Concise choice selections for what to do with nerve damage level post hernia pains. I love algorithms – they are so practical.
Hernia. 2015 May 9. [Epub ahead of print]
An algorithm for assessment and treatment of postherniorrhaphy pain.
Voorbrood CE(1), Burgmans JP, Van Dalen T, Breel J, Clevers GJ, Wille F,
- First issue is to determine it is nerve damage – ie. neuropathic – thought to be about 1/2 of post hernia pains
- palpate pubic tubercle for pubalgia
- Palpate abdomen while tensing muscles (test of Carnett)
- Check hip adductors
- Check back – try straight leg raising
- Check hip and hip bursa.
If neurogenic then ultrasound guided block – if positive block with 80 mg depo-medrol as well. If that failed – then peripheral nerve stimulation
- 21/28 ilioinguinal nerve – as found in other studies
- 60% responded to blocks
- 6 had peripheral stimulators that brought pain down to 2/10
- 24/28 (83%) gained control of pains
Comment – peripheral stimulators are becoming more common and that is good. Had one case lately that didn’t want me handling the case because the surgeon should have to fix it – finally let me look at it – turned out to be adductor pull – I injected steroid around the inner upper pubic arch and worked area and he is much better.