الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Chronic pain, affecting daily activities, is observed in 5% to 10% of patients after inguinal hernia repair. Injury to ilioinguinal, iliohypogastric, or genitofemoral nerves is considered to be concerned in the development of chronic post-herniorrhaphy pain.
A promising treatment choice for this circumstance is reoperation with neurectomy of 1 or more of the inguinal nerves, with or without simultaneous mesh removal which has verified pain relief and improvement in functional ability in 60% to 80% of patients.
Ilioinguinal and iliohypogastric diagnostic nerve block may additionally detect which patients will benefit from neurectomy and in some studies, they have been used preoperatively. Moreover, inguinal nerve block has been used in the treatment of chronic inguinal pain and permanent pain relief has been reported.
On the other hand, none of these studies were the block performed placebo controlled and the methods used were not adequately described. Currently, the paucity of well-designed controlled nerve block researches in patients with chronic pain has been emphasized.
In the current study, we aimed to evaluate the effect of pre-emptive analgesia in the form of ilioinguinal and iliohypogastric nerve block alone or with Lidocaine (5%) patch on acute and chronic post herniorraphy pain and patient satisfaction on 60 cases divided into two groups.
group (I): Ultrasound guided ilioinguinal and iliohypogastric nerve block.
group (II): Ultrasound guided ilioinguinal and iliohypogastric nerve block with Lidocaine (5%) patch for the first 24 hours post-operative.
Result:
- In the current study, we found that there were insignificant differences between the two groups regarding demographic data and basic data (surgical duration and technique of surgery).
- In the current study, we found that there were insignificant differences between two the groups as regard intraoperative and postoperative data (total fentanyl, number of patients received nalbuphine, dose of nalbuphine and first time to rescue analgesia).
- In the current study, we found that there were insignificant differences between the two groups as regard heart rate and mean arterial blood pressure all over the period of follow-up.
- In the current study, we found that there were insignificant differences between the two groups as regard patients’ satisfaction.
Summary, Conclusion & Recommendation
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- In the current study, we found that there were insignificant differences between the two groups as regard postoperative VAS at rest and during movement with p-value >0.05.
- In the current study, we found that there were significant differences between the two groups as regard DN4 as it was higher in group I with p-value <0.001.
- In the current study, we found that there were significant differences between the two groups where it was better in group II when compared to group I as regard BPI after 1, 3 and 6 months postoperative.
6.2. Conclusion
US-guided ilioinguinal and iliohypogastric nerve block provides good analgesia for pain following unilateral uncomplicated inguinal hernia repair surgeries. Addition of Lidocaine (5%) patch enhances patient acceptability and chronic pain outcome
6.3. Recommendations
-We recommend to:
- Study the use of US-guided ilioinguinal and iliohypogastric nerve block in comparison to control group to establish its role in postoperative herniorraphy pain.
- Study the application of up to 3 Lidocaine (5%) patches to establish its tolerability, safety and efficacy in chronic pain relief.
- Do future controlled trials with ultrasound guided nerve block to establish the role of the ilioinguinal, iliohypogastric, and genitofemoral nerves in the underlying pathophysiology of inguinal post- herniorrhaphy pain.