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Hung TY, Bai GH, Tsai MC, Lin YC. Analgesic Effects of Regional Analgesic Techniques in Pediatric Inguinal Surgeries: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Anesth Analg 2024; 138:108-122. [PMID: 36571797 DOI: 10.1213/ane.0000000000006341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Various regional analgesic techniques have been used in pediatric inguinal surgery to facilitate postoperative recovery. However, each technique's relative performance was undetermined owing to the lack of quantitative analysis. METHODS We systematically searched MEDLINE, Cochrane Library, EMBASE, and Web of Science for randomized controlled trials that compared regional analgesia in pediatric inguinal surgeries. After critical study screening and selection, a random-effects network meta-analysis was performed. The primary outcome was the time to the first rescue analgesic after surgery, and the secondary outcomes were the number of patients requiring rescue analgesics after surgery, postoperative pain scores, incidence of postoperative nausea and vomiting, and other adverse events. RESULTS This network meta-analysis included 69 randomized controlled trials (4636 patients) that compared 10 regional analgesic techniques. Our study revealed that the quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic after pediatric inguinal surgeries, by 7.7 hours (95% confidence interval [CI], 5.0-10.3) and 6.0 hours (95% CI, 3.9-8.2) when compared with the control group, respectively. In the subgroup involving only inguinal hernia repair, the quadratus lumborum block significantly prolonged the time to the first rescue analgesic than all other regional analgesics. In contrast, in the subgroup involving orchidopexies, only the caudal block significantly prolonged the time to the first rescue analgesic when compared with the control group (4.1 hours; 95% CI, 0.7-7.5). Wound infiltration and landmark-based ilioinguinal-iliohypogastric block had relatively poor analgesic effects than other regional analgesics. No serious adverse effects related to the regional analgesic techniques were reported in any of the included studies. CONCLUSIONS The quadratus lumborum and transversus abdominis plane blocks had the longest time to the first rescue analgesic and the least rescue analgesic requirement for pediatric inguinal surgeries. Specifically, the quadratus lumborum block had the longest analgesic duration in inguinal hernia repair, and the caudal block was found to be the only regional analgesia that extended the time to the first rescue analgesic in pediatric orchidopexy. Most included randomized controlled trials had some concern or a high risk of bias, and future studies should focus on providing high-quality evidence to further clarify the analgesic effects of regional analgesia for pediatric inguinal surgeries.
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Affiliation(s)
- Tsung-Yu Hung
- From the Department of Anesthesia, MacKay Memorial Hospital, Taipei, Taiwan
| | - Geng-Hao Bai
- Department of General Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Chen Tsai
- Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ying-Chun Lin
- From the Department of Anesthesia, MacKay Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Sangkum L, Tangjitbampenbun A, Chalacheewa T, Brennan K, Liu H. Peripheral Nerve Blocks for Cesarean Delivery Analgesia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1951. [PMID: 38004000 PMCID: PMC10673165 DOI: 10.3390/medicina59111951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Effective postoperative analgesia using multimodal approach improves maternal and neonatal outcomes after cesarean delivery. The use of neuraxial approach (local anesthetic and opioids) and intravenous adjunctive drugs, such as nonsteroidal anti-inflammatory drugs and acetaminophen, currently represents the standard regimen for post-cesarean delivery analgesia. Peripheral nerve blocks may be considered in patients who are unable to receive neuraxial techniques; these blocks may also be used as a rescue technique in selected patients. This review discusses the relevant anatomy, current evidence, and advantages and disadvantages of the various peripheral nerve block techniques. Further research is warranted to compare the analgesic efficacy of these techniques, especially newer blocks (e.g., quadratus lumborum blocks and erector spinae plane blocks). Moreover, future studies should determine the safety profile of these blocks (e.g., fascial plane blocks) in the obstetric population because of its increased susceptibility to local anesthetic toxicity.
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Affiliation(s)
- Lisa Sangkum
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Amornrat Tangjitbampenbun
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Theerawat Chalacheewa
- Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (L.S.); (A.T.); (T.C.)
| | - Kristin Brennan
- Department of Anesthesiology, Penn Medicine Lancaster General Hospital, 555 N Duke St., Lancaster, PA 17602, USA;
| | - Henry Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Mitrousias V, Chytas D, Banios K, Fyllos A, Raoulis V, Chalatsis G, Baxevanidou K, Zibis A. Anatomy and terminology of groin pain: Current concepts. J ISAKOS 2023; 8:381-386. [PMID: 37308079 DOI: 10.1016/j.jisako.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/13/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023]
Abstract
Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.
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Affiliation(s)
- Vasileios Mitrousias
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece; Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, 41110 Larissa, Greece.
| | - Dimitrios Chytas
- Department of Physiotherapy, University of Peloponnese, 23100 Sparta, Greece
| | - Konstantinos Banios
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Apostolos Fyllos
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Vasileios Raoulis
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
| | - Georgios Chalatsis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, General University Hospital of Larissa, 41110 Larissa, Greece
| | - Kyriaki Baxevanidou
- Department of General Surgery, General Hospital of Larissa, 41221, Larissa, Greece
| | - Aristeidis Zibis
- Department of Anatomy, Faculty of Medicine, University of Thessaly, 41334 Larissa, Greece
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Karadjova M. Changes in range of motion and neurological symptoms in patients with thoracolumbar junction syndrome treated with spinal manipulations. MANUELLE MEDIZIN 2023. [DOI: 10.1007/s00337-023-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Fernández-Garrido M, Torrano L, González López J, Masia J, Sisternas Hernández L, D'Guilio Arevalo G, Zamora Alarcón P. To bulge or not to bulge: Rectus abdominis functional reconstruction after soft tissue sarcoma resection. J Plast Reconstr Aesthet Surg 2023; 78:10-12. [PMID: 36736105 DOI: 10.1016/j.bjps.2022.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Manuel Fernández-Garrido
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Laura Torrano
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - José González López
- General Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jaume Masia
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lucía Sisternas Hernández
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gabriella D'Guilio Arevalo
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Paúl Zamora Alarcón
- Plastic and Reconstructive Surgery Department, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
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Posthuma JJ, Sandkuyl R, Sloothaak DA, Ottenhof A, van der Bilt JDW, Gooszen JAH, Verbeek PCM, In't Hof KH. Transinguinal preperitoneal (TIPP) vs endoscopic total extraperitoneal (TEP) procedure in unilateral inguinal hernia repair: a randomized controlled trial. Hernia 2023; 27:119-125. [PMID: 35925503 PMCID: PMC9931826 DOI: 10.1007/s10029-022-02651-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/06/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The Lichtenstein hernioplasty has long been seen as the gold standard for inguinal hernia repair. Unfortunately, this repair is often associated with chronic pain, up to 10-35%. Therefore, several new techniques have been developed, such as the transinguinal preperitoneal patch (TIPP) and the endoscopic total extraperitoneal (TEP) technique. Several studies showed beneficial results of the TIPP and TEP compared to the Lichtenstein hernioplasty; however, little is published on the outcome when comparing the TIPP and TEP procedures. This study aimed to evaluate outcomes after the TIPP vs the TEP technique for inguinal hernia repair. METHODS A single-center randomized controlled trial was carried out between 2015 and 2020. A total of 300 patients with unilateral inguinal hernia were enrolled and randomized to the TIPP- or TEP technique. Primary outcome was chronic pain (defined as any pain following the last 3 months) and quality of life, assessed with Carolinas comfort scale (CCS) at 12 months. Secondary outcomes were: wound infection, wound hypoesthesia, recurrence, readmission within 30 days, and reoperation. RESULTS A total of 300 patients were randomized (150 per group). After a follow-up of 12 months, we observed significantly less postoperative chronic groin pain, chronic pain at exertion, wound hypoesthesia, and wound infections after the TEP when compared to the TIPP procedure. No significant differences in quality of life, reoperations, recurrence rate, and readmission within 30 days were observed. CONCLUSION We showed that the TEP has a favorable outcome compared to the TIPP procedure, leading to less postoperative pain and wound complications, whereas recurrence rates and reoperations were equal in both the groups.
