Page 55 - International guidelines for groin hernia management

Hernia

Evidence in literature subfascial infiltration. 665 Another randomized study com-
Herniorrhaphy postoperative pain prevention measures pared combined subfascial and subcutaneous infiltration to
include the use of preoperative and intraoperative local subcutaneous or subfascial infiltration alone. Combination
anesthetic infiltration and/or preoperative or intraoperative infiltration resulted in improved early postoperative pain
field block and paravertebral block and conventional scores, less supplementary analgesic need and longer time-
NSAIDs or selective COX-2 inhibitors. to-first-analgesic request. 666
The use of a preoperative or intraoperative field block Two studies compared local anesthetic infiltration to
(mostly of the ilio-inguinal and ilio-hypogastric nerves) placebo or no treatment and found local infiltration supe-
with or without local wound infiltration is superior to rior with respect to early postoperative pain and supple-
placebo or no treatment for reducing early postoperative mental analgesic use. 667, 668
pain scores and the need for supplementary Three studies investigated local anesthetic timing,
analgesics. 649–653 comparing preoperative to at/near-wound-closure infiltra-
669–671
Seven randomized trials reported that field block of the tion. Two of the three studies reported no differences
ilio-inguinal and ilio-hypogastric nerve with wound infil- in early postoperative pain and supplemental analgesic use
tration was superior to no treatment or placebo for reducing after preoperative field block versus at-wound-closure field
postoperative pain scores and supplementary analgesic block during general anesthesia. 669, 670 The third study
654–660
requirements. compared pre-incisional and before-wound-closure infil-
A 2012 review 614 summarized four randomized trials tration during general anesthesia concluded that pre-inci-
comparing wound infiltration with local anesthetic to sional infiltration with lidocaine was a more effective
placebo. 642, 661–663 Wound infiltration was found to be method of providing postoperative analgesia. 671 The 2012
superior to placebo for reducing early postoperative pain review referenced above concluded that preoperative and
scores and the use of supplementary analgesics. Wound at-wound-closure local anesthetic regimens had equal
infiltration also lengthened the time-to-first-analgesic benefit in reducing pain scores and supplemental analgesic
614
request. use.
A 2015 randomized trial of wound infiltration versus Two studies found that ultrasound-guided nerve blocks
placebo found no difference in pain incidence 3 months (involving the ilio-hypogastric/ilio-inguinal nerves) were
postoperatively. 664 superior to anatomic-landmark nerve blocks at providing
A prospective, double-blind, randomized trial compared effective analgesia. 672, 673
subfascial to subcutaneous local anesthetic infiltration and Paravertebral nerve blocks (PVBs) are established
reported improved early postoperative pain scores after methods of providing analgesia to thoracic- and

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