Purpose of Review

This is a comprehensive review of the literature regarding post-surgical cutaneous nerve entrapment, epidemiology, pathophysiology, and clinical presentation. It focuses mainly on nerve entrapment leading to chronic pain and the available therapies.

Recent Findings

Cutaneous nerve entrapment is not an uncommon result (up to 30% of patients) of surgery and could lead to significant, difficult to treat chronic pain. Untreated, entrapment can lead to neuropathy and damage to enervated structures and musculature, and significant morbidity and financial loss. Nerve entrapment is defined as pressure neuropathy from chronic compression. It causes changes to all layers of the nerve tissue. It is most significantly associated with hernia repair and other procedures employing a Pfannenstiel incision. The initial insult is usually incising of the nerve, followed by formation of a neuroma, incorporation of the nerve during closing, or constriction from adhesions. The three most commonly involved nerves are the iliohypogastric, ilioinguinal, and genitofemoral nerves. Cutaneous abdominal nerve entrapment could occur during thoracoabdominal surgery. The presentation of nerve entrapment usually involved post-surgical pain in the territory innervated by the trapped nerve, possibly with radiation that tracks the nerve course. Once a suspected neuropathy is identified, it can be diagnosed with relief in pain after a nerve block has been instilled. Treatment is usually started with pharmaceutical solutions, topical first and oral if those fail. Most patients require escalation to a second line of treatment and see good result with injection therapy. Those that require further escalation can choose between ablation and surgical therapies.

Summary

Post-surgical nerve entrapment is not uncommon and causes serious morbidity and financial loss. It is underdiagnosed and thus undertreated. Preventing nerve entrapment is the best treatment; when it does occur, options include topical and oral analgesics, nerve blocks, ablation therapy, and repeat surgery.

中文翻译：

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术后皮神经卡压的综合回顾与更新

审查目的

这是对关于术后皮神经卡压、流行病学、病理生理学和临床表现的文献的全面回顾。它主要关注导致慢性疼痛的神经卡压和可用的治疗方法。

最近的发现

皮神经卡压在手术中并不少见（高达 30% 的患者），可能导致严重且难以治疗的慢性疼痛。未经治疗的卡压会导致神经病变以及对虚弱结构和肌肉组织的损害，以及严重的发病率和经济损失。神经卡压被定义为慢性压迫引起的压力性神经病。它会导致神经组织的所有层发生变化。它与采用 Pfannenstiel 切口的疝气修复和其他手术密切相关。最初的损伤通常是神经切开，随后形成神经瘤、闭合过程中神经并入或因粘连而收缩。三种最常受累的神经是髂腹下神经、髂腹股沟神经和生殖股神经。胸腹手术期间可能会发生腹部皮肤神经卡压。神经卡压的表现通常涉及被卡住神经支配的区域的术后疼痛，可能伴随着追踪神经路线的辐射。一旦发现疑似神经病变，在进行神经阻滞后，可以诊断出疼痛缓解。治疗通常从药物溶液开始，先局部使用，如果失败则口服。大多数患者需要升级到二线治疗，并通过注射治疗看到良好的效果。那些需要进一步升级的人可以在消融和手术治疗之间进行选择。可能使用跟踪神经过程的辐射。一旦发现疑似神经病变，在进行神经阻滞后，可以诊断出疼痛缓解。治疗通常从药物溶液开始，先局部使用，如果失败则口服。大多数患者需要升级到二线治疗，并通过注射治疗看到良好的效果。那些需要进一步升级的人可以在消融和手术治疗之间进行选择。可能与跟踪神经过程的辐射。一旦发现疑似神经病变，在进行神经阻滞后，可以诊断出疼痛缓解。治疗通常从药物溶液开始，先局部使用，如果失败则口服。大多数患者需要升级到二线治疗，并通过注射治疗看到良好的效果。那些需要进一步升级的人可以在消融和手术治疗之间进行选择。

概括

手术后神经卡压并不少见，会导致严重的发病率和经济损失。它未得到充分诊断，因此未得到充分治疗。预防神经卡压是最好的治疗方法；当它确实发生时，选择包括局部和口服镇痛剂、神经阻滞、消融治疗和重复手术。