Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Blocks for Persistent Inguinal Postherniorrhaphy Pain

Bischoff, Joakim M.; Koscielniak-Nielsen, Zbigniew J.; Kehlet, Henrik; Werner, Mads U.

doi:10.1213/ane.0b013e31824d6168

Cited by 74 publications

(61 citation statements)

References 26 publications

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“…The importance of using placebo can be seen in a well-designed randomized, placebo-controlled, double-blinded crossover trial examining the effects of peripheral nerve blockade in postherniotomy pain patients. 28 The results showed the same pain response after placebo compared with after local anesthetic blockade and also found a high proportion (5 of 12) of patients were placebo responders, casting doubt on much of the previous research on peripheral nerve blockade.…”

Section: Discussionmentioning

confidence: 74%

Neural Blockade for Persistent Pain After Breast Cancer Surgery

Wijayasinghe

Andersen

Kehlet

2014

Regional Anesthesia and Pain Medicine

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Persistent pain after breast cancer surgery is predominantly a neuropathic pain syndrome affecting 25% to 60% of patients and related to injury of the intercostobrachial nerve, intercostal nerves, and other nerves in the region. Neural blockade can be useful for the identification of nerves involved in neuropathic pain syndromes or to be used as a treatment in its own right. The purpose of this review was to examine the evidence for neural blockade as a potential diagnostic tool or treatment for persistent pain after breast cancer surgery. In this systematic review, we found only 7 studies (n = 135) assessing blocks directed at 3 neural structures-stellate ganglion, paravertebral plexus, and intercostal nerves-but none focusing on the intercostobrachial nerve. The quality of the studies was low and efficacy inconclusive, suggesting a need for well-designed, high-quality studies for this common clinical problem.

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Section: Discussionmentioning

confidence: 74%

Neural Blockade for Persistent Pain After Breast Cancer Surgery

Wijayasinghe

Andersen

Kehlet

2014

Regional Anesthesia and Pain Medicine

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“…A double blinded, randomized, crossover trial showed no efficacy when compared with placebo [70]. The authors hypothesized that the GF nerve may have a greater role in lower abdominal and pelvic pain than realized [70].…”

Section: Iliohypogastric Nervesmentioning

confidence: 99%

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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“…QST has been used to document the somatosensory profiles of such deficits and to quantify the effects of treatments on different forms of pain, such as allodynia and hyperalgesia [32]. Investigators have tried to establish the analgesic and sensory effects of ultrasoundguided nerve blocks in specific postprocedural pain syndromes [33], but no recommendations for therapeutic changes could be made on the basis of the data obtained.…”

Section: • • Therapeutic Interventions and Prediction Of Therapeutic Oumentioning

confidence: 99%

Quantitative Sensory Testing in Pain Management

Roldan

Abdi

2015

Pain Manag.

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Quantitative sensory testing (QST), a set of noninvasive methods used to assess sensory and pain perception, has been used for three decades. The precision of the instruments and the uninvasiveness encouraged many QST-based trials. The developments made have benefited multiple disciplines. QST relies on analysis of an individual's response to external stimuli, reflecting the integrity of the PNS and the sensory pathway. The sensory pathway cannot be assessed in isolation from the affective and cognitive characteristics of patients or testers. Many variables potentially affect the reliability and reproducibility of QST, which after all, is designed for the testing of individuals by other individuals. Several decades of QST research have yielded exciting contributions, but the future of QST cannot be fully known.

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Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Blocks for Persistent Inguinal Postherniorrhaphy Pain

Abstract: Ultrasound-guided lidocaine blocks of the ilioinguinal and iliohypogastric nerves, at the level of the anterior superior iliac spine, are not useful in diagnosis and management of persistent inguinal postherniorrhaphy pain.

Cited by 74 publications

References 26 publications

Neural Blockade for Persistent Pain After Breast Cancer Surgery

Neural Blockade for Persistent Pain After Breast Cancer Surgery

Ultrasound-Guided Interventional Procedures for Chronic Pain Management

Quantitative Sensory Testing in Pain Management

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