A scoping review of perineural steroids for the treatment of chronic postoperative inguinal pain.

purposeTo review the literature on the efficacy and safety of perineural steroid injections around the ilioinguinal, iliohypogastric, and genitofemoral nerves for chronic postoperative inguinal pain (CPIP).

methodsA scoping review was performed to find all relevant case reports, case series, prospective or retrospective cohort studies, case-control studies, and randomized controlled trials (RCTs) where a steroid was used for perineural procedures around ilioinguinal, iliohypogastric, and/or genitofemoral nerves for CPIP. Databases searched included Ovid MEDLINE, EMBASE, CINHAL, Cochrane CENTRAL, and Google Scholar.

resultsA total of five publications were found-three studies were prospective case series, one a retrospective cohort study, and one a RCT. The most common steroids used were methylprednisolone and triamcinolone. The average methylprednisolone-equivalent dose used per procedure was 46 mg (SD 21.9). Procedural guidance included anatomic landmarks (three studies), nerve stimulation and ultrasound (one study), and computed tomography guidance (one study). Four studies reported analgesic benefit in 55-75 % of included patients, with one study documenting an effect up to 50 months later after steroid perineural injections. The RCT demonstrated no benefit of adding steroid to a local anesthetic in the perioperative setting but it did not enroll patients with existing neuropathic pain. No adverse outcomes of perineural steroids were documented within reviewed studies.

conclusionsThe paucity of data, heterogeneity and lack of appropriate control groups in the available literature precludes firm conclusions on the efficacy and safety of perineural steroids for CPIP. Future adequately powered, high-quality, placebo-controlled studies are needed.