Immediate Postoperative Release of the Ilioinguinal Nerve as a Treatment Approach for Nerve Entrapment Pain [24I]. (May 2016) - Storey, Jean
Abstract : INTRODUCTION: The Pfannenstiel incision is the incision of choice for most benign gynecologic and obstetric surgery. One potential complication is nerve entrapment, usually involving the ilioinguinal or iliohypogastric nerve. METHODS: A 24 year old primigravida at 39 weeks gestation was admitted for induction of labor for gestational hypertension. An uncomplicated primary low transverse cesarean delivery was performed for persistent category II tracing remote from delivery. Immediately following completion of the surgery the patient reported unilateral, focal, burning pain at the right aspect of the Pfannenstiel incision that rapidly spread to the entire right abdomen. An abdominal exam revealed rebound and intentional guarding in the right upper and lower quadrants. An abdominal ultrasound was negative for free fluid. The patient was taken back to the operating room for abdominal exploration. On release of the fascial closure, the ilioinguinal nerve was noted to be entrapped at the right lateral aspect of the fascial incision. The hysterotomy was hemostatic. The ilioinguinal nerve was released and the incision was closed without further postoperative complications. RESULTS: N/A. CONCLUSION: Incisional pain can be found in 1–4% of patients after Pfannenstiel incisions. Most reported cases present with chronic pain and have been treated with local injections or excision of the associated neuroma. Our case presents the first documented report of immediate release of the nerve as a therapeutic approach to nerve entrapment pain experienced in the postoperative period. When readily identified, surgical release can result in relief from pain without need for long-term management strategies.