Neurolysis for Megalgia Paresthetica

Abstract

ObjectiveMeralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue.MethodsDuring the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted.ResultsTwelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported.ConclusionNeurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.

The Anatomical Course of the Lateral Femoral Cutaneous Nerve with Special Attention to the Anterior Approach to the Hip Joint

“…5). This information is also of interest when neurolysis of the LFCN 40 or an ultrasound-guided LFCN block 41 has to be performed. Therefore, a skin incision at the ASIS is not problematic per se, as long as the incision remains in the superficial subcutaneous fat layer.…”

“…Others noted that the anatomy of the membranous layer varied with sex, adiposity, and body region 45 and that it was thicker in the lower compared with the upper extremity and on the posterior compared with the anterior aspect of the body 46 . Many anatomical studies have described the LFCN anatomy and its variations in relation to the ASIS, the approach for iliac crest bone harvesting, or the surgical management of meralgia paresthetica [19][20][21][22][23][24][25][26]40 . In the present study, most LFCN branches entered the thigh above (27%) or medial to (62%) the ASIS.…”

Tratamiento laparoscópico de la meralgia parestésica. Revisión de la bibliografía

“…Las complicaciones atribuidas a esta opción son una anestesia permanente sobre la cara anterior del muslo, probable restricción motora, infección local, sangrado y persistencia del dolor. Los pacientes deben ser advertidos de estas posibilidades en el trascurso del consentimiento informado sobre sus opciones terapéuticas [29][30][31] . Algunos autores han sugerido utilizar la neurolisis como un tratamiento previo a la resección 6 .…”

Delayed Diagnosis of Meralgia Paresthetica: A Case Report

“…In the classic form of MP, the symptoms are fairly stereotypical and the clinical diagnosis is fairly straightforward 7,9) . However, a diagnosis of MP is not always straightforward in clinical practice 7,9) .…”

“…In the classic form of MP, the symptoms are fairly stereotypical and the clinical diagnosis is fairly straightforward 7,9) . However, a diagnosis of MP is not always straightforward in clinical practice 7,9) . This condition can be easily confused with lumbosacral radicular pain in a small group of patients 7,9) .…”