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The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade.
- Source :
-
BJA: The British Journal of Anaesthesia . Jun2016, Vol. 116 Issue 6, p829-837. 9p. 3 Diagrams, 2 Charts, 2 Graphs. - Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>Severe, persistent inguinal postherniorrhaphy pain (PIPP) is a debilitating condition that develops in 2-5% of patients. PIPP may be neuropathic in nature, yet the lesion in the peripheral nervous system has not been located. Most PIPP-patients demonstrate a tender point (TP) in the medial aspect of the inguinal region that triggers pain upon minimal pressure. As TPs may play a role in the pathophysiology of PIPP, the aim of this trial was to investigate the analgesic effects of local anaesthetic TP-blockade.<bold>Methods: </bold>A randomized, double-blind, placebo-controlled, crossover trial was performed in 14 PIPP-patients and six healthy volunteers. All participated in two sessions, seven days apart, receiving 10 ml of 0.25% bupivacaine or normal saline via an ultrasound-guided fascial plane block at the TP. The TP-area was used for pain assessments (at rest, on movement, with 100 kPa pressure-algometry) and quantitative sensory testing (pressure pain thresholds, thermal detection/pain thresholds, supra-threshold heat perception), before and after the TP-blockade.<bold>Results: </bold>The median (95% CI) reduction in pain was 63% (44.1 to 73.6%) after bupivacaine compared with 36% (11.6 to 49.7%; P=0.003) after placebo. Significant increases in cool detection (P=0.01) and pressure pain thresholds (P=0.009) with decreases in supra-threshold heat pain perception (P=0.003) were seen after bupivacaine only. In four out of six volunteers, increased thermal and evoked-pain thresholds after bupivacaine compared with placebo, was demonstrated.<bold>Conclusions: </bold>This trial demonstrates that peripheral afferent input from the TP-area is important for maintenance of spontaneous and evoked pain in PIPP.<bold>Clinical Trial Registration: </bold>NCT02065219. [ABSTRACT FROM AUTHOR]
- Subjects :
- *AFFERENT pathways
*GROIN
*PLACEBOS
*PATHOLOGICAL physiology
*BLIND experiment
*INGUINAL hernia
*COMPARATIVE studies
*CROSSOVER trials
*HERNIA surgery
*LOCAL anesthetics
*RESEARCH methodology
*MEDICAL cooperation
*NERVE block
*PERIPHERAL nervous system
*POSTOPERATIVE pain
*RESEARCH
*RESEARCH funding
*SENSORY neurons
*ULTRASONIC imaging
*EVALUATION research
*PAIN measurement
*RANDOMIZED controlled trials
*HUMAN research subjects
*PAIN threshold
*BUPIVACAINE
*SURGERY
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 116
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 115584989
- Full Text :
- https://doi.org/10.1093/bja/aew071