Ultrasound Guided Peripheral Nerve Stimulation Implant for Management of Intractable Pain after Inguinal Herniorrhaphy

Background: Inguinal hernia repair is one of the most common operations performedworldwide. 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 afteringuinal 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 electricalstimulation to decrease post inguinal herniorrhaphy pain, increase patients’ functionality, anddecrease pain medication use.Study Design: Three patients with intractable pain after inguinal herniorrhaphy wereincluded in this case series. Two patients had right-sided inguinal repair and one had a leftsided repair. Pain in these patients all began after the inguinal repair and had an averagepain duration of 3.4 years after surgery. All 3 patients had been treated with multiple painmanagement modalities without significant pain improvement. We will describe the clinicalcourse of these patients who presented with chronic intractable pain. After a period of failedconservative medical management and repetitive successful nerve blocks, we decided toproceed with utilizing electrical nerve stimulation as a treatment modality.Setting: This retrospective study was done at the university hospital and has an IRB assignednumber.Results: After careful consideration of the patients’ history and physical examinationand a thorough psychological assessment, we proceeded with a temporary percutaneouselectrical neurostimulation that provided significant pain relief. Ultrasound guided permanentpercutaneous electrical neurostimulation implant was shown to provide significant pain reliefat 12-month follow-ups. We reviewed all existing pertinent medical literature related to themanagement of post herniorrhaphy pain. This case series adds to our current knowledge forchronic intractable post herniorrhaphy pain management.Limitations: This study is a retrospective assessment of a new technique that was applied toa limited number of cases. It remains to be determined whether this technique is superior tothe classical open surgical technique in the future. Our findings warrant further studies on theutilization of peripheral nerve stimulation with chronic post herniorrhaphy pain.Key words: Peripheral nerve stimulation, ilioinguinal nerve, iliohypogastric nerve, nerveblock, inguinal hernia repair, ultrasound guided procedure