POSTOPERATIVE NEURALGIA

Objective: To evaluate paresthesia following routine ilioinguinal nerve excision compared to nerve preservation in patientsundergoing anterior inguinal hernioraphy. Design: prospective experimental study. Place and duration of study: The study was conductedat Madina Teaching hospital, University Medical & Dental College, Faisalabad from July 01,2005 to June 30,2007. Patients and methods:Two hundred and eighteen patients were operated for their inguinal hernias. Ilio-inguinal nerve preservation (n=96) and nerve excision (n=122)was performed on alternative operation days. All patients were contacted and data was collected on incidence and duration of postoperativeparesthesia. Comparison was made by x2 analysis. Results: The patients with routine neurectomy were similar to the group without neurectomybased on mean age (68 ± 14 vs. 58 ± 18 years). The incidence of postoperative paresthesia was not significantly higher in the neurectomygroup versus the nerve preservation group at 1 month: 15% versus 4% (P = 0.078); 6 months: 11% versus 5% (P = 0.107); 1 year: 09% versus05% (P = 0.303); (Table 2). In patients with postoperative paresthesia, mean severity scores on a visual analog scale (0-10) were lower in theneurectomy group versus nerve preservation group at 1 month (2.6 ± 2.0 vs. 5.2 ± 0.0) and at 6 month (2.4 ± 2.0 vs. 5.2 ± 0.0) but similar inthe neurectomy and nerve preservation patients at 1 year (2.2 ± 1.8 vs. 3.8 ± 0.0) (Table 3). Conclusion: There is a trend towards increasedincidence of subjective paresthesia in patients undergoing routine neurectomy at 1 month, but there is no significant increase at any other endpoint in time. When performing anterior inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option

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Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis

World Journal of Surgery ◽

10.1007/s00268-021-05968-x ◽

2021 ◽

Cited By ~ 1

Author(s):

Roberto Cirocchi ◽

Marco Sutera ◽

Piergiorgio Fedeli ◽

Gabriele Anania ◽

Piero Covarelli ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Meta Analysis ◽

Group Versus ◽

Chronic Groin Pain ◽

Ilioinguinal Nerve ◽

Nerve Preservation ◽

Lichtenstein Hernia Repair

Abstract Objective This study aimed to evaluate the incidence of chronic groin pain (primary outcome) and alterations of sensitivity (secondary outcome) after Lichtenstein inguinal hernia repair, comparing neurectomy with ilioinguinal nerve preservation surgery. Summary background data The exact cause of chronic groin postoperative pain after mesh inguinal hernia repair is usually unclear. Section of the ilioinguinal nerve (neurectomy) may reduce postoperative chronic pain. Methods We followed PRISMA guidelines to identify randomized studies reporting comparative outcomes of neurectomy versus ilioinguinal nerve preservation surgery during Lichtenstein hernia repairs. Studies were identified by searching in PubMed, Scopus, and Web of Science from April 2020. The protocol for this systematic review and meta-analysis was submitted and accepted from PROSPERO: CRD420201610. Results In this systematic review and meta-analysis, 16 RCTs were included and 1550 patients were evaluated: 756 patients underwent neurectomy (neurectomy group) vs 794 patients underwent ilioinguinal nerve preservation surgery (nerve preservation group). All included studies analyzed Lichtenstein hernia repair. The majority of the new studies and data comes from a relatively narrow geographic region; other bias of this meta-analysis is the suitability of pooling data for many of these studies. A statistically significant percentage of patients with prosthetic inguinal hernia repair had reduced groin pain at 6 months after surgery at 8.94% (38/425) in the neurectomy group versus 25.11% (113/450) in the nerve preservation group [relative risk (RR) 0.39, 95% confidence interval (CI) 0.28–0.54; Z = 5.60 (P < 0.00001)]. Neurectomy did not significantly increase the groin paresthesia 6 months after surgery at 8.5% (30/353) in the neurectomy group versus 4.5% (17/373) in the nerve preservation group [RR 1.62, 95% CI 0.94–2.80; Z = 1.74 (P = 0.08)]. At 12 months after surgery, there is no advantage of neurectomy over chronic groin pain; no significant differences were found in the 12-month postoperative groin pain rate at 9% (9/100) in the neurectomy group versus 17.85% (20/112) in the inguinal nerve preservation group [RR 0.50, 95% CI 0.24–1.05; Z = 1.83 (P = 0.07)]. One study (115 patients) reported data about paresthesia at 12 months after surgery (7.27%, 4/55 in neurectomy group vs. 5%, 3/60 in nerve preservation group) and results were not significantly different between the two groups [RR 1.45, 95% CI 0.34, 6.21;Z = 0.51 (P = 0.61)]. The subgroup analysis of the studies that identified the IIN showed a significant reduction of the 6th month evaluation of pain in both groups and confirmed the same trend in favor of neurectomy reported in the previous overall analysis: statistically significant reduction of pain 6 months after surgery at 3.79% (6/158) in the neurectomy group versus 14.6% (26/178) in the nerve preservation group [RR 0.28, 95% CI 0.13–0.63; Z = 3.10 (P = 0.002)]. Conclusion Ilioinguinal nerve identification in Lichtenstein inguinal hernia repair is the fundamental step to reduce or avoid postoperative pain. Prophylactic ilioinguinal nerve neurectomy seems to offer some advantages concerning pain in the first 6th month postoperative period, although it might be possible that the small number of cases contributed to the insignificancy regarding paresthesia and hypoesthesia. Nowadays, prudent surgeons should discuss with patients and their families the uncertain benefits and the potential risks of neurectomy before performing the hernioplasty.

