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• W2016099207 abstract "We would like to draw attention to the problem that occurs when an anaesthetist performs a procedure in the area in which the surgeon is operating and a complication arises. We present two patients who suffered chronic pain in the distribution of the lateral cutaneous nerve of the thigh following open inguinal hernia repair. The pain was blamed on peripheral nerve blockade but was more likely to have been caused by surgery. The two patients had inguinal hernias repaired under general anaesthesia. Both had an ilioinguinal nerve block performed medial to the anterior superior iliac spine with a standard 21G needle after induction of anaesthesia. The first patient complained of shooting pains in the lateral aspect of the right thigh the following morning. The pain persisted but changed to a burning sensation with anaesthesia over the lateral thigh. Nerve conduction studies confirmed complete transection of the lateral cutaneous nerve of the thigh. The second patient reported sharp pain in the left anterolateral thigh the next day. There was no sensation to pin prick over the anterolateral aspect of the thigh below the inguinal ligament. There was allodynia on the left side of the shaft of the penis and below the medial half of the inguinal ligament. Both patients suffered persistent, disabling pain. The syndrome of a dull ache, sharp pain, burning sensation, tingling or numbness in the distribution of the lateral cutaneous nerve of the thigh is known as meralgia paraesthetica. Entrapment by staples of the lateral cutaneous nerve of the thigh and femoral branch of the genitofemoral nerve is a documented complication of laparoscopic inguinal hernia repair [1]. Surgical procedures on the lower abdominal or inguinal region have resulted in damage to nerves including the ilioinguinal, iliohypogastric and genitofemoral nerves [2]. On the other hand, local anaesthetic blockade of the lateral cutaneous nerve of the thigh has been used for harvesting split skin grafts from the thigh without complications [3,4]. We could find no cases reported of permanent damage to the nerve following open inguinal hernia repair. The lateral cutaneous nerve of the thigh is entirely sensory and originates from the anterior divisions of the second and third lumbar nerves. It emerges from the lateral border of psoas major and courses obliquely across the surface of the iliac muscle towards the anterior superior iliac spine. Before it reaches the inguinal ligament, a number of anatomical variations have been described (Fig. 7)[5,6]. The commonest route for the nerve is downward and under the inguinal ligament, crossing anterior to the sartorius muscle and dividing into an anterior and a posterior branch. A recent study of cadavers [6] described five anatomical positions of the nerves that varied from superficial to posterior and from lateral to medial. This study found that, in 13.5% of cases, the nerve divided into two branches before passing beneath the inguinal ligament with the medial branch forming the femoral branch of the genitofemoral nerve. Another anatomical study [7] found that the nerve contributed to the genitofemoral nerve 30% of the time. Variations in the position of the lateral cutaneous nerve of the thigh as it exits the abdomen. Type A – nerve courses across the iliac crest posterior to the anterior superior iliac spine. Type B – nerve is medial to the anterior superior iliac spine ensheathed in either the inguinal ligament, tendinous origin of sartorius muscle or found between sartorius and iliopsoas muscles. Type C – nerve is in most medial position superior to iliopsoas muscle, contributing the femoral branch to the genitofemoral nerve. The first patient had nerve damage in the usual distribution of the lateral cutaneous nerve of the thigh but the second patient had damage in an area involving both the genitofemoral nerve and the lateral cutaneous nerve of the thigh. In both cases, the peripheral nerve blocks were blamed for the nerve damage resulting in chronic pain because they had been performed close to the operative site. However, local anaesthetic injection is unlikely to cause complete nerve damage, in contrast to surgery which is more likely to cause neurotmesis. While damage to the lateral cutaneous nerve of the thigh is presumed to be rare, as judged by the paucity of reports, it is probably underreported. These patients serve as a reminder that regional anaesthesia can be blamed for surgical complications and highlight the importance of explanation and proper patient consent." @default.
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• W2016099207 date "2003-04-15" @default.
• W2016099207 modified "2023-09-23" @default.
• W2016099207 title "Lateral cutaneous nerve of the thigh pain in association with inguinal hernia repair" @default.
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• W2016099207 doi "https://doi.org/10.1046/j.1365-2044.2003.03154_13.x" @default.
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