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INTRODUCTION

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Perhaps because much of its path is intra-abdominal, the genitofemoral nerve (GFN) nerve is an under-recognized cause of abdominal and pelvic pain.

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INDICATIONS

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  • The diagnosis and treatment of:

    • Groin pain

    • Inguinal pain, especially after inguinal hernia repair using mesh and/or staples

    • Pelvic pain

    • Suprapubic pain (mimicking interstitial cystitis)

    • Vaginal or penile pain

  • Used with ilioinguinal and iliohypogastric nerve blocks for inguinal herniorrhaphy

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  • Used with femoral nerve block for saphenous vein stripping

  • Used to diagnose genitofemoral neuralgia

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RELEVANT ANATOMY

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Genitofemoral Nerve

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  • Branch of the L1 and L2 nerve root

  • Pierces the psoas muscle at the level of the third and fourth lumbar vertebra behind the ureter and divides into 2 branches (Figures 60-1 and 60-2)

    • The genital branch provides the efferent and afferent components of the cremasteric reflex

    • The femoral branch, which supplies the anterior skin in the femoral triangle

      • Accompanies the external iliac artery in the femoral sheath lateral to the artery

    • The genital branch, which travels along the medial pelvic ring, enters the inguinal canal through the deep (ventral) inguinal ring in 97% of patients,1 passing lateral to the pubic tubercle

      • In males, the genital branch travels through the inguinal canal within the spermatic cord and supplies the cremaster muscle and the scrotal skin.

      • In females, the genital branch travels with the round ligament and supplies sensation to the mons pubis and labia majora.2

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BASIC CONCERNS AND CONTRAINDICATIONS

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  • Large volumes of local anesthetic are often used for blind anesthetic blocks for surgery, but diagnostic injections need to be low volume.

  • Contraindications

    • Absolute

      • Infection

      • Severe anxiety to needle sticks

      • Severe scarring over entire area to be injected

      • Coagulopathy

    • Relative

      • Psychogenic pain

      • Inability to communicate with the patient

      • Anticoagulant or nonaspirin antiplatelet therapy (for the superficial injections, there is little risk of bleeding, since these are small gauge needles)

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Because of its intra-abdominal as well as abdominal wall location, the genitofemoral nerve can be injured by conditions such as:

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  • Psoas abscess

  • Postoperative intra-abdominal scarring

  • Any laparoscopic abdominal procedures

  • Transpsoas lateral interbody fusion3

  • Femoral branch

    • Trauma to the groin

  • Genital branch

    • Inguinal hernia repair, especially mesh repairs, when the mesh is secured to the Poupart ligament at the symphysis pubis4,5

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Pain pathology is usually distal; however, occasionally it is necessary to address the nerve proximally at L1.

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PREOPERATIVE CONSIDERATIONS

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  • Informed consent and proper explanation of risks, complications, and benefits must be performed.

  • Anticoagulation does not necessarily ...

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