Orly Avitzur, MD, MBA

Disclosures

August 04, 2004

Question

What treatment modes are available for meralgia paresthetica (MP)? How often is surgical decompression needed? If required, what would be the indications and who is the best person to do it -- a general surgeon, a neurosurgeon, or some other specialist? Can injection of lidocaine at the start of the nerve's course in the thigh be helpful?

Response From the Expert

Orly Avitzur, MD, MBA
Lecturer, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut; Assistant Professor, Department of Neurology, New York Medical College, Valhalla, New York

MP is a condition characterized by numbness, tingling, pain, irritation, or burning in the anterior or anterolateral thigh resulting from compression or injury to the lateral femoral cutaneous nerve. Causes include mechanical factors, such as compressive clothing, belts, obesity, and pregnancy. MP has also reportedly occurred following surgical procedures and trauma, or has been related to plexopathy due to mass or hemorrhage. A recent study found that the incidence rate of MP is 4.3/10,000 persons per year and that it is found in higher numbers in patients suffering from carpal tunnel syndrome (suggesting a predisposition to nerve entrapment syndromes) and during pregnancy.[1]

Successful treatment can often be achieved with conservative therapy, such as physical therapy, acupuncture,[2] weight reduction to shrink abdominal girth, avoiding constrictive garments, and using analgesics and other medications.

Medications used in other forms of neuropathic pain, such as tricyclic antidepressants or anticonvulsants, may alleviate some of the symptoms of pain, dysesthesias, or paresthesias. The advent of the newer antiepileptic drugs with weight-reducing effects may be ideally suited to those patients in whom obesity is a factor, and diet and weight loss are goals.

Injection of a local anesthetic may be helpful in establishing the diagnosis but only gives temporary relief. If successful, local blocks with steroids may be effective. A report from a pain clinic found that a treatment plan of repeated, subsequent injection blocks on alternate days was successful. They used .25% of bupivacaine combined with methylprednisolone acetate in divided doses of 20 mg each, up to a maximum of 80-120 mg along with oral diphenylhydantoin (100-300 mg daily), and 85% of their population attained complete relief within 10 weeks.[3]

Surgery is generally reserved for patients with persistent and debilitating pain refractory to other modalities of treatment. Various techniques have been used, and it is not clear whether neurolysis or transaction is the procedure of choice; some believe that the best results may be achieved by local decompression in combination with neurolysis via the infrainguinal ligament approach.[4] Surgery is most often performed by neurosurgeons, but general surgeons or orthopaedists may be involved, depending on the institution.

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