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Affiliation(s)
- J J Posthuma
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
| | - R Sandkuyl
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - D A Sloothaak
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - A Ottenhof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - J D W van der Bilt
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - J A H Gooszen
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - P C M Verbeek
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - K H In't Hof
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
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Tavoletti D, Nanka O, Rosano’ E, Cerchiara P, Cerutti E, Pecora L. A novel technique of ultrasound‐guided lateral cutaneous branch of the iliohypogastric nerve block: a cadaveric study. Acta Anaesthesiol Scand 2022; 66:1003-1008. [DOI: 10.1111/aas.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Diego Tavoletti
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Ondrej Nanka
- Institute of Anatomy, First Faculty of Medicine Charles University Prague Czech Republic
| | - Elisabetta Rosano’
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Paolo Cerchiara
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Elisabetta Cerutti
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
| | - Luca Pecora
- Anaesthesia and Intensive care of Transplantation and Major Surgery, Department of Emergency, Ospedali Riuniti di Ancona Italy
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Manolakos K, Zygogiannis K, Mousa C, Demesticha T, Protogerou V, Troupis T. Anatomical Variations of the Iliohypogastric Nerve: A Systematic Review of the Literature. Cureus 2022; 14:e24910. [PMID: 35698694 PMCID: PMC9186473 DOI: 10.7759/cureus.24910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
Several anatomical variations of the iliohypogastric nerve branches have been observed in earlier studies. Knowledge of these variations is useful for the improvement of peripheral nerve blocks and avoidance of iatrogenic nerve injuries during surgeries. The purpose of this study was to perform a systematic review of the literature about the anatomical topography and variations of the iliohypogastric nerve. An extensive search on PubMed, Scopus, and Web of Science electronic databases was conducted by the first author in November 2021, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Anatomical or cadaveric studies about the origin, the course, and the distribution of the iliohypogastric nerve were included in this review. Thirty cadaveric studies were included for qualitative analysis. Several anatomical variations of the iliohypogastric nerve were depicted including its general properties, its origin, its branching patterns, its course, its relation to anatomical landmarks, and its termination. Among them, the absence of the iliohypogastric nerve ranged from 0 to 34%, its origin from L1 ranged from 62.5 to 96.5%, and its isolated emergence from psoas major ranged from 47 to 94.5%. Numerous anatomical variations of the iliohypogastric nerve exist but are not commonly cited in classic anatomical textbooks. The branches of the iliohypogastric nerve may be damaged during spinal anesthesia and surgical procedures in the lower abdominal region. Therefore, a better understanding of the regional anatomy and its variations is of vital importance for the prevention of iliohypogastric nerve injuries.
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Idris S, Alshammari A, Alrashid F, Fathuldeen A, Khalifah E, Elamin A, Elhaj A. Anatomic pattern and variations of the ilioinguinal nerve as it travels throughout the anterior abdominal wall: Cadaveric study. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_155_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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PECULIARITIES OF INNERVATION OF MUSCLES AND SKIN OF THE ANTERIOR AND LATERAL ABDOMINAL WALLS IN HUMAN FETUSES. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-2-80-247-251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abdelrehem A, Shi J, Wang X, Wu Z, Mashrah MA, Zhang C, Li S, Zhang C, Wang L. A novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap. Head Neck 2021; 44:46-58. [PMID: 34664349 DOI: 10.1002/hed.26896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 09/30/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aimed to introduce a novel loop neurorrhaphy technique using an innervated vascularized iliac bone flap (VIBF) with vascularized ilioinguinal nerve (IIN) to reconstruct the inferior alveolar nerve (IAN) and preserve lower lip sensation simultaneously with mandibular reconstruction. METHODS This study prospectively included patients who underwent mandibular reconstruction using VIBF from May 2018 to April 2020. Subjects were allocated into two groups: (1) Group I; innervated VIBF with loop neurorrhaphy (IIN doubly anastomosed with IAN and mental nerve), (2) Group II (control); conventional VIBF. Evaluation was done with operative time, intraoperative indocyanine green (ICG), lower lip sensory assessment (two-point discrimination [TPD] test and current perception threshold [CPT]), and drooling. RESULTS Twelve patients were included; 6 in each group, (7 males and 5 females), age ranging from 18 to 57 years (average: 36.75 years). In all cases, intraoperative perfusion of IIN was confirmed by ICG. Group I showed a statistically significant more flap harvesting time compared with group II (mean difference, 5.67 min; P = 0.0091). There was a significant difference in sensory recovery favoring group I (P < 0.05). The TPD results in group I showed an average of 9.8 ± 6.9 mm and 6.2 ± 5.7 mm on operated and non-operated sides, while Group II showed a poor sensory recovery, and the TPD showed an average of 24.6 ± 6.7 mm and 8.4 ± 2.3 mm on operated and non-operated sides. The CPT results showed a significant difference between both groups. In Group I, the extent of drooling was 3.16 ± 0.75, while in Group II, the score was 1.6 ± 0.81, revealing a significant difference favoring Group I. CONCLUSIONS Concurrent mandibular reconstruction using VIBF and loop neurorrhaphy with vascularized IIN to reconstruct IAN successfully restore lower jaw form and preserve lip sensation.
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Affiliation(s)
- Ahmed Abdelrehem
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China.,Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Jingcun Shi
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xudong Wang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Ziqian Wu
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengyao Zhang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China.,Department of Head and Neck Cancer Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Siyi Li
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chenping Zhang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Lei Wang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
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Management of Groin Pain Using an Iliohypogastric Nerve Block in a Patient with Inguinal Hernia due to Persistent Müllerian Duct Syndrome. Case Rep Urol 2021; 2021:7577632. [PMID: 34422431 PMCID: PMC8376460 DOI: 10.1155/2021/7577632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/05/2021] [Indexed: 11/18/2022] Open
Abstract
Persistent Müllerian duct syndrome can cause an inguinal hernia, although this is a rare occurrence; recurrent inguinal hernias can, in turn, cause ongoing groin pain. Management of groin pain plays an important role in patients' quality of life. We present our experience with a 43-year-old man who had a 2-week history of left-sided groin pain. The patient underwent laparoscopic surgery for a left inguinal hernia via the transabdominal preperitoneal approach. Right-sided cryptorchidism was noted during surgery, with a solid structure-thought to be a uterus-extending into the left inguinal canal. The diagnosis was persistent Müllerian duct syndrome, and the groin pain was relieved after a laparoscopic right orchiectomy with a bilateral preperitoneal hernia repair using a mesh. Four years later, magnetic resonance imaging performed for new-onset left groin pain showed a left inguinal hernia caused by the uterine structure. We diagnosed the recurrent hernia as the cause of his pain. Prior to performing any invasive surgical procedures, an iliohypogastric nerve block was performed using 1% lidocaine. Short-term analgesia was provided by the block, improving his quality of life. He has been followed since then and has declined surgical neurectomy. An iliohypogastric nerve block can be an effective method of controlling groin pain caused by an inguinal hernia resulting from persistent Müllerian duct syndrome; the effectiveness of the nerve block will help determine whether surgical neurectomy is indicated for permanent pain control.
