Treatment for persistent chronic neuralgia after inguinal hernioplasty.
Following an inguinal hernia repair with open or laparoscopic technique, 1-15% of patients show persistent neuralgia, a severe, potentially debilitating, complication. Several therapeutic procedures have been proposed, but consensus regarding choice of treatment has not yet been achieved. We performed a prospective study on 32 such cases. Patients underwent anaesthetic infiltration to identify, when possible, the involved nerve, and we then carried out a step-by-step therapeutic protocol. In the initial phase, patients were treated with oral analgesic and afterwards with repeated infiltrations of anaesthetic and cortisone. Surgery was reserved for patients not responding to the infiltrations, though with no good success. The authors believe that noninvasive methods are to be preferred, whereas neurectomy interventions should be reserved for selected cases.
Dipartimento di Chirurgia Francesco Durante, 1st Faculty of Medicine, Università degli Studi di Roma La Sapienza, Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome 00161, Italy. piergaspare.palumbo@uniroma1.it
P
P
Palumbo
A
A
Minicucci
A G
AG
Nasti
I
I
Simonelli
F
F
Vietri
A M
AM
Angelici
D000284:Administration, Oral; D000700:Analgesics / Q000008:administration & dosage*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007267:Injections; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D009437:Neuralgia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000700:Analgesics; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008775:Methylprednisolone