Pain relief after surgical neurolysis in Gazan patients with peripheral nerve injuries: A report amidst the ongoing conflict.

Abstract

Neuropathic pain from peripheral nerve injuries (PNIs) poses a major challenge, especially in conflict zones. Surgical neurolysis is a known intervention for pain due to nerve scarring and compression, but its impact in resource-limited settings remains underreported. This study evaluates pain outcomes following neurolysis in a conflict-affected region. A prospective case series was conducted in three major hospitals in Gaza from May to August 2024. Patients with severe neuropathic pain (VAS >7) persisting >3 months despite medical therapy underwent neurolysis by a single peripheral nerve surgeon. Data included demographics, injury mechanisms, operative findings, and VAS scores preoperatively and at 2 weeks and 3 months postoperatively. Analgesic use and statistical significance (p<0.05) were analyzed using SPSS. Seventy-five patients (62 males, 13 females; mean age 31.2 years) were included. Injuries were caused by shrapnel (80%) and gunshots (16%). Mean VAS score decreased from 9.2 (SD 1.2) preoperatively to 2.9 (SD 2.7) at 2 weeks and 2.7 (SD 2.5) at 3 months (p<0.001), representing 68% and 71% reductions, respectively. Analgesic use dropped from 73% preoperatively to 8% at 3 months. No significant differences were noted based on age, sex, or nerve affected. Pain reduction >2 points on the VAS, the threshold for clinical significance per EFNS guidelines, was achieved in 94.7% of patients. Surgical neurolysis significantly reduces neuropathic pain and analgesic reliance in PNI patients, highlighting its effectiveness and the need to expand surgical capacity in conflict zones.