Liem Liong, Mekhail Nagy
Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Pain Pract. 2016 Sep;16(7):915-23. doi: 10.1111/papr.12424. Epub 2016 Feb 23.
Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain. The development of chronic pain may be prevented via a number of perioperative measures. For pain that is already established, some surgical approaches including inguinal neurectomy can be effective, in addition to standard pharmacological treatments and local infiltrations. An unmet need may still exist with these options, however, leaving a role for neuromodulation for the treatment of intractable cases. A pain management algorithm for iterative interventions including stimulation of the dorsal root ganglion (DRG) is described. It is expected that cross-disciplinary awareness of surgeons for nonsurgical pain management options in the treatment of chronic neuropathic postherniorrhaphy pain will contribute to better clinical outcomes.
慢性神经性腹股沟疼痛是疝气手术的后遗症，其发生率高得令人难以接受，对生活质量产生广泛影响。尽管医学界开始认识到手术技术在疝修补术后神经性疼痛的引发和维持中所起的作用，但关于这种病症的疼痛管理策略的信息却很少。本综述概述了疼痛状况、其治疗选择及治疗建议。通过文献综述和临床经验，制定了一种针对疝修补术后疼痛的治疗算法。可通过一些围手术期措施预防慢性疼痛的发生。对于已经出现的疼痛，除了标准的药物治疗和局部浸润外，包括腹股沟神经切除术在内的一些手术方法可能有效。然而，这些选择可能仍无法满足需求，这就使得神经调节在治疗顽固性病例中发挥作用。本文描述了一种针对包括刺激背根神经节（DRG）在内的迭代干预的疼痛管理算法。预计外科医生对于慢性神经性疝修补术后疼痛治疗中非手术疼痛管理选择的跨学科认识将有助于改善临床结果。
