Tap block in chronic pain treatment: a case of entrapment syndrome of iliohypogastric and ilioininguinal nerves

Abstract

The patient is a 42 years old woman with entrapment syndrome of the “nerves of passage” – ilioinguinal (IING) and Iliohypogastric (IHPO) – after abdominal surgery. The patient was suffering for IV stage infiltrating endometriosis and went through 13 abdominal surgical interventions (laparoscopic and open). Consequently, she developed chronic neuropathic pain in the IING and IHPO areas, unresponsive to drug therapy. Ultrasound images showed a subverted anatomy with fibrosis of the involved nerves. After three TAP (transversus abdominis plane) block sessions the ultrasound sight resulted improved: a significant amount of preexistent adhesions had lysed and pain was considerably reduced. Temporarily, pain totally disappeared and gradually resume with different features in terms of intensity and continuity. This case highlights the possibility to treat this kind of painful iatrogenic syndromes of injurious and adhesive nature with this technique, with variations in imaging aspects as well as in clinical symptoms. In this particular case we did not get a total resolution of pain, maybe due to the long history of the symptoms and their chronicity. The study of a number of pain cases of more recent onset could be extremely useful in the evaluation of this technique, as suggested by this case history.

Keywords

• tap block
• entrapment of iliohypogastric and ilioininguinal nerves