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Moreno-Egea A. A study to improve identification of the retroperitoneal course of iliohypogastric, ilioinguinal, femorocutaneous and genitofemoral nerves during laparoscopic triple neurectomy. Surg Endosc 2020; 35:1116-1125. [PMID: 32430523 DOI: 10.1007/s00464-020-07476-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic triple neurectomy is an available treatment option for chronic groin pain, but a poor working knowledge of the retroperitoneal neuroanatomy makes it an unsafe technique. OBJECT Describe the retroperitoneal course of iliohypogastric, ilioinguinal, lateral femoral cutaneous and genitofemoral nerves, to guide the surgeon who operates in this region. METHODS Fifty adult cadavers were dissected resulting in 100 anatomic specimens. Additionally, 30 patients were operated for refractory chronic inguinal pain, using laparoscopic triple neurectomy. All operations and dissections were photographed. Measurements were made between the nerves of the lumbar plexus and various landmarks: interneural distances in a vertical midline plane, posterior or anterior iliac spine and branch presentation model. RESULTS The ilioinguinal and iliohypogastric nerves were independent in 78% (Type II) and separated by an average of 2.5 ± 0.8 cm. In surgery study, only 38% were recognized as Type II and at a significantly greater distance (3.5 ± 1.2 cm, p < 0.001). The distance between ilioinguinal and lateral femoral cutaneous nerves was also greater during surgery, with statistical significance (5.1 ± 1.5 versus 4.2 ± 1.5, p < 0.005). The distance of the nerves to their bone references were not statistically different. The genitofemoral nerve emerged from the psoas major muscle in 20% as two separate branches (Type II), regardless of the study. The lateral femoral cutaneous nerve had a mean distance of 0.98 ± 1.6 cm medial to the anterior superior iliac spine. CONCLUSION The identification of the IH, II, FC and GF nerves is essential to reduce the rate of failures in the treatment of CGP. The frequent anatomical variations of the lumbar plexus nerves make knowledge of their courses in the retroperitoneal space essential to ensure safe surgery. The location of the nerves in the LTN is distorted by up to 1 cm. regarding references in the cadavers.
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Affiliation(s)
- Alfredo Moreno-Egea
- Hernia Clinic, La Vega University Hospital, Avda Primo de Rivera 7, 5ºD, 3008, Murcia, Spain.
- School of Medicine, San Antonio University, Murcia, Spain.
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Surgical treatment for chronic postoperative inguinal pain-short term outcomes of a specialized center. Am J Surg 2020; 219:425-428. [DOI: 10.1016/j.amjsurg.2019.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 11/19/2022]
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Flaherty JM, Auyong DB, Yuan SC, Lin SE, Meier AW, Biehl TR, Helton WS, Slee A, Hanson NA. Continuous Transversus Abdominis Plane Block for Primary Open Inguinal Hernia Repair: A Randomized, Double-Blind, Placebo-Controlled Trial. PAIN MEDICINE 2020; 21:e201-e207. [PMID: 31670776 DOI: 10.1093/pm/pnz275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Patients undergoing open inguinal hernia repair may experience moderate to severe postoperative pain. We assessed opioid consumption in subjects who received a continuous transversus abdominis plane block in addition to standard multimodal analgesia. DESIGN Randomized, double-blind, placebo-controlled. SETTING Tertiary academic medical center. SUBJECTS Adult patients undergoing open inguinal hernia repair at Virginia Mason Medical Center. A total of 90 patients were enrolled. METHODS Subjects presenting for surgery were randomized to receive either a continuous transversus abdominis plane block or a subcutaneous sham block. The primary outcome was opioid consumption within the first 48 hours after surgery. Secondary outcomes included pain scores, activities assessment scores, and opioid-related adverse events. Multimodal analgesia utilized in both groups included acetaminophen, nonsteroidal anti-inflammatory drugs, and surgical local anesthetic infiltration. RESULTS Eighty-two subjects, 42 from the block group and 40 from the sham group, completed the study, per protocol. The intention-to-treat analysis demonstrated no difference in 48-hour postoperative oxycodone equivalent consumption between the block and sham groups (27.8 mg ± 26.8 vs 32 mg ± 39.2, difference -4.4 mg, P = 0.55). There was a statistically significant reduction in pain scores at 24 hours in the block group. There were no other differences in secondary outcomes. CONCLUSIONS Continuous transversus abdominis plane blocks provide modest improvements in pain after open inguinal hernia repair but fail to significantly reduce opioid consumption or improve functional activity levels in the setting of multimodal analgesia use.
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Affiliation(s)
- James M Flaherty
- University of Minnesota, Department of Anesthesiology, Minneapolis, Minnesota.,Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
| | - David B Auyong
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
| | - Stanley C Yuan
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
| | - Shin-E Lin
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
| | - Adam W Meier
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington.,University of Utah, Department of Anesthesiology, Salt Lake City, Utah, USA
| | - Thomas R Biehl
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
| | - W Scott Helton
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
| | - April Slee
- University College London, Institute of Epidemiology and Healthcare, London, United Kingdom
| | - Neil A Hanson
- Virginia Mason Medical Center, Departments of Anesthesiology and General Surgery, Seattle, Washington
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Blaichman JI, Chan BY, Michelin P, Lee KS. US-guided Musculoskeletal Interventions in the Hip with MRI and US Correlation. Radiographics 2020; 40:181-199. [DOI: 10.1148/rg.2020190094] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jason I. Blaichman
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
| | - Brian Y. Chan
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
| | - Paul Michelin
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
| | - Kenneth S. Lee
- From the Department of Radiology, University of British Columbia, Royal Columbian Hospital, 300 Columbia St E, New Westminster, BC, Canada V3L 3W7 (J.I.B.); Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah (B.Y.C.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.M., K.S.L.)
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Konschake M, Zwierzina M, Moriggl B, Függer R, Mayer F, Brunner W, Schmid T, Chen DC, Fortelny R. The inguinal region revisited: the surgical point of view : An anatomical-surgical mapping and sonographic approach regarding postoperative chronic groin pain following open hernia repair. Hernia 2019; 24:883-894. [PMID: 31776877 PMCID: PMC7395915 DOI: 10.1007/s10029-019-02070-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Inguinodynia or chronic post-herniorrhaphy pain, defined as pain lasting longer than 3 months after open inguinal hernia repair, has become the most important complication after inguinal surgery and therefore compromises the patient´s quality of life. A major reason for inguinodynia might be the lack of neuroanatomical knowledge and suboptimal "management" of the nerves during surgery. METHODS We present a detailed neuroanatomic mapping of the inguinal region by dissection including the most important surgical landmarks with all nerves confirmed by immunohistochemistry, ultrasound guided visualization of the iliohypogastric, ilio-inguinal, and genital branch of the genitofemoral nerve, and a practical (preoperative) algorithm for clinical management. RESULTS Surgically and ultrasonographically relevant structures ("landmarks") in open hernia repair are the anterior-superior iliac spine, pubic tubercle, Camper´s fascia (superficial layer of the superficial abdominal fascia), External oblique aponeurosis, Internal oblique muscle, Transversus abdominis muscle, superficial inguinal ring, external spermatic fascia, cremasteric fascia with cremaster muscle fibers, internal spermatic fascia, cremasteric vein (=external spermatic vein = "blue line"), ductus deferens, pampiniform plexus, inguinal ligament and the inferior epigastric vessels. CONCLUSION A detailed understanding of inguinal anatomy is an indispensable basic requirement for all surgeons to perform inguinal ultrasonography as well as open inguinal hernia repair, avoiding complications, especially postoperative inguinodynia.
