Review of Ilioinguinal Nerve Blocks for Ilioinguinal Neuralgia Post Hernia Surgery
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ANESTHETIC TECHNIQUES IN PAIN MANAGEMENT (D WANG, SECTION EDITOR)
Review of Ilioinguinal Nerve Blocks for Ilioinguinal Neuralgia Post Hernia Surgery Andrew K. Wong 1 & Andrew T. Ng 1 Accepted: 20 November 2020 # The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2020
Abstract Purpose of Review The purpose of this review is to evaluate the current evidence on ultrasound-guided ilioinguinal nerve blocks for ilioinguinal neuralgia post hernia surgery. Methods A literature search was performed to find all relevant case reports, case series, prospective or retrospective cohort studies, and randomized controlled trials (RCTs) where ultrasound-guided or landmark-based ilioinguinal nerve blocks were used for ilioinguinal neuralgia post-inguinal hernia surgery. Recent Findings A total of six studies were identified with suitable data for inclusion. Three studies were retrospective, two studies were prospective, and one study was a randomized controlled trial. A total of 133 subjects were enrolled across these studies. Approximately 55–70% had a beneficial analgesic response to treatment. No major complications were reported in these studies. Summary Ultrasound- and landmark-based ilioinguinal nerve blocks are safe and effective for pain relief post inguinal hernia surgery. Although there were two studies that did not show a statically significant difference in both techniques, the ultrasoundguided injection has the advantage of direct visualization of pathology, more accurate needle placement, and decreased risks of intravascular injections. Keywords Ilioinguinal nerve block . Ilioinguinal neuralgia . Post-herniorrhaphy groin pain . Post-operative pain . Ultrasound guided nerve block . Landmark-based ilioinguinal nerve block
Introduction Inguinal hernia surgery is one of the most common general surgery procedures performed in the USA. It has been estimated that about 700,000 inguinal hernia repairs are performed each year [23]. As high as 15–53% of patients suffer from iatrogenic ilioinguinal neuralgia following abdominal surgery [17]. The rate of incidence depends on how and when it is measured. Risk factors for iatrogenic ilioinguinal neuralgia are young age (< 40 years old), high BMI (> 25), use of mesh for inguinal hernia repair, and same day surgery [14]. This article is part of the Topical Collection on Anesthetic Techniques in Pain Management * Andrew T. Ng [email protected] 1
Department of Anesthesiology, Division of Pain Medicine, Thomas Jefferson University Hospital, 3 Crescent Drive, Philadelphia, PA 19112, USA
The ilioinguinal nerve originates from anterior rami of L1 nerve root. The nerve travels across the quadratus lumborum muscles as it courses laterally as it approaches the iliac crest. It then wraps around anteriorly and courses between the transverse abdominus and internal oblique muscles to enter the inguinal canal and exit at the superficial inguinal ring to innervate the scrotum or labia majora. Due to this long course, entrapment and injur
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