Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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196 B.J. Dunkin Table 14.1. Summary of analgesics for multimodal pain therapy. Agent Mode of Action Dose Safety Local anesthetics Nerve conduction blockade Ropivacaine 0.2 % infiltration Bupivacaine 0.1–0.25 % infiltration Bupivacaine liposome injectable suspension (EXPAREL) 1.3 % infiltration NSAIDs COX-2 inhibition IV: ketorolac 15–30 mg q6 h PO: celecoxib 200 mg BID Gabapentinoids α-agonists (Clonidine) Acetaminophen (APAP) Opioids Ketamine α2δ ion channel blockade Enhanced monoaminemediated analgesia GABA inhibition, serotonergic interaction Gabapentin 600 mg po TID Pregabalin 100 mg po BID Patch: 0.1 mg/24 h PO: 650 mg q6 h IV: 1000 mg q6 h μ-receptor agonist Varied depending on formulation Nonselective NMDA antagonism Neurotoxicity and cardiotoxicity Wound site and GI bleeding a , renal toxicity b Sedation c Hypotension and bradycardia Hepatotoxicity Sedation, hypotension, respiratory depression, nausea 1 mg/kg/h infusion Hallucinations, confusion a Ketorolac should not be administered preoperatively b More selective COX-2 inhibitors like celecoxib are associated with lower incidence of these complications c Adjust carefully in renal failure patients tissue to block nerves locally, regionally to block pain perception from an area of the body, or around the spinal cord to block transmission of pain signals to the brain. They may also be short acting (lidocaine: 1–2 h duration), intermediate acting (bupivacaine: 3–6 h duration), or long acting (liposomal bupivacaine: 72 h duration). Local anesthetics may also be continuously pumped into the surgical site using an elastomeric or electrical pump in an effort to prolong the duration of their
14. Perioperative Pain Management Multi-modalities to Prevent… 197 effect. For hernia surgery, local anesthetics may be applied using four different techniques: inguinal nerve block (discrete nerve block at the site of the ilioinguinal, iliohypogastric, and/or genitofemoral nerve); field block (infiltration into the superficial and deeper structures in the field of surgery, which may result in a block of the ilioinguinal, iliohypogastric, and/or genitofemoral nerve); infiltration (injection of local anesthetic into the cutaneous/subcutaneous/deeper structures of the surgical field); and instillation (local anesthetic application without needles (e.g., spray) into the surgical site). Techniques for Administration of Local Anesthetics Inguinal Nerve Block The ilioinguinal and iliohypogastric nerves can be blocked by a directed administration of local anesthetic pre- or intraoperatively. Beginning two fingerbreadths superior and medial to the anterior superior iliac spine, a 1.5 inch needle is introduced deep into the abdominal wall, targeting the layers between the internal and external oblique fascia (Fig. 14.3 ). Depth is estimated by feeling for the “pop” of the needle across the external oblique fascial layer and 10 mL of long- acting local anesthetic (bupivacaine or liposomal bupivacaine) is infiltrated. Transversus Abdominis Plane Block This procedure is done under ultrasound or laparoscopic guidance and used to block T11–L1 cutaneous, myofascial, and peritoneal nerves, including the iliohypogastric and ilioinguinal nerves. It provides excellent pain relief for surgeries involving the infra-umbilical abdominal wall. Fig. 14.3. Landmarks for inguinal nerve block.
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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250 J.F.M. Lange Jr. Best available
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252 J.F.M. Lange Jr. Neuropathic pa
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254 J.F.M. Lange Jr. This algorithm
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19. Radiologic Evaluation for Posto
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19 Radiologic Evaluation for Postop
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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286 R. Álvarez Subsequently, we mu
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288 R. Álvarez G : Granuloma H : H
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290 R. Álvarez Fig. 21.14. Same pa
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292 R. Álvarez 6. Lermite E, Arnau
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294 K.A. Seymour and J.S. Yoo Table
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296 K.A. Seymour and J.S. Yoo repro
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298 K.A. Seymour and J.S. Yoo Recur
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23. Mesh Removal for Chronic Pain:
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23. Mesh Removal for Chronic Pain
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320 I.T. MacQueen et al. inguinodyn
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322 I.T. MacQueen et al. Fig. 24.2.
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324 I.T. MacQueen et al. Timing and
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326 I.T. MacQueen et al. Fig. 24.4.
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328 I.T. MacQueen et al. Posthernio
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330 I.T. MacQueen et al. never be e
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25. Laparoscopic Triple Neurectomy
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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