Management of medically intractable genitofemoral and ilioingunal neuralgia

Abstract

AIm:To evaluate the effectiveness of invasive procedures in medically intractable genitofemoral and ilioingunal neuralgia. mAterIAl and methOds: This is a prospective study of 20 patients with genitofemoral and ilioinguinal neuralgias who were treated at our medical center between 2007 and 2011. Genitofemoral and ilioinguinal nerve blocks were performed in all cases after medical treatment had failed to alleviate the patients' pain. Neurectomy was performed for the patients whose pain did not improve. Patient histories, physical examinations and visual analogue scale scores before and after treatments were analyzed.results: Fourteen (70%) of the patients were treated with nerve blocks and six (30%) of the patients whose pain did not improve with nerve block application underwent neurectomy which resulted in pain relief.COnClusIOn: For patients with medically intractable genitofemoral and ilioinguinal neuralgias, nerve blocks and neurectomies can be applied safely for pain control. BulGulAr: Hastalardan 14'ü (%70) sinir blokları ile sinir bloğu ile rahatlamayan 6 hasta (%30) ise nörektomi ile tedavi edildi. sOnuÇ: Medikal tedavi ile ağrı kontrolü sağlanamayan genitofemoral ve ilioinguinal nevraljili hastalarda sinir blokları ve nörektomiler güvenle uygulanabilecek etkili tedavi alternatifleridir.

Revisiting the genital and femoral branches of the genitofemoral nerve: Suggestion for a more accurate terminology

“…Genitofemoral neuralgia most commonly develops as a result of iatrogenic injury. Surgical procedures often associated with genitofemoral neuralgia include appendectomy, lymph node biopsy, caesarian section, vasectomy, hysterectomy, and inguinal herniorrhaphy (Harms et al, ; Murovic et al, ; Acar et al, ). Genitofemoral neuralgia can be treated with invasive or non‐invasive procedures.…”

Diagnostic Accuracy of Selective 3-T MR Neurography–guided Retroperitoneal Genitofemoral Nerve Blocks for the Diagnosis of Genitofemoral Neuralgia

“…All MR imaging studies were performed with a clinical wide-bore 3-T MR imaging system (Magnetom Skyra, Numaris/4 Syngo MR D13A; Siemens direct therapeutic decision making (5,9,19).…”

Genitofemoral neuralgia: A review

“…Neuromas may also develop as a result of the ligation of the genital branch using the Shouldice repair, thus causing the symptoms of genitofemoral neuralgia (Starling and Harms, 1989;Sampath et al, 1995;Rho et al, 2001;Ducic et al, 2008;Amin and Chen, 2011). Iatrogenic nerve injury can also be the result of electrical damage and direct injury of the nerve (Acar et al, 2013;Chen et al, 2013).…”

“…Obtaining an accurate diagnosis of genitofemoral neuralgia is difficult, due to the fact that it presents in a very similar way to other inguinal neuralgias (Acar et al, 2013). There is significant sensory overlap between the ilioinguinal and GFNs, so it is important to consider ilioinguinal neuralgia as a differential diagnosis to effectively manage this neuropathy (Harms et al, 1984;Lichtenstein et al, 1988;Starling and Harms, 1989;Perry, 1997;Murovic et al, 2005;Acar et al, 2013). If clinicians misdiagnose genitofemoral neuralgia as ilioinguinal neuropathy, there is a risk of mistreatment and unnecessary surgical exploration of the inguinal region (Harms et al, 1984;Shanthanna, 2014).…”

“…If contraindications or failure of resolution of pain are noted, opioids, gabapentin, and pregabalin may be used (Kalso, 2006). In addition, other non-surgical pharmacological interventions for genitofemoral neuralgia include NSAIDs, selective serotonin/norepinephrine reuptake inhibitors, antiepileptics, and N-methyl-D-aspartate antagonists, (Lichtenstein et al, 1988;Cunningham et al, 1996;Rho et al, 2001;Fanelli et al, 2003;Palumbo et al, 2007;Ducic et al 2008;Acar et al, 2013). Ultrasound guided nerve block injections have also proven valuable in the management of genitofemoral neuralgia (Shanthanna, 2014).…”