Treatment for meralgia paraesthetica.
BACKGROUND
Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local anaesthetic and surgery. We aimed to examine the evidence for the relative efficacy of these interventions.


OBJECTIVE
To assess the relative efficacy of commonly used treatments.


METHODS
We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2008), MEDLINE (January 1 1966 to April 18 2008), EMBASE (January 1 1980 to May 12 2008) and CINAHL (January 1 1980 to May 12 2008) for randomised controlled studies. Non-randomised studies were identified by searching MEDLINE (January 1 1966 to April 18 2008) and EMBASE (January 1 1980 to May 12 2008). We also inspected the reference lists of these studies to identify further studies.


METHODS
We were unable to identify any randomised controlled or quasi-randomised controlled trials. We therefore looked for high quality observational studies meeting the following criteria:(1) At least five cases of meralgia paraesthetica.(2) Follow-up of at least three months after intervention (if any).(3) At least 80% of cases followed up.


METHODS
Relevant data from each study meeting the selection criteria were extracted independently by all three authors and transferred into a data extraction form created for the review.


RESULTS
We found no randomised controlled or quasi-controlled trials. Cure or improvement have been described in high quality observational studies:(1) A single study describes spontaneous improvement of meralgia paraesthetica in 20 (69%) out of 29 cases.(2) Four studies evaluating the injection of corticosteroid and local anaesthetic found cure or improvement in 130 (83%) out of a combined total of 157 cases.(3) Surgical treatments have been found to be beneficial in 264 (88%) out of 300 cases treated with decompression (nine studies); and 45 (94%) out of 48 cases treated with neurectomy (three studies).(4) Ninety-nine (97%) out of 102 patients with iatrogenic meralgia paraesthetica recovered completely (three studies).


CONCLUSIONS
In the absence of any published randomised controlled or quasi-randomised controlled trials, the objective evidence base for treatment choices in meralgia paraesthetica is weak. High quality observational studies report comparable high improvement rates for meralgia paraesthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy). However, a similar outcome has been reported without any intervention in a single natural history study.
Khalil
Nofal
N
Clinical Neurophysiology, West London Neurosciences Centre, Charing Cross Hospital, Fulham Palace Road, London, UK, W6 8RF. nofal.khalil@imperial.nhs.uk
Nicotra
Alessia
A
Rakowicz
Wojtek
W
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D019299:Decompression, Surgical; D005267:Femoral Nerve / Q000601:surgery; D020428:Femoral Neuropathy / Q000628:therapy*; D006801:Humans; D009407:Nerve Block; D009408:Nerve Compression Syndromes / Q000628:therapy*; D010292:Paresthesia / Q000628:therapy*; D013848:Thigh / Q000294:innervation
D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local