Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
Hernia. 2013 Jun;17(3):329-32. doi: 10.1007/s10029-012-0998-y. Epub 2012 Sep 27.
The aim of this study was to evaluate the outcome of ilioinguinal and iliohypogastric nerve blocks in patients with chronic pain after herniorrhaphy, by comparing nerve stimulator and ultrasound guidance to administer the block.
A total of 43 patients who received nerve blocks for chronic inguinal post-herniorrhaphy pain received standardized questionnaires. Nerve stimulator-guided blocks were performed prior to January 2009, and thereafter, ultrasound-guided blocks were performed using a local anaesthetic solution and a corticosteroid.
The questionnaire was completed by 38 patients (88 %). The inguinal hernia repair was performed for a median 16 months (range 3-219) ahead of the nerve blocks. A median of 2 pain treatments (range 1-7) was calculated. Median follow-up was 21 months (range 3-68). According to the DN4, 21 patients (55.3 %) no longer reported neuropathic pain. Subjectively, 32 % no longer reported moderate-to-severe pain. After ultrasound-guided blocks, a higher VAS score (at rest and during activities), a higher proportion of daily pain and more anxiety and depression are reported compared to blocks performed after nerve stimulator guidance.
Ilioinguinal/iliohypogastric nerve blocks can be effective to treat chronic inguinal pain following surgery of the groin. The use of ultrasound was not superior to nerve stimulator-guided blocks. These blocks could be considered prior to more invasive procedures such as neurectomy.
本研究旨在通过比较神经刺激器和超声引导下进行阻滞的方法，评估髂腹股沟和髂腹下神经阻滞治疗疝修补术后慢性疼痛的效果。
共 43 例慢性腹股沟疝修补术后疼痛患者接受神经阻滞治疗，并接受了标准化问卷调查。2009 年 1 月前采用神经刺激器引导下阻滞，此后采用局部麻醉药和皮质类固醇进行超声引导下阻滞。
38 例患者（88%）完成了问卷调查。疝修补术距神经阻滞的中位数时间为 16 个月（范围 3-219）。计算中位数为 2 次疼痛治疗（范围 1-7）。中位随访时间为 21 个月（范围 3-68）。根据 DN4，21 例患者（55.3%）不再报告神经病理性疼痛。主观上，32%的患者不再报告中重度疼痛。与神经刺激器引导下的阻滞相比，超声引导下的阻滞后静息和活动时的 VAS 评分更高、每日疼痛比例更高、焦虑和抑郁程度更高。
髂腹股沟/髂腹下神经阻滞可有效治疗腹股沟手术后的慢性腹股沟疼痛。与神经刺激器引导下的阻滞相比，超声引导下的阻滞并无优势。这些阻滞可以在神经切除术等更具侵入性的手术之前考虑使用。