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Affiliation(s)
- M Konschake
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria.
| | - M Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - B Moriggl
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Müllerstr. 59, 6020, Innsbruck, Austria
| | - R Függer
- Department of Surgery, Elisabethinen Hospital, Linz, Austria
| | - F Mayer
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - W Brunner
- Department of Surgery, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - T Schmid
- Department for Visceral-, Transplantation- and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - D C Chen
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Lichtenstein Amid Hernia Clinic, Santa Monica, CA, USA
| | - R Fortelny
- Department of General-, Visceral- and Oncological Surgery, Wilhelminenspital, Vienna, Austria
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Mitchell KD, Smith CT, Mechling C, Wessel CB, Orebaugh S, Lim G. A review of peripheral nerve blocks for cesarean delivery analgesia. Reg Anesth Pain Med 2019; 45:rapm-2019-100752. [PMID: 31653797 PMCID: PMC7182469 DOI: 10.1136/rapm-2019-100752] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/20/2019] [Accepted: 10/11/2019] [Indexed: 11/03/2022]
Abstract
Peripheral nerve blocks have a unique role in postcesarean delivery multimodal analgesia regimens. In this review article, options for peripheral nerve blocks for cesarean delivery analgesia will be reviewed, specifically paravertebral, transversus abdominis plane, quadratus lumborum, iliohypogastric and ilioinguinal, erector spinae, and continuous wound infiltration blocks. Anatomy, existing literature evidence, and specific areas in need of future research will be assessed. Considerations for local anesthetic toxicity, and for informed consent for these modalities in the context of emergency cesarean deliveries, will be presented.
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Affiliation(s)
- Kelsey D Mitchell
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - C Tyler Smith
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Courtney Mechling
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Charles B Wessel
- Health Sciences Library, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Orebaugh
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Grace Lim
- Anesthesiology & Perioperative Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Anesthesiology, Perioperative Medicine, Obstetrics & Gynecology, UPMC Magee Womens Hospital, Pittsburgh, Pennsylvania, USA
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Clifton W, Nicolas Cruz CF, Dove C, Damon A, Pichelmann M, Nottmeier E. Abdominal wall paresis after posterior spine surgery: An anatomic explanation. Clin Neurol Neurosurg 2019; 186:105551. [PMID: 31605897 DOI: 10.1016/j.clineuro.2019.105551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Affiliation(s)
- William Clifton
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, United States.
| | | | - Conrad Dove
- Department of Education, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Aaron Damon
- Department of Education, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Mark Pichelmann
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Eric Nottmeier
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, FL, United States
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20
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Gupta A, Sondekoppam R, Kalagara H. Quadratus Lumborum Block: a Technical Review. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00338-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Toreih AA, Sallam AA, Ibrahim CM, Maaty AI, Hassan MM. Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study. J Neurosurg Spine 2019; 30:268-278. [DOI: 10.3171/2018.8.spine181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.
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Affiliation(s)
| | | | | | - Ahmed I. Maaty
- 3Physical Medicine, Rheumatology, and Rehabilitation, Suez Canal University Hospitals
| | - Mohsen M. Hassan
- 4Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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22
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Abstract
A review of anatomy, potential mechanisms of action, and techniques and summary of clinical evidence for quadratus lumborum block.
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23
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Anterograde colonic irrigations by percutaneous endoscopic caecostomy in refractory colorectal functional disorders. Int J Colorectal Dis 2019; 34:169-175. [PMID: 30406317 DOI: 10.1007/s00384-018-3183-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE In case reports or small studies, percutaneous endoscopic caecostomy (PEC) has been proposed as an alternative to the Malone intervention to perform antegrade colonic enemas. Our goal was to assess the feasibility, efficacy, and tolerance of PEC in a large group of patients with refractory colorectal functional disorders. METHODS From September 2006 to April 2014, all patients undergoing PEC for constipation, fecal incontinence, and incontinence after rectal resection in two expert centers were studied. The PEC procedure consisted in anchoring the caecum to the abdominal wall (caecopexy) and placing a specifically designed tube in the colonic lumen to perform antegrade enemas. The quality of life (GIQLI), constipation (Kess), and incontinence (Cleveland) scores were assessed before PEC and at 3, 6, 12, and 24 months. RESULTS A total of 69 patients were included. GIQLI scores were significantly improved in constipation group (n = 43), incontinence group (n = 19), and rectal resection group (n = 10). In the constipation group, Kess score decreased from 25.9 before PEC to 20.6 at 2 years (p = 0.01). In the incontinence and post-rectal resection groups, Cleveland scores decreased from 14.3 before PEC to 2.7 at 6 months (p = 0.01) and to 10.4 at 2 years (p = 0.04). Overall, PEC was considered successful by patients in 58%, 74%, and 90% of cases, in constipation, incontinence, and rectal resection groups, respectively. Chronic pain (52%) at the catheter site was the most frequent complication. CONCLUSIONS Percutaneous endoscopic caecostomy for antegrade colonic enemas improves significantly the quality of life of patients with colorectal disorder refractory to medical treatment.
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Cirocchi R, Henry BM, Mercurio I, Tomaszewski KA, Palumbo P, Stabile A, Lancia M, Randolph J. Is it possible to identify the inguinal nerves during hernioplasty? A systematic review of the literature and meta-analysis of cadaveric and surgical studies. Hernia 2018; 23:569-581. [PMID: 30570686 PMCID: PMC6586705 DOI: 10.1007/s10029-018-1857-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/08/2018] [Indexed: 11/27/2022]
Abstract
Purpose Patients who undergo inguinal hernioplasty may suffer from persistent postoperative pain due to inguinal nerve injuries. The aim of this systematic review and meta-analysis was to provide comprehensive data on the prevalence (identification rates), anatomical characteristics, and ethnic variations of the ilioinguinal (IIN), the iliohypogastric (IHN) and the genital branch of the genitofemoral (GNF) nerves. Methods The systematic literature search was conducted using the PubMed, Scopus and Web of Science databases. Results A total of 26 articles (5265 half-body examinations) were included in this study. The identification rate of the IIN was 94.4% (95% CI 89.5–97.9) using a random-effects model. Unweighted multiple regression analysis showed that study sample size (β = − 0.74, p = .036) was the only statistically significant predictor of lower prevalence. The identification rates of the IHN and GNF was 86.7% (95% CI 78.3%–93.3%) and 69.1% (95% CI 53.1%–83.0%) using a random-effects model, respectively. For those outcomes, a visual analysis of funnel and Doi plots indicated irregularity and provided evidence that larger studies tended to have lower identification rates. In terms of the synthesis of anatomical reference points, there was a large and statistically significant amount of heterogeneity for most outcomes. Conclusions The identification rates of the inguinal nerves in our study were lower than reported in literature. The lowest was found for GNF, suggesting that this nerve was the most difficult to identify. Knowledge regarding the anatomy of the inguinal nerves can facilitate their proper identification and reduce the risk of iatrogenic injury and postoperative pain.
