The amazing Dr. Baumbach - another life-changing diagnosis?

[paindoc]

This is actually a very common problem seen particularly in patients with inguinal hernia repairs, and sometimes after spine surgery in the upper lumbar/ lower thorasic spine (the following nerves originate there). The ilioinguinal nerve and genitofemoral nerves can be entrapped by scar tissue after the surgery.I'll bet that scar from when the patient was 5yrs old was most likely a hernia repair. As a former surgery resident, I was able to perform hernia repairs often and now as an interventional pain doc it is easy to see why the problem is so widespread. During the surgery, the ilioinguinal nerve has to be reflected out of the surgical field. This is often done using hemostat clamps, which sometimes find themselves clamping the nerve and not the tissue surronding it! Also, because the problem is so common, there was one attending who used to cut the nevre to "deinnervate" it, so that entrapment pain could not occur. As an ill-informed surgeon, this made sense...cut the nerve and the patient can't have any pain right? WRONG!!!! The proximal end of the neve grows neural "buds" that will constantly fire looking for the distal end which is no longer there. This "firing" causes even worse pain in many of these patients.I'll bet I don't got 2-3 weeks without seeing a nerve entrapment like this, and the answeris to cryo the nerve. This seems to work the best without damaging the nerve itself. Sometimes a revised surgery is in order for an enterapment, but the thing that seems to work the best is placing a spinal cord stimulator lead underneath the skin along the path of the nerve.