Stop the euthanasia of the lateral femoral cutaneous nerve
Amgad S Hanna, MD; University of Wisconsin, Madison, WI
Introduction: Meralgia paresthetica causes pain, in the anterolateral thigh, associated with dysesthesia and decreased sensation in the lateral femoral cutaneous nerve (LFCN) territory. Surgery is offered when conservative measures fail. Simple decompression is associated with high failure rate. Neurectomy leaves the patient with an area of loss of sensation in the thigh. A new technique of LFCN transposition is described. Anatomical feasibility and early case series are presented.
Methods: Three embalmed cadavers had the LFCN dissected in the upper thigh and retroperitoneum. THE LFCN canal was opened and the nerve mobilized medially. Nineteen cases of meralgia paresthetica were surgically treated between 2011 and 2016. We had 3 groups: simple decompression (S), deep decompression (D), and transposition (T).
Results: In all cadavers, it was possible to mobilize the LFCN medially for about 2 cm. Four patients underwent simple decompression, 5 deep decompression, and 10 transposition. The average preoperative NRS for S was 7; 3.2 at 3 months postoperatively, and 1 at 1 year (p = 0.0867). The average preoperative NRS for D was 6.4; 1.6 at 3 months postoperatively, and 2.2 at 1 year (p = 0.0148). The average preoperative NRS for T was 6.5, 3 months postoperatively 1.5 , and 1 year 1 (p < 0.0001). When comparing the reduction in NRS between the three groups, the results were not statistically significant. In the S group, 2 patients underwent reoperation for nerve transection. In the D group, one patient was reoperated for an infected hematoma. In the T group, no patient underwent reoperation (p = 0.0454).
Conclusions: In most cases of meralgia paresthetica, the LFCN is too close to the ASIS and needs to be mobilized medially. Transection should not be the primary treatment, but saved for recurrences. Treating nerve entrapment by cutting the nerve is counterintuitive and is almost equivalent to euthanasia to treat cancer pain.
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