Ilioinguinal + Genitofemoral Nerve Blocks and Radiofrequency
The anatomy of the ilioinguinal + genitofemoral nerve
The ilioinguinal nerve is a branch from the first lumbar nerve which arises from the spinal column. It comes through the psoas major’s (a spine stabilising muscle) lateral border, just under the iliohypogastric, and passes across the quadratus lumborum and iliacus in the hip rotator muscles.
The genitofemoral nerve is a branch from the lumbar plexus and is one of the three components which make up the larger lumbosacral plexus (a nerve network in the lower vertebral). The genitofemoral nerve goes through the surface of the psoas major before splitting into two branches – the femoral ramus and genital ramus.
Causes of Ilioinguinal + genitofemoral nerve pain
Ilioinguinal nerve pain or ilioinguinal neuropathy is caused by dysfunction or damage. This typically occurs as a result of surgery such as a hernia operation, compression of the nerve from the trauma of the pelvis or abdomen through injury. Sensitisation in this nerve may occur as a result of persisting groin and pelvic pain.
Genitofemoral nerve pain or genitofemoral neuralgia can be caused by the compression of the nerve, commonly due to blunt trauma to the nerve caused by injury, or damage to the nerve which is sustained in the process of pelvic surgery. Sensitisation in this nerve may occur as a result of persisting groin and pelvic pain.
Ilioinguinal + genitofemoral nerve blocks and radiofrequency procedure
Ilioinguinal and genitofemoral nerve blocks or Pulsed radiofrequency are day case procedures which can be performed with an anatomical landmark technique or ultrasound guidance. This will take place in theatre under full aseptic conditions with the patient on his or her back. A small needle in the back of your hand can be used to administer sedation or in case of an emergency. The skin is well cleaned before a small amount of local anaesthetic is applied in order to numb the injection area. The physician then directs a small needle the nerve. A small mixture of steroid (anti-inflammatory medication) and anaesthetic is then injected into the nerve.
Pulsed radiofrequency is a relatively new treatment for pain which uses neurostimulation therapy in order to modulate the function of the nerve. As a result the pain signals to the brain are modified by the electrical pulse, meaning the patient does not feel the same pain as he or she did previously. This may be indicated if there is a significant reduction in the pain levels after the Ilioinguinal and genitofemoral nerve block to prolong the benefit. This procedure can be described as a ‘retuning’ of the nerves so that they modulate pain transmission.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for five or more days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases.This window of pain relief should be utilised for performance of strengthening exercises and physiotherapy.
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding. Pelvic organ trauma or nerve damage is extremely rare.