GroinPain Trial: the effect of a neurectomy compared with an injection with lidocain, corticosteroids and hyaluronic acid on postherniorrhaphy inguinodynia.

Chronic pain is a common complication after inguinal hernia repair (20-40%). In approximately 4% of patients, pain originates from entrapment or damage of the inguinal nerves. Previous retrospective research has showed surgical treatment, neurectomy, to be effective in 70-80% of these patients. However, current treatment by pain specialists comprises of injections with lidocain, corticosteroids and hyaluronic acid. To evaluate appropiate treatment for these neuropathic pain syndromes a randomised controlled trial was set up comparing these treatment modalities.
We expect the surgical treatment to be more effective in reducing pain than injections (max 3 injections using a neurostimulator with a two-week interval). After six months patients in the injection-group are offered a cross-over to the surgical group.
Statistical analysis: sample-size 2 groups of 27 patients, power 90%, type I error 0.05, intention-to-treat analysis.
Primary outcome measure: pain reduction (Surgical Pain Scales, McGill Pain questionnaire - Dutch language version), Secondary outcomes: 1. complications, 2. neurophysiological changes (LANNS), 3. Quality of life (SF-36 version II), 4. Change in employement status.

The pain reductive effect of a neurectomy of the ilio-inguinal, ilio-hypogastric or/ and genital branch of the genito-femoral nerve(s) is significantly more compared to an injection with lidocain, corticosteroids and hyaluronic acid for neuropathic groin pain syndrome.

Neurectomy of ilio-inguinal, ilio-hypogastric or/ and genital branch of the genito-femoral nerve(s) compared with an injection with lidocain, corticosteroids and hyaluronic acid on postherniorrhaphy inguinodynia.