Comparative study of postoperative pain in elderly undergoing open hernia repair– spinal anesthestia vs. combined spinal and ilioinguinal block

D. Ologoiu,  M. Negoi,  M.Vartic,  A. Cotae,  A. Scrieciu, M Tiglis,  I. Grintescu

Background: Preoperative and immediate postoperative pain in inguinal hernia repair is associated with reported frequency from 0% to 54%. Onset of post-hernia repair pain usually occurs immediately after surgery and predictive factors include repair of recurrent hernia, preoperative pain, severe early postoperative pain, psychological vulnerability or psychiatric disorder. Chronic pain is the most frequent long-term complication of treating inguinal hernia. Ilioinguinal/ iliohipogastric (IHN) block has been shown promise for postoperative analgesia and preventing chronic pain.
Methods: 154 patients undergoing open inguinal hernia repair with a mesh were randomly allocated to receive spinal or combined spinal with IHN block with ropivacaine 0.5% before surgery. Patients were monitored for visual analog scale (VAS) scores at rest and cough (in post-anesthesia care unit at 4 and 12h) and at rest, cough and movement (at 24, 48h and 1month). Pain at 1 month was  assessed using the DN4 questionnaire for neuropathic pain.
Results: Median VAS pain scores at rest were lower in the IHN  group at 4 h (11 vs 25, P0.04), at 12 h (20 vs 40, P0.014), and at 24 h (29 vs 43, P0.013). Pain after the ﬁrst 24 h and at 1 month after surgery, and DN4 scores were better in IHN group (P 0.01). The proportion of patients with VAS.40 mm on movement at 1 months was better  18.2% vs 42.4% in the spinal and IHN groups, respectively( P0.018). Postoperative morphine requirements were lower during the ﬁrst 24 h in the IHN block group (P0.03).
Conclusion: As part of a multimodal analgesia strategy IHN block provides successful peroperative analgesia.In comparison to only subarachnoid anesthesia,combined spinal with IHN block technique has proved superior and very effective  providing better pain control and the occurrence of chronic pain.

Comparative study of postoperative pain in elderly undergoing open hernia repair – spinal anesthestia vs. combined spinal and ilioinguinal block