Neurectomy

A neurectomy is a type of nerve block involving the severing or removal of a nerve. This surgery is performed in rare cases of severe chronic pain where no other treatments have been successful, and for other conditions such as involuntary twitching and excessive blushing or sweating.

A brief "rehearsal" local anesthetic nerve block is usually performed before the actual neurectomy, to determine efficacy and detect side effects. The patient is typically under general anesthetic during the neurectomy, which is performed by a neurosurgeon.

A presacral neurectomy is typically conducted to decrease severe pain and menstrual cramps in the lower abdomen. Pain in this region is difficult to treat with noninvasive treatments. Endometriosis is the most common cause for this severe pain. One solution that doctors often mistakenly recommend as a cure is a hysterectomy, or removal of the uterus. However, this often does not relieve endometriosis pain because the disease is left behind on other organs such as the bladder, bowels, or pelvic side walls, and it can thrive on its own hormone supply. Another is to perform a presacral neurectomy. This is a procedure that interrupts the nerves going towards and/or around the uterus. Pain located on either side of the lower abdomen (but not mid line) should not be treated with a neurectomy. Only individuals with pain that is not relieved by the use of NSAIDs should consider this procedure. Techniques have been developed for this procedure to be performed laparoscopically.

The incision is typically directly under the navel. Normally three small holes are made in the lower abdomen to allow for the instruments and other various surgical tools. Nerve tissue that runs to the uterus is interrupted at the sacral promontory; a point at which spine and tailbones meet. This is the best area to access and obtain a clear view of the nerves in the uterus. Proper precautions must be taken as to avoid unnecessary complications with the major blood vessels surrounding the uterus. Some of the complications post-operation include urinary retention, as well as constipation. Neither has been reported to cause lasting effects.

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