Laparoscopic approach to refractory extraspinal sciatica and pudendal pain caused by intrapelvic nerve entrapment.

Autor: Lemos N; Department of Obstetrics and Gynecology, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada. nucelio.lemos@utoronto.ca.; Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil. nucelio.lemos@utoronto.ca.; Department of Obstetrics and Gynecology, Mount Sinai and Women's College Hospital, University of Toronto, 700 University Avenue|Room 8-917, Toronto, ON, M5S 1Z5, Canada. nucelio.lemos@utoronto.ca., Sermer C; Department of Obstetrics and Gynecology, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada., Fernandes G; Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil., Morgado-Ribeiro A; Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil., Rossos A; Department of Obstetrics and Gynecology, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada., Zhao ZY; Department of Obstetrics and Gynecology, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada., Girão MJBC; Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil., Peng P; Department of Anesthesiology and Pain Management, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2021 May 24; Vol. 11 (1), pp. 10820. Date of Electronic Publication: 2021 May 24.
DOI: 10.1038/s41598-021-90319-y
Abstrakt: Entrapments of the intrapelvic portions of the lumbosacral plexus are an important extraspinal cause of sciatica and pudendal neuralgia. They can be treated using Laparoscopic Neuronavigation (LANN), a minimally invasive technique that has set the foundations of an emerging field in Medicine-Neuropelveology. This retrospective-prospective study analyzes the outcomes of 63 patients treated with the LANN technique over a 10 year time period. One year after surgery, 78.3% of patients reported clinically relevant pain reduction, defined as ≥ 50% reduction in Numeric Rating Scale (NRS) score; these results were maintained for a mean follow up of 3.2 years. Preoperative chronic opioid use (≥ 4 months of ≥ 10 mg morphine equivalents/day) was a predictor of poor surgical outcome-clinically relevant pain reduction was observed in only 30.8% in this group of patients, compared to 91.5% in patients not regularly taking opioids preoperatively (p < 0.01). Perioperative complication rate was 20%. Our results indicate that the LANN technique is an effective and reproducible approach to relieve pain secondary to intrapelvic nerve entrapments and that preoperative chronic opioid therapy significantly reduces the likelihood of a successful surgical outcome. This study provides detailed information on perioperative complication and postoperative course, which is essential for patient consenting.
Databáze: MEDLINE
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