1. 2015;18;E31-E38Ultrasound Guided Peripheral Nerve Stimulation Implant for Management of Intractable Pain after Inguinal Herniorrhaphy
   Retrospective Evaluation
   Chandan G Reddy, MD, Foad Elahi, MD, and David Ho, MD.

BACKGROUND: Inguinal hernia repair is one of the most common operations performed worldwide. Intractable pain following this operation is a potential debilitating complication. The exact etiology of this complex pain is unknown and the treatment of chronic pain after inguinal herniorrhaphy can be a difficult task for both the patient and the clinician.

OBJECTIVES: The objectives of this study are to identify the ability of peripheral nerve electrical stimulation to decrease post inguinal herniorrhaphy pain, increase patients’ functionality, and decrease pain medication use.

STUDY DESIGN: Three patients with intractable pain after inguinal herniorrhaphy were included in this case series. Two patients had right-sided inguinal repair and one had a left-sided repair. Pain in these patients all began after the inguinal repair and had an average pain duration of 3.4 years after surgery. All 3 patients had been treated with multiple pain management modalities without significant pain improvement. We will describe the clinical course of these patients who presented with chronic intractable pain. After a period of failed conservative medical management and repetitive successful nerve blocks, we decided to proceed with utilizing electrical nerve stimulation as a treatment modality.

SETTING: This retrospective study was done at the university hospital and has an IRB assigned number.

RESULTS: After careful consideration of the patients’ history and physical examination and a thorough psychological assessment, we proceeded with a temporary percutaneous electrical neurostimulation that provided significant pain relief. Ultrasound guided permanent percutaneous electrical neurostimulation implant was shown to provide significant pain relief at 12-month follow-ups. We reviewed all existing pertinent medical literature related to the management of post herniorrhaphy pain. This case series adds to our current knowledge for chronic intractable post herniorrhaphy pain management.

LIMITATIONS: This study is a retrospective assessment of a new technique that was applied to a limited number of cases. It remains to be determined whether this technique is superior to the classical open surgical technique in the future. Our findings warrant further studies on the utilization of peripheral nerve stimulation with chronic post herniorrhaphy pain.