Landmark-based versus ultrasound-guided ilioinguinal/iliohypogastric nerve blocks in the treatment of chronic postherniorrhaphy groin pain: a retrospective study

Abstract

BackgroundChronic postherniorrhaphy groin pain (CPGP) is a debilitating condition, which is often refractory to conservative medical management. To our knowledge, there have been no studies directly comparing landmarked-based and ultrasound-guided approaches in this population.ObjectiveTo compare the effectiveness of landmark-based and ultrasound-guided ilioinguinal/iliohypogastric nerve blocks in the treatment of CPGP.Study designThis is a retrospective chart review of patients who presented to our tertiary care pain medicine clinic with a diagnosis of CPGP. Inclusion criteria were the following: age >18 years, diagnosis of groin pain, and prior history of herniorrhaphy. Exclusion criteria included those who were seen for initial consultation but were lost to follow-up. Primary outcomes were 50% or greater reduction in pain on visual analog scale (VAS). Secondary outcomes were 30% or greater reduction in VAS pain score, changes in VAS pain scores, and reported complications.ResultsA total of 36 patients were included in the study. Of them, 20 patients underwent the landmark-based and 16 underwent the ultrasound-guided techniques. There was no significant difference in baseline demographics. The average VAS score preinjection was 7.08 in the landmark-based and 7.0 in the ultrasound-guided groups (P=0.65). A total of 14 patients (70%) in the landmark-based and eleven patients (79%) in the ultrasound-guided groups experienced at least a 50% reduction in VAS scores. There was no statistically significant difference between the two groups (P=1.0), and no complications were noted. We also did not find a significant difference in terms of number of patients with 30% or greater reduction (P=0.71) and changes in VAS pain scores (P=0.64). No complications were reported in either group.ConclusionIn our study, there was no statistically significant difference between the landmark-based and ultrasound-guided groups in terms of a reduction in VAS pain scores, and no complications were noted in either group.

Femoral Nerve Palsy Following Landmark Based Ilioinguinal-Iliohypogastric Nerve Block: Case Report and Safety Review

“…While all sources agree that the insertion occurs 2 cm medial to the ASIS, there is variation in coronal infiltration from 2 cm superior/inferior to the ASIS [7,13]. This variation is in part due to anatomic variations of the II/IH nerves.…”

“…In addition to transient FNP, complications include trauma to blood vessels, pelvic hematoma, intravascular injection, urinary retention, and bladder/enteric penetration [3,5,9,12]. Practitioner experience and modality of administration have been associated with complications and failure of NB to provide adequate analgesia [5,13]. In an effort to avoid these complications, ultrasoundguidance was introduced as an alternative to traditional landmark-based administration.…”

“…Local anesthetic, typically 0.5% bupivacaine, is infiltrated into this plane [2,13]. Inadequate analgesic rates of 28-45% are reported [5,7,13].…”

“…Inadequate analgesic rates of 28-45% are reported [5,7,13]. Suggested mechanisms include unpredictable nerve course, inaccuracy of tactile clicks, user experience and anatomic muscular variation [5].…”

“…These include a fan distribution of infiltration, multiple site injection, and direct visualization [5,7,10,13].…”