assoc Med Bras. 2011;57(5):545-9.
21. 21. Sakalli M, Ceyhan A, Uysal HY, Yazici I, Başar H. The efficacy of ilioinguinal and iliohypogastric nerve block for postoperative pain after caesarean section. J Res Med. Sci 2010;15(1):6-13.