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

21. Dermatome Mapping: Preoperative
and Postoperative Assessment
Rigoberto Álvarez
History
During the last two decades, there has been an important decrease in
recurrence rates after inguinal hernia repair [ 1 – 3 ]. Consequently, postoperative
chronic pain has become the more frequent and important
outcome that occupies our attention [ 4 ]. The proper study of chronic
postoperative pain both prior to its treatment and during subsequent
monitoring is of great significance, to the extent that the success or failure
of our management depends on proper terminology, characterization,
description, and diagnosis. Unfortunately, at present there are no
radiological or electromyographic studies that show us with certainty the
real scenarios that we face in clinical practice. The available pain evaluation
questionnaires are more oriented to determine the degree of limitation
and disability than to provide us with reliable guidelines to
implement the proper therapies for each individual case [ 5 , 6 ]. The significance
cannot be understated, given the importance of the labor and
legal concerns due to the implications and impact of disabling pain after
inguinal hernia repair. The generally accepted time frame for defining
chronic postoperative pain is after the third postoperative month [ 7 , 8 ].
There are two main types of postoperative pain that contribute to postinguinal
herniorrhaphy inguinodynia. The first is the nociceptive or
non-neuropathic pain, which is the most common and is caused by the
rupture of soft tissues such as skin, subcutaneous tissue, and muscles; as
a result of tissue trauma, cutting, or cauterization during surgery; as well
as pain caused by the presence of orchialgia, meshomas, or granulomas.
The second type of pain is neuropathic. It usually appears in the early
postoperative period and involves injury of one or several nerve
branches, mainly caused by two mechanisms: when these nerves are cut
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_21
277