Adrian Imre Kastler, Presenter: Nothing to Disclose

Sebastien Aubry MD, PhD, Abstract Co-Author: Nothing to Disclose

Bruno Alfred Kastler MD, PhD, Abstract Co-Author: Nothing to Disclose

Chronic ilioinguinal and iliohypogastric neuralgias are a frequent complication of surgical procedures involving lower abdominal incision such as hernia repair, appendicitis surgery or C-sections. Chronic Inguinal neuralgia is a very painful condition and diagnosis can be challenging as it is a disregarded impairment. Existing specific treatments are inefficient and often fail. We therefore studied the efficacy, safety and feasibility of both local nerve infiltration and radiofrequency neurolysis (RFN) in the management of chronic ilioinguinal and iliohypogastric pain. The purposes of this study are to describe, evaluate and compare these two treatments.

Fourty one patients suffering from chronic inguinal pain refractory to specific medication were included in this monocentric retrospective study between 2005 and 2011. A total of 17 RFN procedures and 28 infiltrations were performed. Pain was assessed in both groups using VAS scores measured immediately before and after procedure and at 1,3,6, 9 and 12 months after procedure. Mean duration of pain prior procedure and mean duration of pain relief were noted. All procedures were realized ambulatory under CT guidance. After needle retrieval, control slices were realized and patients were supervised 30 minutes at CT unit.

A total of 41 patients were included in our study, 13 in the RFN group and 28 in the LNI group. Seventeen RFN procedures were performed and 28 local steroid infiltration LNI post surgical inguinal pain, 61% of which occured after hernia repair. All included patients had undergone previous unsuccessful pain therapies. Mean VAS scores were respectively 7,76 and 7,46 in the RFN and LNI groups. Mean duration of pain relief was statistically significant (p=006) in the RF group (12,5 months) compared to the LNI Group (1,2 month). Mean VAS scores at 1,3,6,9 and 12 months were all statistcally in favor of RFN. They are represented in figure 1.

CT guided RFN appears to be significantly more effective than hitherto performed LNI. It is a safe and effective treatment of chronic inguinal pain. Local steroid injection along with injection of anesthetics should be used as a confirmation of the diagnosis before RFN

Chronic inguinal neuralgia is an underestimated impairment (up to40% after hernia repair). RF neurolysis is a safe and more effective treatment than hitherto performed nerve infiltrations

Kastler, A, Aubry, S, Kastler, B, Refractory Chronic Inguinal Neuralgia: CT-guided Radiofrequency Neurolysis vs Infiltrations in 41 Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014884.html