title: Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial.
abstract: BACKGROUND
  Ilioinguinal and iliohypogastric nerve blocks are used in the clinical management of persistent inguinal postherniorrhaphy pain, but no controlled studies have been published on the subject. In this controlled study, we investigated the analgesic and sensory effects of ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerves with lidocaine.
  
  
  METHODS
  A randomized, double-blind, placebo-controlled, crossover trial in 12 patients with severe persistent inguinal postherniorrhaphy pain, including a control group of 12 healthy controls, was performed. Assessments included pain ratings under standardized conditions with numerical rating scale (0-10), sensory mapping to a cool roller, and quantitative sensory testing (QST), in the groin regions, before and after each ultrasound-guided block. A needle approach of 1 to 2 cm superior and medial to the anterior superior iliac spine was used. Outcomes were changes in pain ratings, sensory mapping, and QST compared with preblock values. Lidocaine responders were a priori defined by a pain reduction of ≥80% after lidocaine block and ≤25% after placebo block, nonresponders by pain reduction of <80% after lidocaine block and ≤25% after placebo block, and placebo responders by pain reduction of >25% after placebo block.
  
  
  RESULTS
  One of 12 pain patients was a lidocaine responder, 6 patients were nonresponders, and 5 patients were placebo responders. No consistent QST changes were observed in patients after the lidocaine block. In 10 of 12 healthy controls, a cool hypoesthesia area developed in the groin after the lidocaine block. Furthermore, QST assessments demonstrated significantly decreased suprathreshold heat pain perception in the groin after lidocaine versus placebo blocks (95% confidence interval = -3.5 to -0.5, P = 0.008).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. jomutahi@hotmail.com
authors.forename: Joakim M
authors.initials: JM
authors.lastname: Bischoff
authors.forename: Zbigniew J
authors.initials: ZJ
authors.lastname: Koscielniak-Nielsen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Mads U
authors.initials: MU
authors.lastname: Werner
mesh_terms: D000005:Abdomen / Q000294:innervation*; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D018592:Cross-Over Studies; D003718:Denmark; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007001:Hypogastric Plexus / Q000000981:diagnostic imaging*; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010919:Placebos; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D010919:Placebos; D008012:Lidocaine