The GroinPain Trial: A Randomized Controlled Trial of Injection Therapy Versus Neurectomy for Postherniorraphy Inguinal Neuralgia.

Abstract

OBJECTIVE:

This study compares tender point infiltration (TPI) and a tailored neurectomy as the preferred treatment for chronic inguinodynia after inguinal herniorraphy.

BACKGROUND:

Some 11% of patients develop chronic discomfort after open inguinal herniorraphy. Both TPI and neurectomy have been suggested as treatment options, but evidence is conflicting.

METHODS:

Patients with chronic neuropathic pain after primary Lichtenstein repair and >50% pain reduction after a diagnostic TPI were randomized for repeated TPI (combined Lidocaine/corticosteroids /hyaluronic acid injection) or for a neurectomy. Primary outcome was success (>50% pain reduction using Visual Analog Scale, VAS) after 6 months. Cross-over to neurectomy was offered if TPI was unsuccessful.

RESULTS:

A total of 54 patients were randomized in a single center between January 2006 and October 2013. Baseline VAS was similar (TPI: 55, range 10-98 vs neurectomy: 53, range 18-82, P = 0.86). TPI was successful in 22% (n = 6), but a neurectomy was successful in 71% (n = 17, P = 0.001). After unsuccessful TPI, 19 patients crossed over to neurectomy and their median VAS score dropped from 60 to 14 (P = 0.001). No major complications after surgery were reported. Two-thirds of patients on worker's compensation returned to work.

CONCLUSION:

A tailored neurectomy is 3 times more effective than tender point infiltration in chronic inguinodynia after anterior inguinal hernia mesh repair. A step up treatment stratagem starting with tender point infiltration followed by a tailored neurectomy is advised.

• Authors: Tim Verhagen, Maarten J A Loos, Marc R M Scheltinga, Rudi M H Roumen
• Journal: Annals of surgery (Ann Surg) Vol. 267 Issue 5 Pg. 841-845 (05 2018) ISSN: 1528-1140 [Electronic] United States
• PMID: 28448383 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Adjuvants, Immunologic
• Anesthetics, Local
• Drug Combinations
• Glucocorticoids
• Hyaluronic Acid
• Lidocaine

Topics

• Adjuvants, Immunologic (administration & dosage)
• Adult
• Aged
• Aged, 80 and over
• Anesthetics, Local (administration & dosage)
• Denervation (methods)
• Drug Combinations
• Female
• Glucocorticoids (administration & dosage)
• Groin
• Hernia, Inguinal (surgery)
• Herniorrhaphy (adverse effects)
• Humans
• Hyaluronic Acid (administration & dosage)
• Inguinal Canal (innervation)
• Injections
• Lidocaine (administration & dosage)
• Lumbosacral Plexus (surgery)
• Male
• Middle Aged
• Neuralgia (diagnosis, etiology, therapy)
• Pain Measurement
• Pain, Postoperative (diagnosis, etiology, therapy)
• Treatment Outcome