gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Significance of invasive neuromodulation in patients with postoperative chronic groin pain

Meeting Abstract

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  • Dirk Rasche - Klinik für Neurochirurgie, Universität zu Lübeck, Lübeck, Deutschland
  • Volker Tronnier - Klinik für Neurochirurgie, Universität zu Lübeck, Lübeck, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch145

doi: 10.3205/15dgch145, urn:nbn:de:0183-15dgch1458

Published: April 24, 2015

© 2015 Rasche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Chronic groin pain can be a significant problem following hernia repair or various surgical interventions in the inguinal region. Up to 20% of patients report chronic neuropathic pain after inguinal hernia repair and specific pain treatment with analgesics or conservative treatment is necessary. In cases of insufficient pain reduction or intolerable medication side effects the indication for invasive pain treatment should be discussed. Neurostimulation for chronic groin pain can be performed in the subcutaneous tissue of the painful area, the spinal dorsal root ganglion or the epidural spinal cord. A single-centre clinical experience of 12 patients is presented.

Material and methods: Chronic groin pain was diagnosed at least one year after surgery. Initial treatment was conservative, pharmacological and psychological. A recurrent hernia or indication for re-surgery was excluded. Three different invasive procedures were offered to those patients: peripheral subcutaneous nerve field stimulation (PNFS), dorsal root ganglion stimulation (DRG) or spinal cord stimulation (SCS). In PFNS one or two quadripolar or octopolar stick leads are implanted in the subcutaneous tissue of the painful area (n=4). In DRG-stimulation the quadripolar leads are implanted at the neuroforamen and upper site of the spinal ganglion of the nerve roots of Th12, L1 or L2 of the painful side (n=3). In SCS an octopolar lead is placed epidural at the level of the 9th-12th thoracic vertebra (n=5). Clinical examples for every procedure are presented.

Results: With every therapy a test trial with an external stimulation device and evoked paraesthesias was conducted. In cases with well-located or focal pain in the inguinal area PNFS is favoured. DRG is considered the first option in patients with spreading pain to the abdominal wall or the ventral or lateral part of the upper leg. In patients with larger pain areas including the inguinal, genital, perianal and femoral region or in cases with ineffective PNFS or DRG the indication for SCS is followed. In case of pain reduction of more than 30%, measured on the numeric rating scale (NRS) or visual analogue scale (VAS) and concomitant reduction or withdrawal of analgesics. Pain reduction was achieved in 3/4 (PNFS), 3/3 (DRG) and 4/5 (SCS) patients during the test trial and at the latest follow-up (range: 8 months up to 8 years) in 2/4 (PNFS), 3/3 (DRG) and 3/5 (SCS). The main procedure-related complications are wound infections, dislocation of the leads and technical failures.

Conclusion: Neurostimulation with PNFS, DRG or SCS are effective procedures to add the existing treatment guidelines to achieve a significant pain reduction in otherwise refractory chronic neuropathic groin pain. These specific procedures should be performed in experienced centres for functional neurostimulation and invasive neurosurgical pain therapies. The risks and complications of the procedures are low and therefore these procedures should be offered to those patients in contrast to high dose opioid or antiepileptic medications and impaired quality of life.