Iliohypogastric Nerve Block for Chronic Pelvic Pain Treatment: Ultrasound-Guide Technique Description and Cases Series

Marta Linares Gago,Jorge Rodríguez García,Inmaculada Díaz-Cano Carmona,Gonzalo Cano Plasencia,Luis Eduardo Alarcón Mora

doi:10.3823/1814

Marta Linares Gago, Jorge Rodríguez García + Show 3 more

Open Access

https://doi.org/10.3823/1814

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Abstract

Background: Chronic pelvic pain is common and often difficult to alleviate. The aim of this study is to describe the technique of the Iliohypogastric Nerve (IPN) block with ultrasound-guide (UG) and show its utility and safety in a Physical Medicine and Rehabilitation Unit. Aim and Objetives: To Todescribe the technique of the Iliohyogastric Nerve (IPN) block with ultrasound-guide (UG) and show its utility and safety in a physical medicine and rehabilitation consulting room. Methods: we present three consecutive patients with a chronic pelvic pain difficult to manage with NSAIDS or analgesics. All this patientes suffered more than six months of burning and lancinating pelvic pain that get worse with trunk movements and when the patient is seated or walking. Due to symthoms and physical examination, the patients were diagnosed of iliohypogastric neuropathy and we decided to perform an ultrasound guided iliohypogastric nerve block in all cases. Results: The VAS punctuation were improved after each nerve blockade in three patients at the finally of follow-up, decreasing VAS 3.5 points (P50) in compare with before start the treatment. Any secondary effects were reported. Discussion: There is little literature concerning this procedure which shows, such our study, that in blockades were used a local anesthetic and the nerve is located with ultrasound guide. The results show partial improvement of the symptoms after the treatment. Although our sample is small and the follow up is short, we continue the study with the aim of improving the technique and provide statistically significant results. Conclusion: The iliohypogastric nerve block is easily repoducible in the clinical setting and offers an advancement for patients with pelvic pain, that could be an initial option of treatment to improve the pain and delay other treatment as surgery.

Highlights

Chronic Pelvic Pain is located at the lower abdomen, the pelvis or intrapelvic structures and it persists for at least six months of continuous or intermittent pain and not associated exclusively to uro-gynecological pathology [1]
The aim of this study is to describe the technique of the Iliohypogastric Nerve (IPN) block with ultrasound-guide (UG) and show its utility and safety in a Physical Medicine and Rehabilitation Unit
Methods: we present three consecutive patients with a chronic pelvic pain difficult to manage with NSAIDS or analgesics

Summary

Introduction

Chronic Pelvic Pain is located at the lower abdomen, the pelvis or intrapelvic structures and it persists for at least six months of continuous or intermittent pain and not associated exclusively to uro-gynecological pathology [1]. The most frequency causes of neuropathic Chronic Pelvic Pain are secondary to peripheral entrapment Ilioinguinal, iliohypogastric and genitofemoral nerves within stitches or scarring after abdominal surgery [3, 4]. The iliohypogastric is a purely sensory nerve derived from the first lumbar roots and enervates the skin and muscles of the lower abdominal wall as well as the skin of the proximal hip and thigh. The nerve injury may be caused by entrapment by sutures at the lateral poles of transverse fascial incisions in differents kinds of surgeries and direct or indirect traumas [6]. The aim of this study is to describe the technique of the Iliohypogastric Nerve (IPN) block with ultrasound-guide (UG) and show its utility and safety in a Physical Medicine and Rehabilitation Unit

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Conclusion