ORIGINAL ARTICLE Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for chronic pain after inguinal hernia repair I. Thomassen • J. A. van Suijlekom • A. van de Gaag • J. E. H. Ponten • S. W. Nienhuijs Received: 14 April 2012 / Accepted: 16 September 2012 Ó Springer-Verlag France 2012 Abstract Purpose The aim of this study was to evaluate the out- come of ilioinguinal and iliohypogastric nerve blocks in patients with chronic pain after herniorrhaphy, by com- paring nerve stimulator and ultrasound guidance to administer the block. Methods A total of 43 patients who received nerve blocks for chronic inguinal post-herniorrhaphy pain received standardized questionnaires. Nerve stimulator–guided blocks were performed prior to January 2009, and there- after, ultrasound-guided blocks were performed using a local anaesthetic solution and a corticosteroid. Results The questionnaire was completed by 38 patients (88 %). The inguinal hernia repair was performed for a median 16 months (range 3–219) ahead of the nerve blocks. A median of 2 pain treatments (range 1–7) was calculated. Median follow-up was 21 months (range 3–68). According to the DN4, 21 patients (55.3 %) no longer reported neuropathic pain. Subjectively, 32 % no longer reported moderate-to-severe pain. After ultrasound-guided blocks, a higher VAS score (at rest and during activities), a higher proportion of daily pain and more anxiety and depression are reported compared to blocks performed after nerve stimulator guidance. Conclusions Ilioinguinal/iliohypogastric nerve blocks can be effective to treat chronic inguinal pain following surgery of the groin. The use of ultrasound was not superior to nerve stimulator–guided blocks. These blocks could be considered prior to more invasive procedures such as neurectomy. Keywords Ilioinguinal Á Iliohypogastric Á Nerve block Á Ultrasound Á Chronic post-surgical pain Á Inguinal hernia Introduction Inguinal hernia repair is one of the most commonly per- formed surgical procedures worldwide. Chronic post-sur- gical pain (CPSP) after inguinal hernia repair occurs frequently with a mean incidence of 11 % (range 0–43 %), resulting in the main problem after inguinal hernia repair [1]. This pain can be invalidating with a neuropathic character. Treatment modalities of this neuropathic pain include pharmacotherapy, peripheral nerve blocks, pulsed radiofrequency treatment, transcutaneous electrical nerve stimulation (TENS), peripheral nerve field stimulation, mesh/staple removal, neurectomy and cryoanalgesic abla- tion [2]. An ilioinguinal or iliohypogastric nerve block is a rather simple and useful regional anaesthetic technique for post- operative analgesia after inguinal surgery [3–6]. Despite its seemingly easy implementation, a relatively high failure rate of 10–25 % has been reported [7]. To decrease this failure rate, a technique using ultrasound to visualize the nerve, before injecting local anaesthetics, is described [6–8]. This technique might also cause fewer side effects, but this has not been definitively proven [9, 10]. A significant increase in the overall success rate for adequate blocks performed using an ultrasound-guided technique versus all non-ultrasound techniques has been shown [10]. It can be I. Thomassen (&) Á J. E. H. Ponten Á S. W. Nienhuijs Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands e-mail: i.thomassen@live.nl J. A. van Suijlekom Á A. van de Gaag Department of Anaesthesiology, ICU and Pain Management, Catharina Hospital Eindhoven, Eindhoven, The Netherlands 123 Hernia DOI 10.1007/s10029-012-0998-y