Department of Obstetrics and Gynecology, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil.
Sci Rep. 2021 May 24;11(1):10820. doi: 10.1038/s41598-021-90319-y.
Entrapments of the intrapelvic portions of the lumbosacral plexus are an important extraspinal cause of sciatica and pudendal neuralgia. They can be treated using Laparoscopic Neuronavigation (LANN), a minimally invasive technique that has set the foundations of an emerging field in Medicine-Neuropelveology. This retrospective-prospective study analyzes the outcomes of 63 patients treated with the LANN technique over a 10 year time period. One year after surgery, 78.3% of patients reported clinically relevant pain reduction, defined as ≥ 50% reduction in Numeric Rating Scale (NRS) score; these results were maintained for a mean follow up of 3.2 years. Preoperative chronic opioid use (≥ 4 months of ≥ 10 mg morphine equivalents/day) was a predictor of poor surgical outcome-clinically relevant pain reduction was observed in only 30.8% in this group of patients, compared to 91.5% in patients not regularly taking opioids preoperatively (p < 0.01). Perioperative complication rate was 20%. Our results indicate that the LANN technique is an effective and reproducible approach to relieve pain secondary to intrapelvic nerve entrapments and that preoperative chronic opioid therapy significantly reduces the likelihood of a successful surgical outcome. This study provides detailed information on perioperative complication and postoperative course, which is essential for patient consenting.
腰骶丛盆腔内段嵌压是坐骨神经痛和阴部神经痛的一个重要的脊柱外原因。可以采用腹腔镜神经导航（LANN）治疗，这是一种微创技术，为医学-盆神经外科学领域的新兴领域奠定了基础。本回顾性前瞻性研究分析了 63 例采用 LANN 技术治疗的患者在 10 年时间内的结果。术后 1 年，78.3%的患者报告临床相关疼痛减轻，定义为数字评分量表（NRS）评分降低≥50%；这些结果在平均 3.2 年的随访中得到维持。术前慢性阿片类药物使用（≥4 个月，每天≥10 毫克吗啡当量）是手术结果不良的预测因素——在该组患者中，仅 30.8%观察到临床相关疼痛减轻，而术前不规律服用阿片类药物的患者为 91.5%（p<0.01）。围手术期并发症发生率为 20%。我们的结果表明，LANN 技术是一种有效且可重复的方法，可缓解盆腔内神经嵌压引起的疼痛，术前慢性阿片类药物治疗显著降低手术成功的可能性。本研究提供了围手术期并发症和术后过程的详细信息，这对患者知情同意至关重要。