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Affiliation(s)
- R Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - B M Henry
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034, Kraków, Poland.
| | - I Mercurio
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - K A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika Street, 31-034, Kraków, Poland
| | - P Palumbo
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - A Stabile
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - M Lancia
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - J Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
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Naja Z, Kanawati S, Khatib ZE, Ziade F, Nasreddine R, Naja AS. Three versus five lumbar paravertebral injections for inguinal hernia repair in the elderly: a randomized double-blind clinical trial. J Anesth 2018; 33:50-57. [PMID: 30446826 DOI: 10.1007/s00540-018-2582-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/01/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The objective of the study was to compare three nerve stimulator-guided paravertebral injections versus five injections for elderly patients undergoing inguinal hernia repair in terms of the amount of intraoperative fentanyl and propofol consumption and conversion to general anesthesia. The secondary objective was postoperative pain. METHODS A prospective, randomized, double-blind clinical trial was performed. 200 elderly patients undergoing unilateral herniorrhaphy were randomized into two groups. Group III received three PVB injections from T12 to L2 and placebo at T11 and L3. Group V received five PVB injections from T11 to L3. RESULTS The mean intraoperative fentanyl and propofol consumption were significantly lower in group V (4.9 ± 7.2 µg versus 20.0 ± 12.9 µg and 5.7 ± 11.6 mg versus 34.6 ± 22.9 mg, respectively, p value < 0.0001). Five patients (5.0%) in group III had failed block and were converted to general anesthesia (p value = 0.024). Group V had significantly lower pain scores compared to group III during the first three postoperative days (p value < 0.0001). CONCLUSION The five PVB injection technique is more suitable as a sole anesthetic technique for elderly patients undergoing herniorrhaphy, since it required less intraoperative supplemental analgesia and provided lower postoperative pain scores compared to the three PVB injection technique. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02537860.
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Affiliation(s)
- Zoher Naja
- Anesthesia and Pain Management Department, Makassed General Hospital, P.O. Box: 11-6301, Riad EI-Solh, Beirut, 11072210, Lebanon.
| | - Saleh Kanawati
- Anesthesia and Pain Management Department, Makassed General Hospital, P.O. Box: 11-6301, Riad EI-Solh, Beirut, 11072210, Lebanon
| | - Ziad El Khatib
- Surgery Department, Makassed General Hospital, Beirut, Lebanon
| | - Fouad Ziade
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
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Abstract
INTRODUCTION Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery. METHODS An expert group of international surgeons (the HerniaSurge Group) and one anesthesiologist pain expert was formed. The group consisted of members from all continents with specific experience in hernia-related research. Care was taken to include surgeons who perform different types of repair and had preferably performed research on groin hernia surgery. During the Group's first meeting, evidence-based medicine (EBM) training occurred and 166 key questions (KQ) were formulated. EBM rules were followed in complete literature searches (including a complete search by The Dutch Cochrane database) to January 1, 2015 and to July 1, 2015 for level 1 publications. The articles were scored by teams of two or three according to Oxford, SIGN and Grade methodologies. During five 2-day meetings, results were discussed with the working group members leading to 136 statements and 88 recommendations. Recommendations were graded as "strong" (recommendations) or "weak" (suggestions) and by consensus in some cases upgraded. In the Results and summary section below, the term "should" refers to a recommendation. The AGREE II instrument was used to validate the guidelines. An external review was performed by three international experts. They recommended the guidelines with high scores. The risk factors for inguinal hernia (IH) include: family history, previous contra-lateral hernia, male gender, age, abnormal collagen metabolism, prostatectomy, and low body mass index. Peri-operative risk factors for recurrence include poor surgical techniques, low surgical volumes, surgical inexperience and local anesthesia. These should be considered when treating IH patients. IH diagnosis can be confirmed by physical examination alone in the vast majority of patients with appropriate signs and symptoms. Rarely, ultrasound is necessary. Less commonly still, a dynamic MRI or CT scan or herniography may be needed. The EHS classification system is suggested to stratify IH patients for tailored treatment, research and audit. Symptomatic groin hernias should be treated surgically. Asymptomatic or minimally symptomatic male IH patients may be managed with "watchful waiting" since their risk of hernia-related emergencies is low. The majority of these individuals will eventually require surgery; therefore, surgical risks and the watchful waiting strategy should be discussed with patients. Surgical treatment should be tailored to the surgeon's expertise, patient- and hernia-related characteristics and local/national resources. Furthermore, patient health-related, life style and social factors should all influence the shared decision-making process leading up to hernia management. Mesh repair is recommended as first choice, either by an open procedure or a laparo-endoscopic repair technique. One standard repair technique for all groin hernias does not exist. It is recommended that surgeons/surgical services provide both anterior and posterior approach options. Lichtenstein and laparo-endoscopic repair are best evaluated. Many other techniques need further evaluation. Provided that resources and expertise are available, laparo-endoscopic techniques have faster recovery times, lower chronic pain risk and are cost effective. There is discussion concerning laparo-endoscopic management of potential bilateral hernias (occult hernia issue). After patient consent, during TAPP, the contra-lateral side should be inspected. This is not suggested during unilateral TEP repair. After appropriate discussions with patients concerning results tissue repair (first choice is the Shouldice technique) can be offered. Day surgery is recommended for the majority of groin hernia repair provided aftercare is organized. Surgeons should be aware of the intrinsic characteristics of the meshes they use. Use of so-called low-weight mesh may have slight short-term benefits like reduced postoperative pain and shorter convalescence, but are not associated with better longer-term outcomes like recurrence and chronic pain. Mesh selection on weight alone is not recommended. The incidence of erosion seems higher with plug versus flat mesh. It is suggested not to use plug repair techniques. The use of other implants to replace the standard flat mesh in the Lichtenstein technique is currently not recommended. In almost all cases, mesh fixation in TEP is unnecessary. In both TEP and TAPP it is recommended to fix mesh in M3 hernias (large medial) to reduce recurrence risk. Antibiotic prophylaxis in average-risk patients in low-risk environments is not recommended in open surgery. In laparo-endoscopic repair it is never recommended. Local anesthesia in open repair has many advantages, and its use is recommended provided the surgeon is experienced in this technique. General anesthesia is suggested over regional in patients aged 65 and older as it might be associated with fewer complications like myocardial infarction, pneumonia and thromboembolism. Perioperative field blocks and/or subfascial/subcutaneous infiltrations are recommended in all cases of open repair. Patients are recommended to resume normal activities without restrictions as soon as they feel comfortable. Provided expertise is available, it is suggested that women with groin hernias undergo laparo-endoscopic repair in order to decrease the risk of chronic pain and avoid missing a femoral hernia. Watchful waiting is suggested in pregnant women as groin swelling most often consists of self-limited round ligament varicosities. Timely mesh repair by a laparo-endoscopic approach is suggested for femoral hernias provided expertise is available. All complications of groin hernia management are discussed in an extensive chapter on the topic. Overall, the incidence of clinically significant chronic pain is in the 10-12% range, decreasing over time. Debilitating chronic pain affecting normal daily activities or work ranges from 0.5 to 6%. Chronic postoperative inguinal pain (CPIP) is defined as bothersome moderate pain impacting daily activities lasting at least 3 months postoperatively and decreasing over time. CPIP risk factors include: young age, female gender, high preoperative pain, early high postoperative pain, recurrent hernia and open repair. For CPIP the focus should be on nerve recognition in open surgery and, in selected cases, prophylactic pragmatic nerve resection (planned resection is not suggested). It is suggested that CPIP management be performed by multi-disciplinary teams. It is also suggested that CPIP be managed by a combination of pharmacological and interventional measures and, if this is unsuccessful, followed by, in selected cases (triple) neurectomy and (in selected cases) mesh removal. For recurrent hernia after anterior repair, posterior repair is recommended. If recurrence occurs after a posterior repair, an anterior repair is recommended. After a failed anterior and posterior approach, management by a specialist hernia surgeon is recommended. Risk factors for hernia incarceration/strangulation include: female gender, femoral hernia and a history of hospitalization related to groin hernia. It is suggested that treatment of emergencies be tailored according to patient- and hernia-related factors, local expertise and resources. Learning curves vary between different techniques. Probably about 100 supervised laparo-endoscopic repairs are needed to achieve the same results as open mesh surgery like Lichtenstein. It is suggested that case load per surgeon is more important than center volume. It is recommended that minimum requirements be developed to certify individuals as expert hernia surgeon. The same is true for the designation "Hernia Center". From a cost-effectiveness perspective, day-case laparoscopic IH repair with minimal use of disposables is recommended. The development and implementation of national groin hernia registries in every country (or region, in the case of small country populations) is suggested. They should include patient follow-up data and account for local healthcare structures. A dissemination and implementation plan of the guidelines will be developed by global (HerniaSurge), regional (international societies) and local (national chapters) initiatives through internet websites, social media and smartphone apps. An overarching plan to improve access to safe IH surgery in low-resource settings (LRSs) is needed. It is suggested that this plan contains simple guidelines and a sustainability strategy, independent of international aid. It is suggested that in LRSs the focus be on performing high-volume Lichtenstein repair under local anesthesia using low-cost mesh. Three chapters discuss future research, guidelines for general practitioners and guidelines for patients. CONCLUSIONS The HerniaSurge Group has developed these extensive and inclusive guidelines for the management of adult groin hernia patients. It is hoped that they will lead to better outcomes for groin hernia patients wherever they live. More knowledge, better training, national audit and specialization in groin hernia management will standardize care for these patients, lead to more effective and efficient healthcare and provide direction for future research.