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Effect of Addition of Dexamethasone or Clonidine to Ropivacaine on Postoperative Analgesia in Ultrasonography Guided Transversus Abdominis Plane Block for Inguinal Hernia Repair: A Prospective Double Blind Randomized Control Trial

Academia Anesthesiologica International ◽

10.21276/aan.2020.5.1.15 ◽

2020 ◽

Vol 5 (1) ◽

pp. 74-77

Author(s):

Sweta Bharadiya ◽

Neelam Meena ◽

Ram Nivas ◽

R.K. Solanki

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Visual Analog Scale ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Analog Scale ◽

Rescue Analgesia

Background: A hernia repair surgery commonly induces moderate to severe postoperative pain for 48 hours. Aim of the study was to compare 0.5% Ropivacaine with dexamethasone and 0.5% Ropivacaine with clonidine for ultrasonography guided transversus abdominis plane (TAP) block as post-operative analgesia in patients undergoing Inguinal hernia repair surgery.Subjects and Methods:A randomized prospective controlled clinical study was conducted in 64 patients undergoing Inguinal Herneoplasty. Participants were divided into two groups in which group RD (n=32) received 0.5% Ropivavacaine with Dexamethasone 8mg and those in group RC (n=32) received 0.5% Ropivacaine with Clonidine 75mcg as USG guided TAP block at the end of surgery. The postoperative pain was evaluated by visual analog scale (VAS) for pain scoring at every 2 hours for 24 hours postoperatively. Subjective assessment of duration of analgesia was done.Results:Time to first rescue analgesia was significantly less in group RC (424.53±34.13) compared to group RD (616.09±31.36min) (P < 0.001). Total tramadol consumed in 24 h was significantly higher in group RC than group RD (P < 0.001). Visual analog scale scores for both somatic and visceral pain were significantly higher in group RC than group RD at 6h, 8 h and 12 h postoperatively.Conclusion:TAP block is a safe and effective way of relieving postoperative pain in inguinal herneoplasty patients. Addition of dexamethasone to Ropivacaine significantly enhances its effect in terms of block quality and analgesia duration as compared to clonidine addition.

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Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20201859 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1503

Author(s):

Renuka Chaudhary ◽

M. Salim ◽

M. Rafik Rao

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Chronic Groin Pain ◽

Ilioinguinal Nerve ◽

Nerve Preservation ◽

Group A ◽

Group B

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

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Comparison of Prophylactic Ilioinguinal Neurectomy and Ilioinguinal Nerve Preservation in Open Inguinal Hernia Repair: A Prospective Study

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v8i7.42 ◽

2020 ◽

Vol 08 (07) ◽

Author(s):

Dr Grace Lalitha Priya Uppada ◽

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Prospective Study ◽

Inguinal Hernia Repair ◽

Ilioinguinal Nerve ◽

Nerve Preservation ◽

Open Inguinal Hernia Repair ◽

A Prospective Study

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Large retroperitoneal haematoma: an unexpected complication of ilioinguinal nerve block for inguinal hernia repair

Anaesthesia ◽

10.1111/j.1365-2044.2011.06971.x ◽

2011 ◽

Vol 67 (1) ◽

pp. 80-81 ◽

Cited By ~ 15

Author(s):

M. A. Parvaiz ◽

V. Korwar ◽

D. McArthur ◽

A. Claxton ◽

J. Dyer ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Nerve Block ◽

Ilioinguinal Nerve ◽

Retroperitoneal Haematoma

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Ilio inguinal neurectomy in inguinal hernia

International Surgery Journal ◽

10.18203/2349-2902.isj20173729 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2977

Author(s):

T. Mohanapriya ◽

T. R. Karthikeyan ◽

K. Balaji Singh ◽

T. Arulappan

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Controlled Trial ◽

Chronic Groin Pain ◽

Study Group ◽

Ilioinguinal Nerve ◽

Nerve Preservation ◽

Significant Complication ◽

Lichtenstein Hernia Repair ◽

Surgery Department

Background: Inguinal hernia is one of the most common surgery done in any hospital. Chronic inguinal pain is one of the common problem these patients complain of. This study aims at evaluating the long-term outcomes of neuralgia and paraesthesia following routine ilioinguinal nerve division, compared to nerve preservation when performing Lichtenstein’s inguinal hernia repair.Methods: The present study is a randomized controlled trial of 60 cases of inguinal hernias admitted in General Surgery Department in our hospital. The patients were randomly chosen into Lichtenstein hernia repair with ilioinguinal neurectomy or Lichtenstein hernia repair with nerve preservation. After surgery, all patients were monitored carefully for pain and paraesthesia. Pain was assessed using visual analogue scale. Paraesthesia was assessed by the monofilament test and evaluated after comparison with the opposite side.Results: In the present study, the incidence of pain as well as the severity of pain is far higher in the nerve preservation study group as opposed to the neurectomy study group. Hypaesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.Conclusions: Prophylactic neurectomy can be an appropriate solution in the prevention of chronic groin pain following Lichtenstein inguinal hernia repair and can be considered as an ideal inclusion into the standard hernia repair procedures. Hypoesthesia is not a significant complication following ilioinguinal neurectomy and does not significantly add to the morbidity of the patient.

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