Directed neurectomy for treatment of chronic postsurgical neuropathic pain

BackgroundChronic neurogenic pain after surgery, especially inguinal herniorrhaphy, remains a major cause of morbidity. The traditional treatment of postinguinal herniorrhaphy neurogenic pain has included triple neurectomy with the removal of any mesh. This report describes a directed, minimally invasive surgical neurectomy that provided pain relief in 28 patients with minimal morbidity.MethodsAfter temporary but successful proximal peripheral nerve blockade, the nerve was blocked in the operating room using a small amount of blue dye mixed with the local anesthetic. After confirming pain relief with the dye-anesthetic mixture, the patient was then sedated, and all blue-stained tissue was excised through a small incision, avoiding both the previous surgical scar and mesh.ResultsAll but 1 of the 28 patients had complete relief for a minimum of 12 months when discharged from follow-up.ConclusionsThis simple directed neurectomy method typically provides long-term relief for patients suffering from chronic postsurgical neurogenic pain.