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

348
J.V. Brahmbhatt et al.
300 mg orally three times daily and may titrate up as needed. Patients
tend to respond well to these medications, but its frequent dosing and
side effect profile lead to a high dropout rate. If patients are placed on
chronic medications, a multidisciplinary approach to their follow-up is
generally recommended.
Spermatic Cord Block
Spermatic cord nerve blocks using local anesthetic with or without
steroids can be therapeutic and diagnostic. In our practice, we mix 15
mL 1 % lidocaine, 15 mL 0.25 % marcaine, and dexamethasone 4 mg.
The blocks target three areas of high nerve density [ 13 ]. First, highpressure
injection of the perivasal tissue is done using a Medi-Jet.
Another 5 mL, using a needle, is directly injected directly around the
perivasal tissue. We then inject 10 mL medially to the external inguinal
ring to target the branches of the ilioinguinal nerve and 10 mL laterally
to the external inguinal ring to target genital branches of the genitofemoral
nerve.
In patients with no apparent etiology, the blocks can provide temporary
relief while helping to predict a positive response to surgical interventions.
Benson et al. demonstrated that a positive response to
spermatic cord block helps predict a durable and complete resolution of
symptoms after microsurgical denervation of the spermatic cord
(MDSC) [ 18 ]. They achieved an average 89 % decrease in pain with
spermatic cord block for median 8 h (1–168 h) in 74 men (77 testicular
units). Also improvement from the spermatic cord block was a predictor
of overall improvement after MDSC ( p = 0.05).
Microsurgical Targeted Denervation
of the Spermatic Cord
Introduction
Microsurgical targeted denervation of the spermatic cord (MDSC) is
a minimally invasive surgical option for the management of CGSCP
after conservative treatments have failed [ 2 , 19 ]. An animal study to
evaluate the effectiveness of the MDSC procedure showed a significant
decrease in median number of nerve fibers remaining around the vas