Nagarkar Purushottam, Ramanadham Smita, Chamseddin Khalil, Chhabra Avneesh, Rozen Shai M
Dallas, Texas.
From the Departments of Plastic Surgery and Radiology, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2017 Jan;139(1):204-211. doi: 10.1097/PRS.0000000000002892.
Incidence of chronic postoperative neurogenic pain after open and laparoscopic trunk operations is reported between 1 and 20 percent, rendering a large population in the United States and worldwide. One possible treatment is selective surgical neurectomy.
All patients who underwent neurectomy for chronic trunk or groin postoperative neurogenic pain were identified. Based on individual history and examination, patients underwent neurectomies of the ilioinguinal, iliohypogastric, genitofemoral, lateral-femoral cutaneous, or intercostal nerves. Recorded preoperative pain levels (Likert score ranging from 0 to 10) were compared to postoperative pain levels and quality-of-life indices were assessed.
Fifty-six patients (32 men and 24 women) were included. Mean age was 49 years. All patients underwent preoperative nerve blocks by either surgeon, radiologist, or referring physician, and had either complete or significant response defined as over 50 percent relief. Forty-five patients completed the survey. Median follow-up was 2.8 years (range, 1.0 to 5.7 years). Average pain level was 9.0 preoperatively and 3.5 postoperatively. Quality-of-life impairment improved from 8.3 preoperatively to 3.5 postoperatively. A subset of patients (n = 12) had minimal improvement, reporting a decrease in pain from 8.5 to 7.2 and quality-of-life improvement from 8.5 to 7.1.
Complete avoidance of nerve injury during all trunk and groin operations is likely unattainable. When chronic postoperative neurogenic pain develops, neurectomy can be an effective means of treatment, significantly improving pain and quality of life in most patients. Better insight is necessary into a patient subset responding to nerve blocks yet experiencing minimal postoperative improvement.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
开放性和腹腔镜下躯干手术术后慢性神经源性疼痛的发生率据报道在1%至20%之间，美国和全球有大量人群受此影响。一种可能的治疗方法是选择性手术神经切除术。
确定所有因慢性躯干或腹股沟术后神经源性疼痛接受神经切除术的患者。根据个人病史和检查情况，患者接受髂腹股沟神经、髂腹下神经、生殖股神经、股外侧皮神经或肋间神经的神经切除术。将术前记录的疼痛水平（李克特评分范围为0至10）与术后疼痛水平进行比较，并评估生活质量指标。
纳入56例患者（32例男性和24例女性）。平均年龄为49岁。所有患者均由外科医生、放射科医生或转诊医生进行术前神经阻滞，且有完全或显著反应，定义为疼痛缓解超过50%。45例患者完成了调查。中位随访时间为2.8年（范围为1.0至5.7年）。术前平均疼痛水平为9.0，术后为3.5。生活质量损害从术前的8.3改善至术后的3.5。一部分患者（n = 12）改善极小，报告疼痛从8.5降至7.2，生活质量从8.5改善至7.1。
在所有躯干和腹股沟手术中完全避免神经损伤可能无法实现。当术后出现慢性神经源性疼痛时，神经切除术可能是一种有效的治疗手段，可显著改善大多数患者的疼痛和生活质量。对于对神经阻滞有反应但术后改善极小的患者亚组，有必要深入了解。
临床问题/证据水平：治疗性，IV级。
