Postoperative Trunk Pain: Role of Peripheral Nerve Surgery

Trunk and abdominal pain cause significant problems for a patient who previously has had trauma or surgery and is left with chronic pain despite a negative work-up. This is particularly true for patients with postoperative breast, chest, or abdominal pain. Beside chronic pain management and frequent spinal nerve blocks, very little is left for the treatment of these patients. The authors identified no clinical reports providing an algorithm or the outcome for these patients when treated with peripheral nerve surgery.

Four patients with abdominal pain were treated. Their pain followed right hemicolectomy, laparoscopic cholecystectomy, tubal ligation, and diagnostic laparoscopy. Patients were 8 to 24 months following surgery and had localized numbness of abdominal skin, pain to light touch and with activities. All diagnostic work-up, that included CT scan, x-rays, small bowel series, endoscopy, colonoscopy, and/or diagnostic laparoscopy, was negative. Patients were on multiple narcotics, had spinal nerve blocks, all without relief of pain. Physical examination and history confirmed their complaints, while diagnostic intercostal nerve (ICN) blocks relieved their localized pain. The selected ICNs were excised, while the proximal stumps were implanted to muscle. All four patients had relief from their preoperative symptoms, three completely and one continued with a vague, dull, deep pain when working out.

This highly selected group of patients with chronic postoperative abdominal and trunk pain can benefit from peripheral nerve surgery.