Directed neurectomy for treatment of chronic postsurgical neuropathic pain

Chronic 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.

After 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.

All but 1 of the 28 patients had complete relief for a minimum of 12 months when discharged from follow-up.

This simple directed neurectomy method typically provides long-term relief for patients suffering from chronic postsurgical neurogenic pain.