title: Perineural bupivacaine injection reduces inguinodynia after inguinal hernia repair.
abstract: Inguinodynia, defined as pain lasting >3 months after inguinal hernia repair, remains the major complication of hernia operation. We sought to determine the effect of direct perineural infiltration on acute pain and inguinodynia after open inguinal hernia repair.
  
  
  
  Patients who presented with an inguinal hernia at a university teaching hospital were evaluated prospectively and randomized to either (1) percutaneous ilioinguinal nerve block or (2) percutaneous ilioinguinal nerve block with additional perineural infiltration of the ilioinguinal, iliohypogastric, genitofemoral nerves. All patients in each group received a total of 12 mL of 0.5% bupivacaine. Self-reported faces of pain level (1-10), minutes to discharge from the recovery room, narcotic quantity consumed (oxycodone 5 mg/paracetamol 325 mg), days on narcotics, and incidence of inguinodynia at 3 months were all recorded.
  
  
  
  Ninety-two patients were randomized in the study. Patients who received perineural bupivacaine infiltration of nerves had less recovery room pain (1.3 vs 3.9, P < .001) and shorter recovery discharge times (89 vs 105 min, P = .047) and consumed fewer narcotics (9.7 vs 15.1 doses, P = .010). The incidence of inguinodynia at 3 months was less in the treatment group (8.2% vs 27.9%, P = .013).
  
  
  
  We have implemented a novel and inexpensive method of local nerve blockade that decreases pain immediately after operation and at 3 months postoperatively. Furthermore, our method leads to shorter recovery room stay and fewer narcotics after operation.
authors: Department of General Surgery, University of California-Los Angeles, Los Angeles, CA.
authors: Joseph G
authors: JG
authors: Crompton
authors: Department of General Surgery, University of California-Los Angeles, Los Angeles, CA; Robert Woods Johnson Clinical Scholars Program, Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA; Department of Health Policy and Management, Fielding UCLA School of Public Health, Los Angeles, CA.
authors: Aaron J
authors: AJ
authors: Dawes
authors: Department of General Surgery, University of California-Los Angeles, Los Angeles, CA.
authors: Graham W
authors: GW
authors: Donald
authors: Department of General Surgery, University of California-Los Angeles, Los Angeles, CA.
authors: Masha J
authors: MJ
authors: Livhits
authors: Department of General Surgery, University of California-Los Angeles, Los Angeles, CA. Electronic address: CChandler@mednet.ucla.edu.
authors: Charles F
authors: CF
authors: Chandler
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine