Journal of Anesthesia

, Volume 31, Issue 5, pp 678–685 | Cite as

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

Original Article
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Accepted:

Abstract

Purposes

The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain.

Methods

This was a prospective randomized controlled open-label study. After approval of the Research Ethics Board, a total of 90 patients were allocated to three groups of 30 by simple randomized sampling as determined with a priori power analysis. Peripheral nerve blocks (TAP block or IHINB) were administered to patients following subarachnoid block according to their allocated group. Patient pain scores, additional analgesic requirements and complication rates were recorded periodically and compared.

Results

Pain scores were significantly lower in the study groups (p < 0.001, p < 0.001, p < 0.001, p = 0.002, p < 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h and at 1 and 6 months, respectively). First pain declaration times were significantly longer in the study groups (TAP block group [GT] 266.6 ± 119.7 min; IHINB group [GI] 247.2 ± 128.7 min; and control group [GC] 79.1 ± 66.2 min; p < 0.001). At 24 h, the numeric rating scale scores of GT were significantly lower than GI (p = 0.048). Additional analgesic requirements of GT and GI patients were found to be significantly lower than GC patients (p = 0.001, p < 0.001, p = 0.006, p = 0.002, p = 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h, respectively).

Conclusion

We conclude that administration of TAP block or IHINB for patients undergoing inguinal herniorrhaphy reduces the intensity of both acute and chronic postoperative pain and additional analgesic requirements.

Keywords

Transversus abdominis plane block Iliohypogastric/ilioinguinal nerve block Postoperative pain Inguinal herniorrhaphy 
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Notes

Compliance with ethical standards

Conflict of interest

No conflict of interest.

References

  1. 1.
    Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Benzon H, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW. Practical management of pain. Philadelphia: Elsevier Health Sciences; 2014.Google Scholar
  3. 3.
    Dolin S, Cashman J, Bland J. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3):409–23.CrossRefPubMedGoogle Scholar
  4. 4.
    Sommer M, de Rijke JM, Van Kleef M, Kessels AG, Peters ML, Geurts JW, Gramke HF, Marcus MA. The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol. 2008;25(04):267–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery: expert consult premium edition: enhanced online features. Philadelphia: Elsevier Health Sciences; 2012.Google Scholar
  6. 6.
    Wu CL, Fleisher LA. Outcomes research in regional anesthesia and analgesia. Anesth Analg. 2000;91(5):1232–42.PubMedGoogle Scholar
  7. 7.
    Buvanendran A, Lubenow TR, Kroin JS. Postoperative pain and its management. In: McMahon SB, Koltzenburg M, Tracey I, Turk D, editors. Wall and Melzack’s textbook of pain. 6th ed. Philadelphia: Saunders; 2013. p. 629–45.Google Scholar
  8. 8.
    Netter FH. Atlas of human anatomy. Philadelphia: Elsevier Health Sciences; 2014.Google Scholar
  9. 9.
    Brown DL. Atlas of regional anesthesia. Philadelphia: Elsevier Health Sciences; 2010.Google Scholar
  10. 10.
    Rafi A. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Freir NM, Murphy C, Mugawar M, Linnane A, Cunningham AJ. Transversus abdominis plane block for analgesia in renal transplantation: a randomized controlled trial. Anesth Analg. 2012;115(4):953–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Gasanova I, Alexander J, Ogunnaike B, Hamid C, Rogers D, Minhajuddin A, Joshi GP. Transversus abdominis plane block versus surgical site infiltration for pain management after open total abdominal hysterectomy. Anesth Analg. 2015;121(5):1383–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Bharti N, Kumar P, Bala I, Gupta V. The efficacy of a novel approach to transversus abdominis plane block for postoperative analgesia after colorectal surgery. Anesth Analg. 2011;112(6):1504–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008;107(6):2056–60.CrossRefPubMedGoogle Scholar
  15. 15.
    Ganta R, Samra S, Maddineni V, Furness G. Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after caesarean section. Br J Anaesth. 1994;72(2):229–30.CrossRefPubMedGoogle Scholar
  16. 16.
    Demirci AEE, Türker G, Gurbet A, Kaya FN, Anil A, Çimen I. 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(5):350–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Findlow D, Aldridge L, Doyle E. Comparison of caudal block using bupivacaine and ketamine with ilioinguinal nerve block for orchidopexy in children. Anaesthesia. 1997;52(11):1110–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Evaluation ASoATFoP. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2002;96(2):485.CrossRefGoogle Scholar
  19. 19.
    Tran TMNIJ, Hebbard P, Barrington MJ. Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth. 2009;102(1):123–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102(1):248–57.CrossRefPubMedGoogle Scholar
  21. 21.
    Fowler S, Symons J, Sabato S, Myles P. Epidural analgesia compared with peripheral nerve blockade after major knee surgery: a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2008;100(2):154–64.CrossRefPubMedGoogle Scholar
  22. 22.
    Simons M, Aufenacker T, Bay-Nielsen M, Bouillot J, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343–403.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Aveline C, Le Hetet H, Le Roux A, Vautier P, Cognet F, Vinet E, Tison C, Bonnet F. 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.CrossRefPubMedGoogle Scholar
  24. 24.
    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(11):1022–7.CrossRefGoogle Scholar
  25. 25.
    Stav A, Reytman L, Stav MY, Troitsa A, Kirshon M, Alfici R, Dudkiewicz M, Sternberg A. Transversus abdominis plane versus ilioinguinal and iliohypogastric nerve blocks for analgesia following open inguinal herniorrhaphy. Rambam Maimonides Med J. 2016;7(3):e0021.CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Wang Y, Wu T, Terry MJ, Eldrige JS, Tong Q, Erwin PJ, Wang Z, Qu W. 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 Therapy Sci. 2016;28(3):1055–60.CrossRefGoogle Scholar
  27. 27.
    Mwaka G, Thrikra S, Ma V. The prevalence of postoperative pain in the first 48 hours following day surgery at a tertiary hospital in Nairobi. Afr Health Sci. 2013;13(3):768–76.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Oh J, Pagé GM, Zhong T, McCluskey S, Srinivas C, O’Neill AC, Kahn J, Katz J, Hofer SO, Clarke H. Chronic postsurgical pain outcomes in breast reconstruction patients receiving perioperative transversus abdominis plane catheters at the donor site: a prospective cohort follow-up study. Pain Pract. 2017;. doi: 10.1111/papr.12550.PubMedGoogle Scholar
  29. 29.
    Jankovic Z, Ahmad N, Ravishankar N, Archer F. Transversus abdominis plane block: how safe is it? Anesth Analg. 2008;107(5):1758–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Farooq M, Carey M. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain Med. 2008;33(3):274–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Amory C, Mariscal A, Guyot E, Chauvet P, Leon A, Poli-Merol M. Is Ilioinguinal/iliohypogastric nerve block always totally safe in children? Pediatr Anesth. 2003;13(2):164–6.CrossRefGoogle Scholar
  32. 32.
    Johr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg. 1999;88(5):1051–2.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2017

Authors and Affiliations

  1. 1.Department of Anesthesiology and ReanimationIzmir Bozyaka Training and Research HospitalIzmirTurkey
  2. 2.Department of General SurgeryIzmir Bozyaka Training and Research HospitalIzmirTurkey

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