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Transversus Abdominis Plane Block for Ilioinguinal Nerve Entrapment Following Cesarean Delivery
Abstract Number: S2D-3
Abstract Type: Case Report/Case Series
Case Report: SS
Title: Transversus Abdominus Plane Block for Ilioinguinal Nerve Entrapment Following Cesarean Delivery
Ilioinguinal nerve entrapment is a rare but possible complication following cesarean delivery. This can cause significant morbidity and increase the amount of opioid used in the postpartum period. Furthermore, between 2-4% of cases of chronic lower abdominal pain after Pfannenstiel incision are thought to be due to nerve entrapment. Confirming the etiology of pain is essential to guide further treatment. A single ilioinguinal nerve block has been previously performed to confirm diagnosis and guide future surgical intervention. Therapeutic relief after single ilioinguinal block has also been reported (1). The use of transversus abdominis plane (TAP) block in those cases has not been previously reported.
A 21-year-old G3P3 woman with a past medical history of HIV presented on postoperative day 8 following cesarean delivery for evaluation of superficial left lower quadrant abdominal pain. She described it as a constant burning sensation which had been present since immediately after surgery. It did not radiate. She was taking 5 mg of oxycodone every 4 hours to manage the pain. The patient rated her pain a 6 out of 10 on a 0-10 pain scale. An ilioinguinal nerve entrapment was suspected based on her symptoms. We therefore performed a TAP block for diagnostic and potentially therapeutic benefit. 20 cc of 0.5% ropivacaine with 1:400,000 epinephrine was injected under ultrasound guidance on the left at approximately T12. Following the procedure, the patient was stable and had no pain. We called the patient for follow up the next day. She reported that she was pain free for about 17 hours, but subsequently the pain returned with a similar severity to pre-block level. Both surgery and conservative management with pain medication were offered to her the following day.
We report a case of ilioinguinal nerve entrapment where the diagnosis was confirmed by temporary relief for about 17 hours following TAP block placement. Given the diagnostic confirmation of neural entrapment, potential further steps would be neurectomy or conservative management with medication (2).
1. Loos MJ, Scheltinga MR, Roumen RM. Ann. Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision. Ann Surg. 2008 Nov;248(5):880-5.
2. Whiteside, J. L. and M. D. Barber (2005). "Ilioinguinal/iliohypogastric neurectomy for management of intractable right lower quadrant pain after cesarean section: a case report." Journal of Reproductive Medicine 50(11): 857-859.