Continuous Ilioinguinal-iliohypogastric Nerve Block for Groin Pain in a Breast-feeding Patient after Cesarean Delivery

Ilioinguinal and iliohypogastric (II/IH) nerve injury is one of the most common nerve injuries following pelvic surgery, especially with the Pfannenstiel incision. We present a case of intractable groin pain, successfully treated with a continuous II/IH nerve block. A 33-year-old woman, following emergency cesarean section due to cephalopelvic disproportion, presented numbness in left inguinal area and severe pain on the labia on the second postoperative day. The pain was burning, lancinating, and exacerbated by standing or movement. However, she didn't want to take additional medicine because of breast-feeding. A diagnostic II/IH nerve block produced a substantial decrease in pain. She underwent a continuous II/IH nerve block with a complete resolution of pain within 3 days. A continuous II/IH nerve block might be a goodoption for II/IH neuropathy with intractable groin pain in breast-feeding mothers without adverse drug reactions in their infants.

A Comparison of the Pfannenstiel Incision and Vertical Midline Incision for Radical Hysterectomy and Pelvic Lymphadenectomy / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to review patients undergoing radical hysterectmy and pelvic lymphadenectomy, comparing Pfannenstiel and Vertical midline incisions for operative feasibility and perioperative outcome. METHODS: Between January 2001 and February 2003, 123 patients underwent radical hysterectomy and pelvic lymphadenectomy for cervical cancer at Busan Paik hospital. All procedures were performed by a gynecologic oncologist. Prospectively, all data were collected from review of each patient's medical record, including age, body mass index (BMI), stage, histology, nodal counts, operative time, estimated blood loss, surgical pathologic margin positivity, complications, and length of hospital stay. Associations between variables were studied using X2 test, t-test, and Fisher Exact test. RESULTS: Radical hysterectomy was performed through a Vertical midline (n=62) and Pfannenstiel (n=61) incision. There were no significant differences in age, BMI, stage, histology, nodal counts, estimated blood loss, surgical pathologic margin positivity, complications, and length of hospital stay. But, patients with a Pfannenstiel incision had shorter operative time than those with Vertical midline incision (169 min vs 197 min, P<0.0001). CONCLUSION: Radical hysterectomy and pelvic lymphadenectomy can be safely performed through a Pfannenstiel incision without increased operative morbidity and equal nodal removal as compared with Vertical midline incision. Pfannenstiel incision may offer the benefits of improved cosmesis and shorter operative time without compromising surgical exposure or increasing the risk of surgical complications.