Background: Chronic inguinal neuralgia involving ilioinguinal and iliohypogastric nerves is a
frequent complication of surgical procedures involving a lower abdominal incision such as hernia
repair, appendicitis surgery, or cesarean sections. Chronic inguinal neuralgia is a very painful condition
and diagnosis can be challenging as it is an overlooked impairment. Existing specific treatments are
inefficient and often fail.
Objective: The purposes of this study are to describe, evaluate, and compare ilioinguinal and
iliohypogastric radiofrequency neurolysis (RFN) and local injection.
Study Design: Retrospective comparison cohort study from 2005 to 2011.
Setting: A single center, Academic Interventional Pain Management Unit
Methods: Forty-two patients suffering from chronic inguinal pain refractory to specific medication
were included. A total of 18 RFN procedures (14 patients) and 28 injections (28 patients) were
performed. Pain was assessed in both groups using Visual Analog Scale (VAS) scores (0-10)
measured immediately before and after the procedure and at one, 3, 6, 9, and 12 months after
the procedure. Mean duration of pain prior to the procedure and mean duration of pain relief were
noted. Moreover, mean maximum early pain relief was assessed. All procedures were ambulatory
under computed tomography (CT) guidance. Injections contained 1.5 mL of cortivazol and 3 mL of
lidocaine-ropivacaine (30%-70%). Radiofrequency neurolysis was performed using a Neurotherm
RF Generator. In both cases, 22-gauge needles were used. After needle retrieval, control slices were
taken and the patient was supervised for 30 minutes at the CT unit.
Results: The mean age in both groups was 48.7 years. Forty-two patients (97.6%) presented
postsurgical inguinal pain, 62% of which occurred after hernia repair. All included patients had
undergone previously unsuccessful pain therapies. Mean VAS scores were 7.72 in the RF group and
7.46 in the infiltration group. Maximum early pain relief did not statistically differ (77% in the RFN
group and 81.5% in the injection group). Mean duration of pain relief was statistically significant
(P = .005) in the RF group (12.5 months) compared to the infilitration group (1.6 months). Mean
VAS scores during the year following the procedure were all significantly in favor of radiofrequency
neurolysis management.
Limitations: Those inherent to small study samples and retrospective studies.
Conclusion: Radiofrequency neurolysis appears to be significantly more effective than local nerve
infiltrations. It is a safe and effective treatment for chronic inguinal pain. Local steroid injection along
with local injection of anesthetics should be used as a confirmation of ilioinguinal neuropathy before
performing radiofrequency neurolysis.
Key words: Radiofrequency, Ilioinguinal, Iliohypogastric, neuropathy, infiltration, computed
tomography guidance.