Genitofemoral Neuralgia Research Articles

Surgical Management of 10 Genitofemoral Neuralgias at the Louisiana State University Health Sciences Center

This is a retrospective review of the charts of 10 patients with genitofemoral neuralgia who underwent neurectomy at the Louisiana State University Health Sciences Center between 1967 and 2000. Operations associated with these neuralgias and postoperative pain outcomes were analyzed. The charts of 10 patients with genitofemoral neuralgias were analyzed retrospectively. The distribution of the 10 genitofemoral neuralgias with regard to right or left side and sex was found to be equal. L1 and L2 nerve blocks had resulted in a complete or substantial decrease in pain before neurectomy was recommended. Of six iatrogenic injuries (60%), gynecological surgery, including two hysterectomy procedures, resulted in a total of three genitofemoral neuralgias (50%), and vasectomy procedures antedated two nerve injuries (33%). Four (40%) of the 10 patients had injury to the genitofemoral nerve after blunt abdominal trauma. Genitofemoral neurectomy was performed in all genitofemoral neuralgia patients after conservative therapy had failed. This procedure resulted in considerable pain relief in all 10 patients, whether their injury was the result of iatrogenic causes or trauma. Genitofemoral neuralgias are infrequent conditions; however, 10 patients were accrued and analyzed in this study, and most had considerable or complete pain relief after neurectomy.

Paradiscal Extraforaminal Technique for Lumbar Sympathetic Block: Report of a Proposed New Technique Utilizing a Cadaver Study

Knowledge of the relationship of the lumbar sympathetic chain to the vertebral bodies is needed to perform sympathetic block and sympatholysis. This information should be correlated with fluoroscopy to determine the best method to perform this technique clinically. Twenty cadavers were dissected to demonstrate the lumbar sympathetic chain. In five cadavers, a 17 G Hustead needle was introduced inferior to the transverse process in the concavity of the body of L2 vertebra utilizing an extraforaminal (paraforaminal) approach and images were obtained in both the anteroposterior and lateral views. Needles were placed by utilizing either the loss of resistance technique (just piercing the psoas muscle) or by placing the needle posterior to the anterior border of the vertebral body. The cadavers were then dissected to demonstrate needle position in relationship to the lumbar sympathetic chain. Each lumbar sympathetic chain was located on the anterolateral aspect of the vertebral body at the medial attachment of psoas major to the vertebral body. When needles were inserted using the loss of resistance technique, dissection revealed needle tips considerably anterior to the ganglia and missing it. When the needle was placed just on the anterior border of the vertebral body, the tip was close to the sympathetic chain. In all of the dissections, lumbar segmental vessels were found in the concavity of the vertebral body ventrodorsally and closely related to the sympathetic chain. The chain varies in both size and location of the ganglia. In the majority of cases, lumbar ganglia were 3 in number. We believe the extraforaminal technique of lumbar sympathetic block is superior to the paramedian approach considering that there should be a reduced chance of passing through viscera and a lower incidence of genitofemoral neuralgia. However, with the extraforaminal technique, two important possible complications need to be highlighted. Chances of injury to the segmental lumbar vessels and the anterior ramus are present. Therefore, the extraforaminal technique needs to be modified. We advocate the extraforaminal paradiscal technique for lumbar sympathetic block. The initial target point for entry should be the lateralmost tip of the transverse process. Advancement of the needle should be extraforaminal with minimal chance of injury to the nerve or the anterior ramus. Final target point should be paradiscal. The needle tip should be positioned just posterior to the anterior border of the vertebral body. Loss of resistance technique should not be utilized and is potentially dangerous. Use of at least two needles is advisable (L2 and L3 vertebral body). Care should be taken to avoid the lumbar vessels. A transdiscal technique recently advocated may also avoid some of the complications with the paramedian technique, but chances of discitis, nerve root injury, accelerated disc degeneration, disc herniation and rupture of the anterior annulus have to be considered when using this technique.

Cryoanalgesic ablation for the treatment of chronic postherniorrhaphy neuropathic pain.

Chronic postoperative pain has been reported in as many as 62.9% of patients after inguinal herniorrhaphy. Moderate to severe neuropathic pain requiring intervention develops in 2.2% to 11.9% of patients as a result of ileoinguinal and genitofemoral nerve entrapment. Cryoanalgesic ablation has been successful in treating chronic pain from craniofacial neuralgia, facet joint syndrome, and malignant pain syndromes. We report our experience using cryoanalgesic ablation for chronic ileoinguinal and genitofemoral neuralgia after inguinal herniorrhaphy. Ten patients with ileoinguinal, genitofemoral, or combined neuralgia underwent 12 cryoanalgesic ablations between April 1996 and June 2001. These patients were referred from a multidisciplinary pain clinic, and focused low-volume nerve blocks were used to map nerve involvement preoperatively. After surgical exposure, nerves and surrounding tissues were cooled to ?70 degrees C for 3 min using the Lloyd Neurostat. Patients were seen 2 weeks postoperatively and offered monthly follow-up assessments. Nine men and one woman, ages 20 to 54 (mean, 42.6 years) were treated during 58 months, with a mean follow-up period of 8.2 months, for ileoinguinal (n = 4), genitofemoral (n = 1), and combined (n = 5) neuralgia. Patients reported one to five prior herniorrhaphies (mean, 1.8), experienced neuropathic pain 0 to 14 years (mean, 6.3 years), and underwent up to 3 (mean, 1.3) ablative pain procedures before referral. After cryotherapy, patients reported overall pain reduction of 0% to 100% (mean, 77.5%; median, 100%); 80% reported decreased analgesic use, and 90% reported increased physical capacity. Two patients underwent additional cryotherapy, one for incomplete relief and one for recurrent pain, both with 100% efficacy. Wound infection (n = 1) was the only complication. Cryoanalgesic ablation successfully eliminates ileoinguinal and genitofemoral neuralgia in most patients, and should be considered early in the treatment of patients with postherniorrhaphy neuropathic pain.