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Mol FM, Lataster A, Scheltinga M, Roumen R. Anatomy of abdominal anterior cutaneous intercostal nerves with respect to the pathophysiology of anterior cutaneous nerve entrapment syndrome (ACNES): A case study. TRANSLATIONAL RESEARCH IN ANATOMY 2017. [DOI: 10.1016/j.tria.2017.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Castañeda-Herrera FE, Buriticá-Gaviria EF, Echeverry-Bonilla DF. Anatomical Evaluation of the Thoracolumbar Nerves Related to the Transversus Abdominis Plane Block Technique in the Dog. Anat Histol Embryol 2017. [PMID: 28643890 DOI: 10.1111/ahe.12279] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Transversus abdominis plane (TAP) is a fascial plane containing the thoracolumbar nerve branches that innervate the abdominal wall. Limited information is available on the anatomical organization of these nerve branches in the dog, which is of great importance for the success of the TAP block anaesthetic technique. The aim of this study was to describe the origin and conformation of thoracolumbar nerves running through the TAP in 20 hemi-abdominal walls of 10 adult mongrel dog cadavers with an average body weight of 12.6 kg (range: 9.6-15.6). The abdominal walls were dissected from superficial to deep direction, the skin and both obliquus externus abdominis and obliquus internus abdominis muscles were dissected and reflected dorsally to expose the transversus abdominis muscle and the thoracolumbar nerve branches located in this plane. The anatomical features of ventral nerve branches were described. The thoracic nerve branches: T7-T12 and costoabdominalis; and the lumbar nerve branches: iliohypogastricus cranialis, iliohypogastricus caudalis, ilioinguinalis and cutaneus femoris lateralis were identified in all the cadavers. Anatomical variations related to the presence or absence within the TAP of the T7, T8 and T9 nerve branches were found. These variations should be taken into account when planning the TAP block technique in dogs.
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Affiliation(s)
- F E Castañeda-Herrera
- Grupo de investigación en Medicina y Cirugía de Pequeños Animales, Universidad del Tolima, Ibagué, 730006299, Colombia.,Facultad de Ciencias Agropecuarias, Universidad de Ciencias Aplicadas y Ambientales U.D.C.A., Bogotá, 111166, Colombia
| | - E F Buriticá-Gaviria
- Grupo de investigación en Medicina y Cirugía de Pequeños Animales, Universidad del Tolima, Ibagué, 730006299, Colombia
| | - D F Echeverry-Bonilla
- Grupo de investigación en Medicina y Cirugía de Pequeños Animales, Universidad del Tolima, Ibagué, 730006299, Colombia
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Preventing Early-Stage Graft Bone Resorption by Simultaneous Innervation. Plast Reconstr Surg 2017; 139:1152e-1161e. [DOI: 10.1097/prs.0000000000003263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kiran LV, Sivashanmugam T, Kumar VRH, Krishnaveni N, Parthasarathy S. Relative Efficacy of Ultrasound-guided Ilioinguinal-iliohypogastric Nerve Block versus Transverse Abdominis Plane Block for Postoperative Analgesia following Lower Segment Cesarean Section: A Prospective, Randomized Observer-blinded Trial. Anesth Essays Res 2017; 11:713-717. [PMID: 28928576 PMCID: PMC5594795 DOI: 10.4103/0259-1162.206855] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Quality of postoperative analgesia after cesarean section makes difference to mother in child bonding, early ambulation, and discharge. Ilioinguinal iliohypogastric (ILIH) and transverse abdominis plane (TAP) block had been tried to reduce the opioid analgesics, but the relative efficacy is unknown. Hence, this study was designed to compare the efficacy of these two regional analgesic techniques in sparing postoperative rescue analgesic requirement following lower segment cesarean section (LSCS). METHODS Sixty patients who underwent LSCS were randomly allocated into two groups to receive either US-guided TAP block or ILIH nerve block using sealed envelope technique at the end of the surgery. In the postoperative ward, whenever patient complained of pain, pain nurse in-charge administered the rescue analgesics as per the study protocol. A blinded observer visited the patient at 0, 2, 4, 6, 8, 10, 12, and 24 h postoperative intervals and recorded the quality of pain relief and the amount of rescue analgesic consumed. RESULTS All patients in both the study groups required one dose of rescue analgesics in the form of injection diclofenac sodium 50 mg intravenously but subsequently 57% of patients did not require any further analgesics till 24 h in the TAP block group whereas in ILIH group, only 13% did not require further analgesics (P = 0.00), correspondingly the cumulative tramadol dose was significantly higher at all the time interval in the ILIH group when compared to the TAP group. CONCLUSION Quality of postoperative analgesia provided by TAP block was superior to ILIH block following LSCS.
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Affiliation(s)
- L Vamsee Kiran
- Department of Anaesthesiology, RVM Medical College, Medak, Telangana, India
| | - T Sivashanmugam
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
| | - V R Hemanth Kumar
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
| | - N Krishnaveni
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
| | - S Parthasarathy
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, India
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Stav A, Reytman L, Stav MY, Troitsa A, Kirshon M, Alfici R, Dudkiewicz M, Sternberg A. Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy. Rambam Maimonides Med J 2016; 7:RMMJ.10248. [PMID: 27487311 PMCID: PMC5001793 DOI: 10.5041/rmmj.10248] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We hypothesized that preoperative (pre-op) ultrasound (US)-guided posterior transversus abdominis plane block (TAP) and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG) will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately. METHODS This is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups. RESULTS A total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two "block" groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each "block" group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar. CONCLUSION Ultrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.).
