Algorithm For Post Hernia Pains

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,
Simmermacher RK.

  • First issue is to determine it is nerve damage – ie. neuropathic – thought to be about 1/2 of post hernia pains

Some tests:

  • 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.


Non-neurogenic included:

Spontaneous decrease of pain 21
Recurrence of hernia 11
   Adductor tendinitis 9
   Pubalgia 6
   Rectus femoris muscle insertion 1
Referred lumbosacral pain 3
Sacroiliac joint dysfunction 3
Arthrosis 2
Urologic 2
ACNES (Anterior cutaneous nerve entrapment syndrome) 2
Femoral nerve irritation (not resulting from hernia surgery) 1
Refractory pain of L1 after previous neurectomy 1
Pelvic varicoses 1
Unclear/other 5

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.


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