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Neurectomies and Neurolysis for the Treatment Of Chronic Postoperative Pain
Purushottam Nagarkar, M; Smita Ramanadham, MD; Khalil Chamseddin, MD; Shai Rozen,MD
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
Introduction: Open and laparoscopic trunk surgeries are very commonly performed procedures in the US –there were approximately 920,000 hernia repairs and 500,000 laparoscopic cholecystectomies performed in 2006. The incidence of chronic pain after such surgeries has been reported to be between 1% and 20%. As such, there is a large population of patients suffering from chronic postoperative neurogenic pain. One possible treatment for such patients is selective surgical neurectomies and less commonly selective neurolysis.
Methods: All patients of the senior author (SMR) who underwent neurectomies or neurolysis for complaints of chronic postoperative pain following trunk or groin surgeries were identified. Based on history and physical exam, patients underwent selective neurectomies including intercostal, ilioinguinal, iliohypogastric, genitofemoral or lateral femoral cutaneous nerves. Patients were administered a phone survey based on the Pain Disability Index to assess their pre- and post-operative pain level and quality of life.
Results: 57 patients (32 male, 25 female) who underwent neurectomies were identified. Mean age was 49 years. All patients underwent preoperative nerve block by the senior author or the referring physician, and had either a complete or significant response. 46 patients completed the survey (7 declined, 2 could not be contacted after three attempts, 2 were deceased). Median follow-up was 2.8 years (0.5-5.7 years). Average pain level was reported to be 9.0 preoperatively and 3.5 postoperatively on a 0-10 Likert scale. Quality of life impairment improved from 8.2 preoperatively to 3.4 postoperatively. A subset of patients (n=12) had minimal improvement, reporting a pain decrease from 9.2 to 7.9, and a quality of life improvement from 9.2 to 7.6.
Conclusions: Neurectomies or less commonly neurolysis can be effective means of relieving chronic postoperative pain caused by trunk or groin surgeries, with excellent improvements in pain and quality of life scores. There is a subset of patients who respond to nerve blocks but have minimal improvement after surgery.
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