Ultrasound-guided genitofemoral nerve block for severe post-caesarean neuropathic pain: a case report

Genitofemoral, ilioinguinal and iliohypogastric neuralgia are known complications of caesarean delivery. Diagnosis can be confirmed with selective low-volume nerve blocks. We present a case of a 37-year-old postpartum patient who developed intractable neuropathic pain immediately after caesarean delivery preventing mobility and discharge. A selective genitofemoral nerve block was performed using a vascular landmark technique due to obscuration of the round ligament by post-operative oedema. A perineural injection of bupivacaine, dexmedetomidine and dexamethasone resulted in 10 days of complete pain relief allowing for mobility and discharge. After 10 days, the pain returned, but at a manageable level allowing for outpatient management. A repeat block 42 days after caesarean delivery resulted in resolution of the neuropathic pain. This case demonstrates the use of vascular landmarks to accurately perform a low-volume diagnostic block during an acute post-operative pain crisis despite obscuring oedema.