Treatment of genitofemoral neuralgia after laparoscopic inguinal herniorrhaphy with fluoroscopically guided tack injection.

This report illustrates that genitofemoral neuralgia can result from laparoscopic inguinal herniorrhaphy and offers a management strategy for this pain syndrome. A patient experienced pain in the distribution of the genitofemoral nerve after laparoscopic herniorrhaphy. Under fluoroscopy, the point of maximal tenderness was elicited and was found to be at the site of a surgical tack placed during the hernia repair. A genitofemoral nerve block was performed at the site of the surgical tack. This resulted in complete resolution of pain symptoms. The patient's treatment and recovery are described. Recognition and proper diagnosis of genitofemoral neuralgia after laparoscopic herniorrhaphy may result in appropriate therapy and hasten recovery.

(222) Treatment of Genitofemoral Neuralgia After Laparoscopic Inguinal Herniorrhaphy with Fluoroscopically-Guided Tack Injection

(222) Treatment of Genitofemoral Neuralgia After Laparoscopic Inguinal Herniorrhaphy with Fluoroscopically-Guided Tack Injection

(222) Treatment of Genitofemoral Neuralgia After Laparoscopic Inguinal Herniorrhaphy with Fluoroscopically-Guided Tack Injection

(222) Treatment of Genitofemoral Neuralgia After Laparoscopic Inguinal Herniorrhaphy with Fluoroscopically-Guided Tack Injection

Lumber sympathetic blockade

Lumbar sympathetic blockade is indicated for diagnosis, prognosis, and therapy of painful and other conditions presumably associated with sympathetic nervous system dysfunction. Anatomy of the lumbar sympathetic chain and the rationale for the block are essential to know before performing the block. Different techniques have been described for the lumbar sympathetic blockade, with efficacy ranging from 13% to 80%, which varies according to the initial patient pathology. Genito-femoral neuralgia occurs in about 5% of patients after neurolytic block. Other potential complications are infection, hematomas, and somatic nerve damage. Copyright © 2001 by W.B. Saunders Company

Laparoscopic treatment of genitofemoral neuralgia

Chronic pain and tenderness in the groin, labia majora, and medial thigh can be caused by neuropathy of the genitofemoral nerve. Differentiation from ilioinguinal neuralgia by diagnostic blocks is crucial to selecting proper treatment. Three women with genitofemoral neuralgia underwent laparoscopic examination and treatment, thus avoiding laparotomy and flank incision.

Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia.

During the past 8 years, a total of 36 patients were diagnosed as having either ilioinguinal or genitofemoral neuralgia. A multidisciplinary approach (surgeon, neurologist, anesthesiologist) as well as local blocks of the ilioinguinal nerve or paravertebral blocks of L1,2 were essential to determine which nerve was likely to be entraped. Seventeen of the 19 patients having a diagnosis of ilioinguinal neuralgia after previous inguinal herniorraphy were completely free of pain after resection of the entrapped portion of the nerve. Seventeen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorraphy, blunt abdominal trauma, or another operation. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 12 of 17 of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of operations in the inguinal region. When the diagnosis is made by a multidisciplinary approach, neurectomy is frequently successful in relieving severe pain and paresthesias without serious morbidity.

Diagnosis and Treatment of Genitofemoral and Ilioinguinal Entrapment Neuralgia

During the past 7 years 30 patients were diagnosed as having either ilioinguinal or genitofemoral entrapment neuralgia. A multidisciplinary approach (surgeon, neurologist, and anesthesiologist), as well as local blocks of the ilioinguinal nerve and/or paravertebral blocks of L-1 and L-2 (genitofemoral nerve), were essential to determine accurately which nerve was specifically involved. Fifteen of the 17 patients (88%) diagnosed as having ilioinguinal neuralgia after previous inguinal herniorrhaphy are pain free after resection of the entrapped portion of the nerve. Thirteen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorrhaphy, blunt abdominal trauma, or other surgery. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 10 of 13 (77%) of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of surgery in the inguinal region. When accurately diagnosed, neurectomy of the specific nerve is highly successful in relieving severe pain and paresthesia without significant morbidity.

Diagnosis and management of genitofemoral neuralgia : Arch. Surg., 119 (1984) 339–341

Diagnosis and management of genitofemoral neuralgia : Arch. Surg., 119 (1984) 339–341