Ilioinguinal/Iliohypogastric versus quadratus lumborum nerve blockade for elective open inguinal herniorrhaphy: a prospective, randomized, double-blinded, equivalency trial.

Autor:	Edwards CJ; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA chedward@wakehealth.edu., Weller RS; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Turner JD; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Dobson SW; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Jaffe JD; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Reynolds JW; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Russell G; Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Henshaw DS; Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	Regional anesthesia and pain medicine [Reg Anesth Pain Med] 2020 Dec; Vol. 45 (12), pp. 970-974. Date of Electronic Publication: 2020 Oct 01.
DOI:	10.1136/rapm-2020-101571
Abstrakt:	Background: Open inguinal herniorrhaphy (OIH) is a commonly performed surgical procedure with expected postoperative pain. Historically, an option for regional analgesia has been an ilioinguinal and iliohypogastric nerve block (IINB). More recently, the transmuscular quadratus lumborum block (QLB) has been used as an analgesic technique for a variety of abdominal and truncal surgical procedures. Given our own institutional experiences with the performance of QLB combined with the body of literature supporting the proximal blockade of the ilioinguinal and iliohypogastric nerves via this approach, we compared the analgesia provided by an IINB to a QLB. We hypothesized that the two blocks would provide equivalent analgesia, as defined by a difference of less than±2 points on the pain scale (0-10 numeric rating scale (NRS)), for patients undergoing OIH. Methods: Sixty patients scheduled for elective outpatient OIH under general anesthesia were randomized to preoperatively receive either an IINB or a transmuscular QLB with 0.25% bupivacaine/epinephrine/clonidine for postoperative analgesia. The primary endpoint was movement NRS pain scores at 8 hours. Secondary outcomes included resting NRS pain scores at 8 and 24 hours, movement NRS pain scores at 24 hours, incidence of opioid related side effects (nausea, vomiting, pruritus), time-to-first oral opioid analgesic, and total opioid consumption at 24 hours. Results: Fifty-nine patients were analyzed per an intention-to-treat approach (one patient was excluded because the surgical procedure was canceled). Movement pain scores at 8 hours were equivalent (IINB 5.10±3.02 vs QLB 5.03±3.01 (mean NRS±SD); two one-sided test mean difference (90% CI), 0.07 (-1.24 to 1.38), p ≤0.01). There were no differences between groups for any of the secondary endpoints. Conclusion: An IINB and a transmuscular QLB are equivalent with regards to their ability to provide postoperative analgesia after OIH. Competing Interests: Competing interests: None declared. (© American Society of Regional Anesthesia & Pain Medicine 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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