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      A clinical trial comparing ultrasound-guided ilioinguinal/iliohypogastric nerve block to transversus abdominis plane block for analgesia following open inguinal hernia repair

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          To compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair.

          Patients and methods

          This was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire.


          NRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant ( P=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, P=0.001). Postoperative opioid requirements did not differ between the two groups.


          This study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB.

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          Most cited references 18

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          Chronic postoperative pain: the case of inguinal herniorrhaphy.

           H Kehlet,  E Aasvang (2005)
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            Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study.

            The transversus abdominis plane (TAP) block is a new regional anaesthesia technique that provides analgesia after abdominal surgery. It involves injection of local anaesthetic into the plane between the transversus abdominis and the internal oblique muscles. The TAP block can be performed using a landmark technique through the lumbar triangle or with ultrasound guidance. The goal of this anatomical study with dye injection into the TAP and subsequent cadaver dissections was to establish the likely spread of local anaesthesia in vivo and the segmental nerve involvement resulting from ultrasound-guided TAP block. An ultrasound-guided injection of aniline dye into the TAP was performed for each hemi-abdominal wall of 10 unembalmed human cadavers and this was followed by dissection to determine the extent of dye spread and nerve involvement in the dye injection. After excluding one pilot specimen and one with advanced tissue decomposition, 16 hemi-abdominal walls were successfully injected and dissected. The lower thoracic nerves (T10-T12) and first lumbar nerve (L1) were found emerging from posterior to anterior between the costal margin and the iliac crest. Segmental nerves T10, T11, T12, and L1 were involved in the dye in 50%, 100%, 100%, and 93% of cases, respectively. This anatomical study shows that an ultrasound-guided TAP injection cephalad to the iliac crest is likely to involve the T10-L1 nerve roots, and implies that the technique may be limited to use in lower abdominal surgery.
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              Improving postoperative pain management: what are the unresolved issues?


                Author and article information

                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                04 January 2019
                : 12
                : 201-207
                [1 ]Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
                [2 ]Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
                [3 ]Pain Research Center, Iran University of Medical Sciences, Tehran, Iran, poupak_rah@ 123456hotmail.com
                Author notes
                Correspondence: Poupak Rahimzadeh, Pain Research Center, Iran University of Medical Sciences, Hazrat Rasul Medical Complex, Sattarkhan Ave, Tehran 1445613131, Iran, Tel +98 912 106 4483, Email poupak_rah@ 123456hotmail.com
                © 2019 Faiz et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Clinical Trial Report


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