Infiltration de lidocaïne dans une cicatrice chirurgicale médiane sus pubienne douloureuse chez la femme : étude préliminaire de l'effet sur les troubles fonctionnels urinaires apparus dans les mois suivants l'intervention chirurgicale

Abstract : Introduction: post-surgical chronic scar pain can be treated by lidocaine infiltration. Two patients with chronic scar pain following pelvic surgery describe, after the infiltration of their surgical scar, the regression of functional urinary disorders, that appeared after surgery. The purpose of this study is to determine whether there is a quantifiable regression of urinary functional disorders associated with the management of scar pain by lidocaine infiltration and to try to explain the underlying mecanisms of the operation of this infiltration. Methods: the patients had to have undergone sus-pubic surgery ; they had to have a painful surgical scar (Numeric Rating Scale> 3) associated with urinary functional disorders. The surgery had to have occured more than 6 months prior. The assesment was based on the completion before and after injection, of the Numeric Rating Scale of pain, the Urinary Handicap Measure scale, the Urinary Symptom profile questionnaire, the Ditrovie scale and the voiding diary. Results: 4 clinical cases were presented ; 2 patients responded favourably to infiltration with an improvement of all parameters. In both cases, the effects were persistant after 2 injections. The 2 patients had an overactive bladder, found in the USP questionnaire and confirmed by a urodynamic test. Discussion: the operation of this injection is most likely based on its interaction with the sympathetic nervous system: functional pain-related changes are responsible for urinary functional disorders and the interruption of the pain message probably leads to new functional changes responsible for the improvement of these disorders. A larger-scale study would make it possible to specify the average duration to be expected from this infiltration; It should include the systematic realization of a urodynamic test in order to have an "objective" idea of the preexistant disorders and of the results of the infiltration.
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Master Thesis
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Edoh Adjovi Sandra. Infiltration de lidocaïne dans une cicatrice chirurgicale médiane sus pubienne douloureuse chez la femme : étude préliminaire de l'effet sur les troubles fonctionnels urinaires apparus dans les mois suivants l'intervention chirurgicale. Médecine humaine et pathologie. 2018. ⟨dumas-01970456⟩

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