Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy

Anatoli Stav, Leonid Reytman, Michael-Yohay Stav, Anton Troitsa, Mark Kirshon, Ricardo Alfici, Mickey Dudkiewicz, Ahud Sternberg, Anatoli Stav, Leonid Reytman, Michael-Yohay Stav, Anton Troitsa, Mark Kirshon, Ricardo Alfici, Mickey Dudkiewicz, Ahud Sternberg

Abstract

Objectives: We 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.

Methods: This 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.

Results: A 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.

Conclusion: Ultrasound-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.).

Figures

Figure 1
Figure 1
CONSORT Flow Chart. *TAP group, transversus abdominis plane block group; **ILI+IHG, ilioinguinal and iliohypogastric nerve blocks group; +GFNB, genitofemoral nerve block; ++PCA, patient-controlled analgesia with morphine.

References

    1. Amid PK, Shulman AG, Lichtenstein IL. Open “tension-free” repair of inguinal hernias: the Lichtenstein technique. Eur J Surg. 1996;162:447–53.
    1. White PF, Kehlet H. Improving post-op pain management: what are the unresolved issues. Anesthesiology. 2010;112:220–5. doi: 10.1097/ALN.0b013e3181c6316e.
    1. Joshi GP, Rawal N, Kehlet H. PROSPECT collaboration. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012;99:168–85. doi: 10.1002/bjs.7660.
    1. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17:131–57. doi: 10.1016/j.jpain.2015.12.008.
    1. Tran TM, Ivanusic JJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth. 2009;102:123–7. doi: 10.1093/bja/aen344.
    1. Mukhtar K. Transversus abdominis plane (TAP) block. [accessed July 17, 2016];Journal of the New York School of Regional Anesthesia. 2009 12:28–33. Available at: .
    1. Jankovic Z. Transversus abdominis plane block: the holy grail of anaesthesia for (lower) abdominal surgery. Period Biol. 2009;111:203–8.
    1. Aveline C, Le Hetet H, Le Roux A, 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;106:380–6. doi: 10.1093/bja/aeq363.
    1. Fredrickson MJ, Paine C, Hamill J. Improved analgesia with the ilioinguinal block compared to the transversus abdominis plane block after pediatric inguinal surgery: a prospective randomized trial. Pediatr Anesth. 2010;20:1022–7. doi: 10.1111/j.1460-9592.2010.03432.x.
    1. Wang Y, Wu T, Terry MJ, et al. Improved perioperative analgesia with ultrasound-guided ilioinguinal/iliohypogastric nerve or transversus abdominis plane block for open inguinal surgery: a systematic review and meta-analysis of randomized controlled trials. J Phys Ther Sci. 2016;28:1055–60. doi: 10.1589/jpts.28.1055.
    1. Willschke H, Marhofer P, Bösenberg A, et al. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005;95:226–30. doi: 10.1093/bja/aei157.
    1. Nan Y, Zhou J, Ma Q, Li T, Lian QQ, Li J. [Application of ultrasound guidance for ilioinguinal or iliohypogastric nerve block in pediatric inguinal surgery]. Zhonghua Yi Xue Za Zhi. 2012;92:873–7. [Article in Chinese, Abstract in English]
    1. Demirci A, Efe EM, Türker G, et al. [Iliohypogastric/ilioinguinal nerve block in inguinal hernia repair for postoperative pain management: comparison of the anatomical landmark and ultrasound guided techniques]. Rev Bras Anestesiol. 2014;64:350–6. [Article in Portuguese, Abstract in English]
    1. Moore DC. Block of the Inguinal Region. In: Moore DC, editor. Regional Block. 4th ed. Springfield, IL: Charles C Thomas; 1981. pp. 167–73.
    1. Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H. Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children. Br J Anaesth. 2005;94:243–6. doi: 10.1093/bja/aei031.
    1. Hadzic A. Common Ultrasound-Guided Truncal and Cutaneous Blocks. In: Hadzic A, editor. Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia. 2nd ed. New York: McGraw-Hill Companies, Inc.; 2012. pp. 459–65.
    1. Liu WC, Chen TH, Shyu JF, et al. Applied anatomy of the genital branch of the genitofemoral nerve in open inguinal herniorrhaphy. Eur J Surg. 2002;168:145–9. doi: 10.1080/110241502320127748.
    1. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13:227–36. doi: 10.1002/nur.4770130405.
    1. Suehiro K, Okutai R. Duration of cerebral desaturation time during single-lung ventilation correlates with mini mental state examination score. J Anesth. 2011;25:345–9. doi: 10.1007/s00540-011-1136-1.
    1. Chung IS, Sim WS, Kim GS, et al. Nurses’ assessment of postoperative pain: can it be alternative to patients’ self-report? J Korean Med Sci. 2001;16:784–8. doi: 10.3346/jkms.2001.16.6.784.
    1. Aubrun F, Monsel S, Langeron O, Coriat P, Riou B. Postoperative titration of intravenous morphine. Eur J Anaesthesiol. 2001;18:159–65. doi: 10.1097/00003643-200103000-00004.
    1. Birnbaum A, Esses D, Bijur PE, Holden L, Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49:445–53. doi: 10.1016/j.annemergmed.2006.06.030.
    1. Callesen T, Bech K, Nielsen R, et al. Pain after groin hernia repair. Br J Surg. 1998;85:1412–14. doi: 10.1046/j.1365-2168.1998.00864.x.
    1. Callesen T, Bech K, Andersen J, Nielsen R, Roikjaer O, Kehlet H. Pain after primary inguinal herniorrhaphy: influence of surgical technique. J Am Coll Surg. 1999;188:355–9. doi: 10.1016/S1072-7515(98)00316-0.
    1. Asad N, Afzal F, Khawar AA, Hanif AA, Saleem H, Hussain SM. Genitofemoral nerve block and intraoperative analgesia in children during inguinal hernia repair. Biomedica. 2009;25:146–9.
    1. McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: a prospective randomized controlled trial. Anesth Analg. 2007;104:193–7. doi: 10.1213/01.ane.0000250223.49963.0f.
    1. Klaassen Z, Marshall E, Tubbs RS, Louis RG, Wartmann CT, Loukas M. Anatomy of the ilioinguinal and iliohypogastric nerves with observations of their spinal nerve contributions. Clin Anat. 2011;24:454–61. doi: 10.1002/ca.21098.

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