Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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15. Chronic Groin Pain Following Anterior Hernia Surgery 213 Fig. 15.1. Borders of the inguinal canal (from Wagner et al. [ 4 ], with kind permission © McGraw-Hill Education). Chronic Post-herniorrhaphy Groin Pain: Definition Chronic post-herniorrhaphy groin pain is defined as pain lasting >3 months following hernia repair. Studies show an incidence of chronic pain of 11 % [ 6 ]. Inguinodynia can be neuropathic or non-neuropathic. Neuropathic pain can be caused by nerve entrapment, stretching of nerves, and partial or complete division of nerves with neuroma formation. The three nerves most commonly involved are the iliohypogastric nerve, the ilioinguinal nerve, and the genital branch of the genitofemoral nerve. Non-neuropathic causes include periosteal reaction and mechanical pressure caused by folded mesh [ 7 ]. Treatments Treatments for chronic groin pain include nonoperative interventions such as pain control with or without narcotic pain medications, and injection-based therapies such as nerve blocks and radiofrequency
214 J.S. Schwartz et al. neurolysis. Additionally, operative intervention has been used for refractory chronic groin pain. Surgical treatments include single nerve resection, triple neurectomy, and mesh removal. Nonsteroidal anti-inflammatory agents are often first-line therapy for chronic groin pain. NSAIDs are nonselective COX inhibitors that decrease inflammation. These are particularly helpful in the postoperative period. Scheduled NSAIDs for 2 weeks improved pain symptoms in 25 % of patients with chronic groin pain after inguinal hernia repair in one study [ 7 ]. For moderate to severe chronic groin pain, opioid analgesia may be required. Treatment with this regimen is recommended for a minority of patients and in conjunction with a pain specialist. Antidepressants are another first-line therapy used for chronic neuropathic pain. At low doses, antidepressants work by blocking neurotransmitter uptake at the presynaptic terminal and function as an analgesic. Tricyclic antidepressants followed by SSRIs are the most commonly used antidepressants. Antiepileptic drugs such as pregabalin, gabapentin, and topiramate have been used for neuropathic pain. The mechanism of action is by modulation of calcium and sodium channels that stabilize neurons involved in rapid firing, thus affecting the intensity of neuropathic pain [ 8 ]. However, there are few studies that investigate the efficacy of these treatment modalities for inguinodynia following hernia repair. Injection-based therapies are another treatment alternative for chronic groin pain following inguinal hernia repair. Multiple studies have been performed looking at the effect of nerve blocks with local anesthetics, often under ultrasound guidance. In a single study, 43 subjects were evaluated for chronic moderate to severe inguinal pain status post open hernia repair. Each was given an ilioinguinal and/or iliohypogastric nerve block with a long-acting local anesthetic (bupivacaine) and a corticosteroid (triamcinolonacetonide). There was an average of two injections per subject. Post-procedure, 32–55 % of subjects reported resolution of their moderate to severe neuropathic pain after 20 months [ 9 ]. Other studies have demonstrated patients receiving at least temporary relief from nerve blocks with local anesthetic. Ilioinguinal or iliohypogastric nerve blocks can be an effective treatment modality for chronic groin pain, though multiple treatments may be required. Longterm success of injection-based therapies is still unclear. This treatment is often used for diagnosis of affected nerve and prior to surgical intervention.
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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144 M. Hibner and C. Coyne present
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146 M. Hibner and C. Coyne Table 11
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148 M. Hibner and C. Coyne Once the
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150 M. Hibner and C. Coyne 3. Hibne
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12. Chronic Pelvic Pain in Women M.
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12. Chronic Pelvic Pain in Women 15
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Page 208 and 209: 194 B.J. Dunkin Noxious peripheral
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Page 214 and 215: 200 B.J. Dunkin COX-1 COX-2 Celecpx
Page 216 and 217: 202 B.J. Dunkin Table 14.2. Common
Page 218 and 219: 204 B.J. Dunkin Possible Preoperati
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Page 222 and 223: 208 B.J. Dunkin Summary Understandi
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Page 234 and 235: 222 E.L. Felix not seem to alter th
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Page 240 and 241: 228 E.L. Felix It has been establis
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Page 244 and 245: 17. The Orthopedic Perspective on G
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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286 R. Álvarez Subsequently, we mu
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288 R. Álvarez G : Granuloma H : H
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290 R. Álvarez Fig. 21.14. Same pa
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292 R. Álvarez 6. Lermite E, Arnau
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294 K.A. Seymour and J.S. Yoo Table
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296 K.A. Seymour and J.S. Yoo repro
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298 K.A. Seymour and J.S. Yoo Recur
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23. Mesh Removal for Chronic Pain:
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23. Mesh Removal for Chronic Pain
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320 I.T. MacQueen et al. inguinodyn
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322 I.T. MacQueen et al. Fig. 24.2.
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324 I.T. MacQueen et al. Timing and
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326 I.T. MacQueen et al. Fig. 24.4.
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328 I.T. MacQueen et al. Posthernio
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330 I.T. MacQueen et al. never be e
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25. Laparoscopic Triple Neurectomy
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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