Landmark-based versus ultrasound-guided ilioinguinal/iliohypogastric nerve blocks in the treatment of chronic postherniorrhaphy groin pain: a retrospective study

• Main Authors: Trainor D, Moeschler S, Pingree M, Hoelzer B, Wang Z, Mauck W, Qu W
• Format: Article
• Language: English
• Published: Dove Medical Press 2015-10-01
• Series: Journal of Pain Research
• Online Access: https://www.dovepress.com/landmark-based-versus-ultrasound-guided-ilioinguinaliliohypogastric-ne-peer-reviewed-article-JPR

Drew Trainor,1 Susan Moeschler,2 Matthew Pingree,1,2 Brian Hoelzer,2 Zhen Wang,2 William Mauck,2 Wenchun Qu1,2 1Department of Physical Medicine and Rehabilitation, 2Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USABackground: Chronic postherniorrhaphy groin pain (CPGP) is a debilitating condition, which is often refractory to conservative medical management. To our knowledge, there have been no studies directly comparing landmarked-based and ultrasound-guided approaches in this population.Objective: To compare the effectiveness of landmark-based and ultrasound-guided ilioinguinal/iliohypogastric nerve blocks in the treatment of CPGP.Study design: This is a retrospective chart review of patients who presented to our tertiary care pain medicine clinic with a diagnosis of CPGP. Inclusion criteria were the following: age >18 years, diagnosis of groin pain, and prior history of herniorrhaphy. Exclusion criteria included those who were seen for initial consultation but were lost to follow-up. Primary outcomes were 50% or greater reduction in pain on visual analog scale (VAS). Secondary outcomes were 30% or greater reduction in VAS pain score, changes in VAS pain scores, and reported complications.Results: A total of 36 patients were included in the study. Of them, 20 patients underwent the landmark-based and 16 underwent the ultrasound-guided techniques. There was no significant difference in baseline demographics. The average VAS score preinjection was 7.08 in the landmark-based and 7.0 in the ultrasound-guided groups (P=0.65). A total of 14 patients (70%) in the landmark-based and eleven patients (79%) in the ultrasound-guided groups experienced at least a 50% reduction in VAS scores. There was no statistically significant difference between the two groups (P=1.0), and no complications were noted. We also did not find a significant difference in terms of number of patients with 30% or greater reduction (P=0.71) and changes in VAS pain scores (P=0.64). No complications were reported in either group.Conclusion: In our study, there was no statistically significant difference between the landmark-based and ultrasound-guided groups in terms of a reduction in VAS pain scores, and no complications were noted in either group.Keywords: abdominal wall, intramuscular injections, ultrasound, anatomic landmarks