title: Pain control with ultrasound-guided inguinal field block compared with spinal anesthesia after hernia surgery: a randomized trial.
abstract: BACKGROUND
  Inguinal field block (IFB) is a recommended technique for pain control after inguinal hernia repair but is also underused by surgeons. Currently, there is no decisive evidence on which technique, IFB or spinal anesthesia block (SAB), provides better pain control during the first day after hernia repair. In this study, we compared ultrasound-guided IFB performed by anesthesiologists and SAB for pain control during the first day after hernia repair.
  
  
  METHODS
  We compared static and dynamic pain scores measured with a numerical rating scale in 86 male patients scheduled for elective unilateral inguinal hernia repair with either ultrasound-guided IFB (n = 42) or SAB (n = 44).
  
  
  RESULTS
  Dynamic and static pain at 4 hours (P < .01, r > 0.34, "large effect size"), and dynamic pain the morning after operation (P = .04, r > 0.20, "medium effect size") were less in the field block group compared with the SAB group. Postoperative analgesic consumption was reduced during hospital stay (P = .005, r > 0.34, "large effect size") and for 7 postoperative days in the field block group (P = .03, r > 0.20, "medium effect size").
  
  
  CONCLUSIONS
  In this study, ultrasound-guided IFB provided lesser dynamic pain scores during the first postoperative day and reduced use of analgesics for 1 week compared with spinal anesthesia after inguinal hernia repair. Our technique could become a substitute performed by anesthesiologists in settings in which IFB is not performed routinely by surgeons.
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy; Study Group on Acute and Chronic Pain, Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI).
authors.forename: Zhirajr
authors.initials: Z
authors.lastname: Mokini
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vitale
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Aletti
authors.affiliation: Department of General Surgery, Lincoln County Hospital, Lincoln, United Kingdom.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sacchi
authors.affiliation: Department of Health Sciences, University of Milan-Bicocca, Monza, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Mauri
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Colombo
authors.affiliation: Department of Health Sciences, University of Milan-Bicocca, Monza, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fumagalli
authors.affiliation: Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy; Department of Health Sciences, University of Milan-Bicocca, Monza, Italy. Electronic address: antonio.pesenti@unimib.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007264:Inguinal Canal / Q000294:innervation; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D011446:Prospective Studies; D016037:Single-Blind Method; D055815:Young Adult