[Hydrodissection for the treatment of postoperative gynecologic neuropathic pain].

Abstract

Postoperative neuropathic pain following gynecologic surgery is a rare phenomenon and is usually self-limiting in most cases. As with other causes of neuropathic pain, its lack of resolution can be difficult to treat and associated with severe impairments in quality of life. Most cases of postoperative neuropathic pain in gynecology are due to involvement of the iliohypogastric, ilioinguinal, or genitofemoral nerves. For cases that do not respond to pharmacological treatment, we should consider minimally invasive treatment alternatives. Peripheral nerve hydrodissection presents growing evidence for the treatment of entrapment neuropathies due to its mechanical decompression effect and relief of regional glycopenia, although there are no reports in the literature for the treatment of iliohypogastric and ilioinguinal entrapment. We present a 40-year-old woman who developed severe neuropathic pain following myomectomy, refractory to pharmacological treatment, with significant functional and emotional impact. Ultrasound-guided hydrodissection of the iliohypogastric and ilioinguinal nerves achieved significant clinical improvement, allowing discontinuation of opioids and complete functional recovery.