Trovisco Sofia, Bem Gonçalo, Silva Manuel, Agrelo Ana
Department of Anesthesiology and Intensive Care Medicine, Instituto Português de Oncologia do Porto Francisco Gentil EPE, Porto, PRT.
Department of Anesthesiology and Intensive Care Medicine, Unidade Local de Saúde de São João EPE, Porto, PRT.
Cureus. 2024 Aug 18;16(8):e67136. doi: 10.7759/cureus.67136. eCollection 2024 Aug.
Chronic postsurgical pain (CPSP) is defined as pain that develops or increases in intensity after a surgical procedure or tissue injury and persists beyond the healing process, lasting at least three months after the precipitating event. Often neuropathic in nature, CPSP can be challenging to manage. CPSP is a common complication, with data suggesting an incidence ranging from 5% to 85%, depending on the type of procedure. Meralgia paresthetica (MP) and ilioinguinal/iliohypogastric neuralgias (IH/IL N) are two possible clinical scenarios of CPSP following lower abdominal procedures. Pulsed radiofrequency (PRF) is a minimally invasive technique of peripheral neuromodulation effective in various pain etiologies; however, evidence is scarce regarding its use in MP and IH/IL N. This case series aims to assess the potential role of PRF in the management of CPSP following abdominal wall procedures. This case series was set in a single oncological center between January 2017 and February 2022 and included adult patients (>18 years old) referred to our unit with a high suspicion of postsurgical MP or IH/IL N refractory to conservative treatment. PRF was performed after a positive diagnostic block in patients whose pain could not be controlled despite optimal medical treatment. The efficacy of PRF was assessed regarding pain intensity using the verbal numeric scale (VNS) and the duration of pain relief in weeks. The follow-up period was from the initial PRF procedure to the end of data collection. Parametric data were presented as mean and standard deviation (SD), and non-parametric data as median (minimum-maximum). Seventeen patients were included: 82.35% (n=14) were female, and the mean age was 58.0 ± 11.35 years. MP was present in 47.1% (n=8) and IH/IL N in 52.9% (n=9). Transverse rectus abdominis muscle flap reconstruction (TRAM) was the most common procedure (n=5, 29.41%). Diagnostic blocks were performed in 88.24% (n=15) of the patients. Initial VNS scores were 7.59 ± 2.62; 2.82 ± 2.62 at 24 hours; and 2.47 ± 1.58 at 15 days. During follow-up, 70.59% (n=12) of patients had no recurrence of initial symptoms. A second PRF was performed in 29.41% (n=5) cases based on the recurrence of symptoms, following a mean period of pain relief of 112 (8-238) weeks. No major or minor complications were identified during early or late follow-up. PRF can be a useful tool to improve the multimodal management of postsurgical abdominal wall chronic pain.
慢性术后疼痛（CPSP）被定义为在外科手术或组织损伤后出现或强度增加且在愈合过程后持续存在的疼痛，在引发事件后至少持续三个月。CPSP通常具有神经性本质，其管理可能具有挑战性。CPSP是一种常见并发症，数据表明其发生率在5%至85%之间，具体取决于手术类型。股外侧皮神经痛（MP）和髂腹股沟/髂腹下神经痛（IH/IL N）是下腹部手术后CPSP的两种可能临床情况。脉冲射频（PRF）是一种外周神经调节的微创技术，对各种疼痛病因有效；然而，关于其在MP和IH/IL N中的应用证据稀少。本病例系列旨在评估PRF在腹壁手术后CPSP管理中的潜在作用。本病例系列于2017年1月至2022年2月在单个肿瘤中心进行，纳入了因高度怀疑术后MP或IH/IL N且保守治疗无效而转诊至我们科室的成年患者（>18岁）。对于尽管进行了最佳药物治疗但疼痛仍无法控制的患者，在诊断性阻滞阳性后进行PRF。使用视觉数字评分量表（VNS）评估PRF在疼痛强度方面的疗效以及以周为单位的疼痛缓解持续时间。随访期从最初的PRF手术至数据收集结束。参数数据以均值和标准差（SD）表示，非参数数据以中位数（最小值 - 最大值）表示。纳入了17例患者：82.35%（n = 14）为女性，平均年龄为58.0 ± 11.35岁。47.1%（n = 8）存在MP，52.9%（n = 9）存在IH/IL N。腹直肌肌皮瓣重建术（TRAM）是最常见的手术（n = 5，29.41%）。88.24%（n = 15）的患者进行了诊断性阻滞。初始VNS评分为7.59 ± 2.62；24小时时为2.82 ± 2.62；15天时为2.47 ± 1.58。在随访期间，70.59%（n = 12）的患者初始症状未复发。基于症状复发，在平均疼痛缓解112（8 - 238）周后，29.41%（n = 5）的病例进行了第二次PRF。在早期或晚期随访中未发现重大或轻微并发症。PRF可以成为改善术后腹壁慢性疼痛多模式管理的有用工具。