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Affiliation(s)
- Anatoli Stav
- Postanesthesia Care Unit, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Leonid Reytman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Anesthesiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Michael-Yohay Stav
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Anton Troitsa
- Department of Surgery A, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mark Kirshon
- Department of Surgery A, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ricardo Alfici
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Surgery B, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mickey Dudkiewicz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Director-General, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ahud Sternberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Surgery A, Hillel Yaffe Medical Center, Hadera, Israel
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Affiliation(s)
- David K Nguyen
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Parviz K Amid
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Lichtenstein Amid Hernia Clinic at UCLA, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA
| | - David C Chen
- Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA; Lichtenstein Amid Hernia Clinic at UCLA, 1304 15th Street, Suite 102, Santa Monica, CA 90404, USA.
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A cadaveric study of the anatomical variations of the lumbar plexus with clinical implications. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pneumoperitoneum Does Not Influence Spread of Local Anesthetics in Midaxillary Approach Transversus Abdominis Plane Block: A Descriptive Cadaver Study. Reg Anesth Pain Med 2016; 40:349-54. [PMID: 26066380 DOI: 10.1097/aap.0000000000000260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The transversus abdominis plane (TAP) block can be used as part of a multimodal analgesia protocol after abdominal surgery. This study investigated whether a pneumoperitoneum during abdominal surgery influences the spread of local anesthetics. METHODS Nine fresh frozen cadavers were used for the study. Using an ultrasound-guided midaxillary technique, a unilateral TAP block-like injection with 20 mL of methylene blue dye was performed. After the injection, a pneumoperitoneum was immediately installed for 1 hour. After desufflation, this ipsilateral side was dissected, and a TAP block-like injection was performed on the contralateral side. One hour after injection, the contralateral side was also dissected. The anatomical dissection was used to determine the extent of dye spread and the nerves stained by the dye. RESULTS In none of the specimens did the dye reach the posterior origin of the transverse abdominal muscle. There was no statistically significant difference in the number of stained nerves and spread of the dye in the insufflated side compared with the noninsufflated side. In 4 of 9 cadavers, we found a variant course of a nerve preventing staining of that nerve. CONCLUSIONS The stretch of the abdominal wall caused by the insufflation of the abdomen does not influence the spread of dye in the abdominal wall. Because of the absence of posterior spread, regardless of the timing of a midaxillary ultrasound-guided approach, we believe that a posterior approach should be chosen if posterior spread is desired.
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Surgical management of postoperative chronic inguinodynia by laparoscopic transabdominal preperitoneal approach. Surg Endosc 2016; 30:5222-5227. [DOI: 10.1007/s00464-016-4867-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
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Geh N, Schultz M, Yang L, Zeller J. Retroperitoneal course of iliohypogastric, ilioinguinal, and genitofemoral nerves: A study to improve identification and excision during triple neurectomy. Clin Anat 2015; 28:903-9. [DOI: 10.1002/ca.22592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Ndi Geh
- University of Michigan Medical School; Ann Arbor Michigan
| | - Mike Schultz
- University of Michigan Medical School; Ann Arbor Michigan
| | - Lynda Yang
- Department of Neurosurgery; University of Michigan Medical School; Ann Arbor Michigan
| | - John Zeller
- Department of Surgery; University of Michigan Medical School; Ann Arbor Michigan
- Department of Orthopedic Surgery; University of Michigan Medical School; Ann Arbor Michigan
- Department of Emergency Medicine; University of Michigan Medical School; Ann Arbor Michigan
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Reinpold W, Schroeder AD, Schroeder M, Berger C, Rohr M, Wehrenberg U. Retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve: consequences for prevention and treatment of chronic inguinodynia. Hernia 2015; 19:539-48. [PMID: 26082397 DOI: 10.1007/s10029-015-1396-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/06/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Chronic inguinodynia is one of the most frequent complications after groin herniorrhaphy. We investigated the retroperitoneal anatomy of the iliohypogastric, ilioinguinal, genitofemoral, and lateral femoral cutaneous nerve to prevent direct nerve injury during hernia repairs and to find the most advantageous approach for posterior triple neurectomy. METHODS We dissected the inguinal nerves in 30 human anatomic specimens bilaterally. The distances from each nerve and their entry points in the abdominal wall were measured in relation to the posterior superior iliac spine, anterior superior iliac spine, and the midpoint between the two iliac spines on the iliac crest. We evaluated our findings by creating high-resolution summation images. RESULTS The courses of the iliohypogastric and ilioinguinal nerve are most consistent on the anterior surface of the quadratus lumborum muscle. The genitofemoral nerve always runs on the psoas muscle. The entry points of the nerves in the abdominal wall are located as follows: the iliohypogastric nerve is above the iliac crest and lateral from the anterior superior iliac spine, the ilioinguinal nerve is with great variability, either above or below the iliac crest and lateral from the anterior superior iliac spine, the genital branch is around the internal inguinal ring, the femoral branch is either cranial or caudal to the iliopubic tract, and the lateral femoral cutaneous nerve is either medial or lateral to the anterior superior iliac spine. CONCLUSION Nerve injury during inguinal hernia repairs can be avoided by taking the topographic anatomy of the inguinal nerves into consideration. The most advantageous plane to look for the iliohypogastric and ilioinguinal nerve during posterior neurectomy is on the anterior surface of the quadratus lumborum muscle. For the surgical treatment of severe chronic inguinodynia, especially after posterior open or endoscopic mesh repair (TAPP/TEP), the retroperitoneoscopic or open retroperitoneal approach for posterior triple neurectomy can be considered.
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Affiliation(s)
- W Reinpold
- Wilhelmsburg Gross Sand Hospital and Hernia Center, Academic Teaching Hospital of the University of Hamburg, Gross-Sand 3, 21107, Hamburg, Germany,
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Does percutaneous internal ring suturing contain risk of ilioinguinal nerve entrapment? Pediatr Surg Int 2015; 31:485-91. [PMID: 25772161 DOI: 10.1007/s00383-015-3689-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2015] [Indexed: 01/23/2023]
Abstract
PURPOSE In this study, we aim to assess the alteration of IIN functions in children with inguinal hernias operated on using open or 'percutaneous internal ring suturing' (PIRS). METHODS This study was based on a prospective clinical trial of 60 pediatric patients. They were operated on using PIRS or conventional open hernia repair technique. Group 1 included 35 patients who were treated with PIRS technique. Group 2 included 22 patients who underwent a conventional open hernia repair. The ilioinguinal nerve stimuli in both the operational and non-operational areas were evaluated in patients with peripheral EMG for possible ilioinguinal nerve damage on the hernia side before the operation and to reevaluate ilioinguinal nerve function in the third postoperative week. RESULT In Group 1, 19 cases underwent a preoperative EMG examination and in 35 cases, EMG examination was obtained postoperatively. Pre- and postoperative EMG results were normal in all cases in Group 1 on both the operational and non-operational sides. In Group 2, 15 preoperative and 25 postoperative EMG examinations were obtained. In Group 2, only one case with a right inguinal hernia who had normal preoperative EMG results showed no IIN response in a postoperative EMG evaluation obtained in the third postoperative week, with a normal left-side response. The EMG was repeated at the three-month postoperative third mark and revealed the same result. In a six-year-old female case, there was a negative EMG response on the non-operative side both pre- and postoperatively.
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Gizzo S, Andrisani A, Noventa M, Di Gangi S, Quaranta M, Cosmi E, D’Antona D, Nardelli GB, Ambrosini G. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review. PLoS One 2015; 10:e0114190. [PMID: 25646621 PMCID: PMC4315586 DOI: 10.1371/journal.pone.0114190] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/05/2014] [Indexed: 02/06/2023] Open
Abstract
The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.
