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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L.A. Cunningham and B. Ramshaw
Invasive Nonsurgical Options
For more severe pain and pain that worsens or persists for more than
a few weeks, it is appropriate to offer the patient more aggressive pain
management. This can include administering inguinal nerve blocks for
diagnostic and potentially therapeutic purposes. If results of the injection
are good, but pain returns, additional nerve blocks may be appropriate.
Some patients will obtain sufficient pain relief to return to a full
quality of life after one or more nerve blocks.
Cryoablation and radiofrequency ablation can also be used and
involve placing specialized needles and probes near the affected nerve
and causing coagulation at very low or very high temperatures, respectively.
These methods work by destroying the nerves at the site of application,
thereby providing at least temporary pain relief. It is still possible
for nerve regeneration to occur; long-term studies with definitive evidence
is lacking.
Surgical Options
If the pain has persisted for more than 3–6 months, and/or the pain
is severe or worsening despite other nonsurgical therapies, it is appropriate
to consider an operation in an attempt to relieve the pain. Prior to
surgery, it is very important to address preoperative, operative, and
potential postoperative complications and factors prior to proceeding
with surgery.
Preoperative Management
In the preoperative setting, it is important to address goals, to assess
the impact of chronic pain on the patient’s quality of life and for risk
factors for continued pain, and to consider alternatives. It is also important
to assess and address any comorbidities and to discuss previous
treatment modalities that the patient has tried, if any, as these may help
predict their response to operative intervention.
Not everyone will benefit from surgery, and it is important to convey
to patients that the pain may stay the same, improve only partially, or
could in fact get worse. If neurectomy is to be performed, it is also
important to address postoperative numbness in the distribution of the
affected nerves.