Successful management of a refractory case of postoperative herniorrhaphy pain with extended duration pulsed radiofrequency

Abstract

Chronic postsurgical pain (CPSP) is a distressful condition following hernia surgery. A 25-year-old, 55 kg male patient presented with severe pain on the right side of the lower abdomen that radiated to the testicle and the inner side of the thigh. Patient was symptomatic since 5 months following inguinal herniorrhaphy surgery. The pain was not relieved with pharmacological and interventional nerve blocks. An ultrasound-guided ilioinguinal-iliohypogastric (II-IH) block with extended duration (42°C, four cycles of 120 s each) pulsed radiofrequency (PRF) and a diagnostic genital branch of genitofemoral nerve (GGFN) block provided pain relief. After 1-month, an extended duration PRF in GGFN resulted in complete resolution of symptoms. During a regular follow-up of 9 months, patient reported an improved quality-of-life. We believe the successful management of CPSP following hernia repair with single extended duration PRF of II-IH and GGFN has not been described in the literature.

Post-operative chronic pain. Is there anything new?

“…[6][7][8][9] Las modalidades de tratamiento además de la farmacoterapia incluyen bloqueos diagnósticos y terapéuticos de nervios periféricos (con o sin esteroides), ablación por radiofrecuencia y crioanalgesia, estimulación neuroeléctrica (cordones posteriores, nervio periférico) y reintervención quirúrgica (neurectomía, descompresión). 10,11 El bloqueo del músculo erector de la espina, bloqueo interfascial novedoso realizado con USG: en series de casos con pacientes que presentan dolor crónico posttoracotomía, llega a ser un procedimiento promisorio para el manejo. 12 Utilizar la estimulación neuroeléctrica en nervio periférico también ha demostrado buena respuesta en dolor crónico postquirúrgico por hernioplastías inguinales (sobre los nervios ilio-inguinal e iliohipogástrico).…”