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Affiliation(s)
- Salvatore Gizzo
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | | | - Marco Noventa
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Stefania Di Gangi
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Michela Quaranta
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Erich Cosmi
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | - Donato D’Antona
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
| | | | - Guido Ambrosini
- Department of Women’s and Children’s Health—University of Padua, Padua, Italy
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Yamamoto T, Yamamoto N, Koshima I. Sensate superficial inferior epigastric artery flap innervated by the iliohypogastric nerve for reconstruction of a finger soft tissue defect. Microsurgery 2014; 35:324-7. [DOI: 10.1002/micr.22360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; Tokyo Japan
- Department of Plastic Surgery; Noda Hospital; Chiba Japan
| | - Nana Yamamoto
- Department of Plastic Surgery; Toranomon Hospital; Tokyo Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery; the University of Tokyo; Tokyo Japan
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Belci D, Di Renzo GC, Stark M, Đurić J, Zoričić D, Belci M, Peteh LL. Morbidity and chronic pain following different techniques of caesarean section: A comparative study. J OBSTET GYNAECOL 2014; 35:442-6. [DOI: 10.3109/01443615.2014.968114] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Demirci A, Efe EM, Türker G, Gurbet A, Kaya FN, Anil A, Çimen İ. Bloqueio dos nervos ílio‐hipogástrico/ilioinguinal em correção de hérnia inguinal para tratamento da dor no pós‐operatório: comparação entre a técnica de marcos anatômicos e a guiada por ultrassom. Braz J Anesthesiol 2014; 64:350-6. [DOI: 10.1016/j.bjan.2014.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/02/2014] [Indexed: 11/16/2022] Open
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Visoiu M. Outpatient analgesia via paravertebral peripheral nerve block catheter and On-Q pump--a case series. Paediatr Anaesth 2014; 24:875-8. [PMID: 24815589 DOI: 10.1111/pan.12427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/30/2022]
Abstract
Outpatient pain management after iliac crest bone harvesting can be challenging. We report the use of home L2 paravertebral nerve block catheter (L2PVBC) in a series of five children. The pain scores were low, and analgesic medication consumption was minimal. No complications were reported related with these catheters, and the patients reported very high pain control satisfaction scores. Outpatient L2PVBC can be beneficial as part of a multimodal analgesia strategy in selected pediatric patients.
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Affiliation(s)
- Mihaela Visoiu
- Department of Anesthesiology, Acute Interventional Pediatric Perioperative Pain Service, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Percutaneous endoscopic caecostomy for severe constipation in adults: feasibility, durability, functional and quality of life results at 1 year follow-up. Surg Endosc 2014; 29:620-6. [DOI: 10.1007/s00464-014-3709-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 06/25/2014] [Indexed: 12/22/2022]
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Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res 2014; 7:277-90. [PMID: 24920934 PMCID: PMC4045265 DOI: 10.2147/jpr.s47005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Inguinal hernia repair is one of the most common surgeries performed worldwide. With the success of modern hernia repair techniques, recurrence rates have significantly declined, with a lower incidence than the development of chronic postherniorrhaphy inguinal pain (CPIP). The avoidance of CPIP is arguably the most important clinical outcome and has the greatest impact on patient satisfaction, health care utilization, societal cost, and quality of life. The etiology of CPIP is multifactorial, with overlapping neuropathic and nociceptive components contributing to this complex syndrome. Treatment is often challenging, and no definitive treatment algorithm exists. Multidisciplinary management of this complex problem improves outcomes, as treatment must be individualized. Current medical, pharmacologic, interventional, and surgical management strategies are reviewed.
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Affiliation(s)
| | - Andrea L Nicol
- Department of Anesthesiology, University of Kansas, Kansas City, KS, USA
| | - Parviz K Amid
- Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, UCLA, Los Angeles, CA, USA
| | - David C Chen
- Department of Surgery, Lichtenstein Amid Hernia Clinic at UCLA, UCLA, Los Angeles, CA, USA
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Soldatos T, Andreisek G, Thawait GK, Guggenberger R, Williams EH, Carrino JA, Chhabra A. High-resolution 3-T MR neurography of the lumbosacral plexus. Radiographics 2014; 33:967-87. [PMID: 23842967 DOI: 10.1148/rg.334115761] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The lumbosacral plexus comprises a network of nerves that provide motor and sensory innervation to most structures of the pelvis and lower extremities. It is susceptible to various traumatic, inflammatory, metabolic, and neoplastic processes that may lead to lumbrosacral plexopathy, a serious and often disabling condition whose course and prognosis largely depend on the identification and cure of the causative condition. Whereas diagnosis of lumbrosacral plexopathy has traditionally relied on patients' medical history, clinical examination, and electrodiagnostic tests, magnetic resonance (MR) neurography plays an increasingly prominent role in noninvasive characterization of the type, location, and extent of lumbrosacral plexus involvement and is developing into a useful diagnostic tool that substantially affects disease management. With use of 3-T MR imagers, improved coils, and advanced imaging sequences, which provide exquisite spatial resolution and soft-tissue contrast, MR neurography provides excellent depiction of the lumbrosacral plexus and its peripheral branches and may be used to confirm a diagnosis of lumbrosacral plexopathy with high accuracy or provide superior anatomic information should surgical intervention be necessary.
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Affiliation(s)
- Theodoros Soldatos
- Russell H. Morgan Department of Radiology and Radiological Science and Department of Plastic Surgery, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287, USA
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Regev GJ, Kim CW. Safety and the anatomy of the retroperitoneal lateral corridor with respect to the minimally invasive lateral lumbar intervertebral fusion approach. Neurosurg Clin N Am 2014; 25:211-8. [PMID: 24703441 DOI: 10.1016/j.nec.2013.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Safe and reproducible outcomes of the lateral lumbar intervertebral fusion (LLIF) procedure rely on meticulous care and understanding of the anatomy of the lateral corridor. This review aims to describe the different important anatomic considerations when performing LLIF and offer technical notes that may help increase the safety of this procedure. The LLIF procedure is divided into 5 stages: patient positioning, abdominal wall dissection, retroperitoneal space dissection, deployment of the surgical retractors, and diskectomy. Each stage is preformed in a distinct anatomic compartment that may cause different typical complications.
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Affiliation(s)
- Gilad J Regev
- Spine Surgery Unit, Departments of Neurosurgery and Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Choll W Kim
- Spine Institute of San Diego, San Diego, CA, USA; Center for Minimally Invasive Spine Surgery, Alvarado Hospital and Pomerado Hospital, Palomar Health, San Diego, CA, USA.
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Baranowski AP, Lee J, Price C, Hughes J. Pelvic pain: a pathway for care developed for both men and women by the British Pain Society. Br J Anaesth 2014; 112:452-9. [PMID: 24394942 DOI: 10.1093/bja/aet421] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
This paper aims to explain the key points and highlight some of the controversies in the development of the British Pain Society's pelvic pain patient pathway map. Many clinicians lack experience and confidence with this group of patients, and this issue is highlighted. Additionally, the difficulties of classification and definitions in this area are discussed in detail. These are historical causes of disagreement among specialists which can lead to confused clinical care. This group of patients have multiple issues that cross many professional boundaries; they are best managed by the co-ordinated involvement of multiple teams. Patients suffer from significant distress and disability that often needs specialist assessment and intervention (interdisciplinary). This suggests that an integrated approach is required across the historic boundaries of primary and secondary care. A variety of interventions, including opioids and neuromodulation are recommended in the pathway and the controversies surrounding these inclusions are aired in detail.
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Affiliation(s)
- A P Baranowski
- Pain Medicine, Pain Management Centre, National Hospital for Neurology & Neurosurgery, University College London Hospitals Foundation Trust, London WC1N 3BG, UK
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