Papa Lou

ASA Member
5+ Year Member
Jul 7, 2013
295
69
Status
Attending Physician
Anybody done this for chronic ilioinguinal / iliohypogastric nerve neuralgia?
This is an elderly patient who I've blocked now twice with relief for about a week each time, but the pain keeps coming back. About 2 years ago he was down this path and a general surgeon removed a "lipoma" out of his inguinal region which apparently relieved all of this pain for about 2 years. There is no lipoma palpable on physical exam but he's overweight so it's hard to tell. GI has worked him up, neurology has worked him up, he has appt with general surgeon in coming weeks. Best case they pull out another lipoma, worst case they cut the nerve and bury it. But if nothing else is an option or helps, I have discussed peripheral nerve stimulation with him. But I've never done it. Has anyone here done it? I don't have an ultrasound and even if I did it would be hard to place this thing down well along the nerve in the inguinal region, wouldn't it?
 

mazinger

10+ Year Member
Aug 8, 2007
152
25
Status
Anybody done this for chronic ilioinguinal / iliohypogastric nerve neuralgia?
This is an elderly patient who I've blocked now twice with relief for about a week each time, but the pain keeps coming back. About 2 years ago he was down this path and a general surgeon removed a "lipoma" out of his inguinal region which apparently relieved all of this pain for about 2 years. There is no lipoma palpable on physical exam but he's overweight so it's hard to tell. GI has worked him up, neurology has worked him up, he has appt with general surgeon in coming weeks. Best case they pull out another lipoma, worst case they cut the nerve and bury it. But if nothing else is an option or helps, I have discussed peripheral nerve stimulation with him. But I've never done it. Has anyone here done it? I don't have an ultrasound and even if I did it would be hard to place this thing down well along the nerve in the inguinal region, wouldn't it?
Why not trying Iovera or a pRF of the nerves or pRF of the DRG?
 

Orin

10+ Year Member
Jul 27, 2009
778
298
Status
Some data for DRG stim for it, a bit more sustainable than a peripheral system.
 

epidural man

ASA Member
10+ Year Member
Jun 3, 2007
3,071
739
49
San Diego
Status
Attending Physician

dunecat

2+ Year Member
Mar 25, 2015
48
5
Status
Attending Physician
I haven't seen cryoablation being used in my (short) training thus far. Would someone mind explaining where it would be superior (i.e. peripheral nerves)? Also, is it difficult to get insurance to approve of it? I wonder if I can get my program to consider using it. Thank you in advance.
 

mazinger

10+ Year Member
Aug 8, 2007
152
25
Status
I haven't seen cryoablation being used in my (short) training thus far. Would someone mind explaining where it would be superior (i.e. peripheral nerves)? Also, is it difficult to get insurance to approve of it? I wonder if I can get my program to consider using it. Thank you in advance.
The billing code for a peripheral nerve ablation is 64640, the disposable needle is approximately $200. Insurance companies sometimes cover it, depending on your documentation and negotiation skills.
If you are a hospital employee, the cost of the needle would not be prohibitive.