domingo, 18 de enero de 2015

Neuralgia genitofemoral / Genitofemoral neuralgia

No.1853                                                                                   16 de enero 2015

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Tratamiento exitoso de neuralgia genitofemoral utilizando inyección guiada con ultrasonido.
Successful treatment of genitofemoral neuralgia using ultrasound guided injection: a case report and short review of literature.
Shanthanna H.
Case Rep Anesthesiol. 2014;2014:371703. doi: 10.1155/2014/371703. Epub 2014 Apr 6.
A young male patient developed chronic, severe, and disabling right sided groin pain following resection of his left testicular cancer. Since there is considerable overlap, ultrasound guided, selective diagnostic nerve blocks were done for ilioinguinal, iliohypogastric, and genitofemoral nerves, to determine the involved nerve territory. It was revealed that genitofemoral neuralgia was the likely cause. As a therapeutic procedure, it was injected with local anesthetic and steroid using ultrasound guidance. The initial injection led to pain relief of 3 months. Subsequent blocks reinforced the existing analgesia and were sufficient to allow for maintenance with the use of analgesic medications. This case report describes the successful use of diagnostic selective nerve blocks for the assessment of groin pain, subsequent to which an ultrasound guided therapeutic injection ofgenitofemoral nerve led to long term pain relief. As a therapeutic procedure, genitofemoral nerve block is done in patients with genitofemoralneuralgia. Ultrasound allows for controlled administration and greatly enhances the technical ability to perform precise localization and injection. There are very few case reports of such a treatment in the published literature. Apart from the case report, we also highlight the relevant anatomy and a brief review of genitofemoral neuralgia and its treatment.
Nuevo abordaje transpsoas guiado con TAC para bloqueo diagnóstico y ablativo de neuralgia genitofemoral
A novel CT-guided transpsoas approach to diagnostic genitofemoral nerve block and ablation.
Parris D, Fischbein N, Mackey S, Carroll I.
Pain Med. 2010;11(5):785-9. doi: 10.1111/j.1526-4637.2010.00835.x.
BACKGROUND: Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. CASE: A 39-year-old woman with chronic lancinating right groin pain after inguinal hernia repair underwent multiple pharmacologic interventions and invasive procedures without relief. Using CT and Stimuplex nerve stimulator guidance, the genitofemoral nerve was localized on the anterior surface of the psoas muscle and a diagnostic block with local anesthetic block was performed. The patient had immediate relief of her symptoms for 36 hours, confirming the diagnosis of genitofemoral neuralgia. She subsequently underwent CT-guided radiofrequency and phenol ablation of thegenitofemoral nerve but has not achieved long-term analgesia. CONCLUSION: CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery.
Tratamiento de la neuralgia genitofemoral e ilioinguinal medicamente intratable
Management of medically intractable genitofemoral and ilioingunal neuralgia.
Acar F, Ozdemir M, Bayrakli F, Cirak B, Coskun E, Burchiel K.
Turk Neurosurg. 2013;23(6):753-7. doi: 10.5137/1019-5149.JTN.7754-12.0.
AIM: To evaluate the effectiveness of invasive procedures in medically intractable genitofemoral and ilioingunal neuralgia. MATERIAL AND METHODS: This is a prospective study of 20 patients with genitofemoral and ilioinguinal neuralgias who were treated at our medical center between 2007 and 2011. Genitofemoral and ilioinguinal nerve blocks were performed in all cases after medical treatment had failed to alleviate the patients' pain. Neurectomy was performed for the patients whose pain did not improve. Patient histories, physical examinations and visual analogue scale scores before and after treatments were analyzed. RESULTS: Fourteen (70%) of the patients were treated with nerve blocks and six (30%) of the patients whose pain did not improve with nerve block application underwent neurectomy which resulted in pain relief. CONCLUSION: For patients with medically intractable genitofemoral and ilioinguinal neuralgias, nerve blocks and neurectomies can be applied safely for pain control.
Anestesia y Medicina del Dolor
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