Selective Neurectomies for Chronic Postoperative Neurogenic Pain
Purushottam Nagarkar, M.D., Smita Ramanadham, M.D., Khalil Chamseddin, Medical Student, Shai Rozen, M.D..
UTSW Medical Center, DALLAS, TX, USA.
Purpose: Trunk surgeries are very commonly performed procedures in the US, with approximately 920,000 hernia repairs and 500,000 laparoscopic cholecystectomies performed in 2006. The incidence of postoperative chronic pain is 1-20%, resulting in a large population of patients with such pain. One treatment for these patients is selective surgical neurectomies.
Methods: All patients, who underwent neurectomies for treatment of chronic postoperative pain following trunk or groin surgeries were identified. Patients underwent selective neurectomies of intercostal, ilioinguinal, iliohypogastric, genitofemoral, or lateral femoral cutaneous nerves. A phone survey based on the Pain Disability Index was administered to assess pre- and post-operative pain level and quality of life.
Results: 57 patients (32 male, 25 female) who underwent neurectomies were identified. Mean age was 49 years. All patients received preoperative nerve blocks, and had either a complete or significant response. 46 patients completed the survey (7 declined, 2 could not be contacted, 2 were deceased). Median follow-up was 2.8 years (0.5-5.7 years). Average pain level was 9.0 preoperatively and 3.5 postoperatively on a 0-10 Likert scale. Quality of life impairment improved from 8.2 to 3.4. A subset of patients (n=12) had minimal improvement, reporting a pain decrease from 9.2 to 7.9, and improvement in quality of life from 9.2 to 7.6.
Conclusions: Neurectomy can be an effective means of relieving chronic postoperative pain following trunk/groin surgeries, with excellent improvement in pain and quality of life. Despite responding to pre-operative nerve blocks there is a subset of patients who have minimal improvement after surgery.
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