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INDICATIONS

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The diagnosis and treatment of:

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  • Ilioinguinal neuralgia

  • Iliohypogastric neuralgia

  • Groin pain

  • Inguinal pain, especially after mesh and/or staples

  • Pelvic pain

  • Postherpetic neuralgia

  • Lateral abdominal wall pain postincision or trocar placement

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CONTRAINDICATIONS

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  • Inability to communicate with the patient

  • Infection

  • Severe anxiety to needle sticks

  • Anticoagulant or nonaspirin antiplatelet therapy

  • Severe scarring over entire area to be injected

  • Coagulopathy

  • Psychogenic pain

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RELEVANT ANATOMY

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Iliohypogastric Nerve

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  • Branch of the L1 nerve root with a contribution from T12 occasionally.

  • In a study of 100 embalmed cadavers, the iliohypogastric nerve originated from T12 on 14 specimens (7%), from T12 and L1 in 28 (14%), from L1 in 20 (10%), and from T11 and T12 in 12 (6%).1

  • Follows an oblique course that takes it from L1 and T12 around the flank to perforate the transverse abdominis muscle and is positioned between it and the external oblique muscle terminating inside the ilium (Figure 59-1).

  • Often entrapped at the lateral edge of the rectus border (Figure 59-2).

  • May also be entrapped more proximally at the edge of the external oblique (Figure 59-3).

  • Divides into an anterior and lateral branch after the perforation of the transverse abdominis muscle.

  • The lateral branch gives sensory skin innervation to the posterolateral gluteal region, whereas the anterior branch gives skin sensory innervation to the abdominal skin above the pubis.

  • Both ilioinguinal and iliohypogastric branches of this L1 nerve root may interconnect and provide significant variation of sensory innervation.

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Figure 59-1.

Ilioinguinal and iliohypogastric nerves.

Graphic Jump Location
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Ilioinguinal Nerve

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  • Branch of the L1 nerve root with a contribution from T12 in some patients.

  • In a study of 100 embalmed cadavers, the ilioinguinal nerve originated from L1 in 130 specimens (65%), from T12 and L1 in 28 (14%), from L1 and L2 in 22 (11%), and from L2 and L3 in 20 (10%).1

  • Penetrates the transversus abdominis at the anterior superior iliac spine and terminates in the ilium.

  • Ilioinguinal nerve may interconnect with the iliohypogastric nerve as it passes along inferiorly and accompanies the spermatic cord through the inguinal ring and into the inguinal canal (Figure 59-1).

  • Often entrapped at the lateral edge of the rectus border (Figure 59-2).

  • May also be entrapped more proximally at the edge of the external oblique (Figure 59-3).

  • Innervation of the ilioinguinal nerve includes the skin of the upper portion of the inner thigh, root of the penis, the upper scrotum in ...

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