Hidden in Plain Sight: Recognizing Post-Surgical Anterior Abdominal Wall Neuralgias

Abstract

Study Objective

Educate gynecologic surgeons on how to suspect and diagnose post-operative iliohypogastric and ilioinguinal neuralgias.

Design

An educational video was created to discuss the prevalence of post-surgical neuralgias, review the different types of pain, and describe pertinent anterior abdominal wall nerve anatomy. We will explain through a clinical scenario how to obtain a thorough history and perform a focused physical examination. We will demonstrate the steps of conducting directed nerve blocks for diagnostic and therapeutic purposes.

Setting

Outpatient clinic and operating room.

Patients or Participants

Post-surgical patients with anterior abdominal wall neuralgias.

Interventions

Not applicable.

Measurements and Main Results

Not applicable.

Conclusion

Post-surgical abdominopelvic neuralgias are a prevalent, yet underdiagnosed condition that can lead to persistent abdominopelvic pain. Treatment options are often multimodal and may involve nonpharmacologic options, pharmacotherapy and/or interventional procedures. We demonstrate in this video step-by-step instructions for diagnostic and therapeutic blocks that can either be performed in the office or operating room. Surgeons should familiarize themselves with the assessment, diagnosis, and treatment of these commonly missed neuralgias.