A 24-Year-Old Man Is Being Evaluated for a Nerve Block

question 280

Multiple Choice

A 24-year-old man is being evaluated for a nerve block procedure.  The patient has had intermittent burning and stabbing pain in the left groin since undergoing mesh repair of an inguinal hernia a year ago.  The pain is often brought on by physical activity and coughing.  He has no other medical conditions and takes no medications.  Vital signs are within normal limits.  On physical examination, there is no weakness of anterior abdominal or lower extremity muscles.  Lightly touching the upper medial thigh or upper part of the scrotum elicits burning pain.  Cremasteric reflex is normal.  The clinical diagnosis is entrapment of a nerve traversing the superficial inguinal ring with the spermatic cord.  Blockade of which of the following nerves with a local anesthetic injection is most likely to relieve this patient's symptoms?

• A)Femoral
• B)Genitofemoral
• C)Iliohypogastric
• D)Ilioinguinal
• E)Obturator

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