Page 57 - herina surgery and possible lawsuits

Gold standard pain rating scale serves best for post hemioplasty pain is lacking.
• Loos et. al had suggested to rounded to near centimeters converting VAS scale 0-10

score and consider moderate to severe pain when VAS score >3 [113]. They further
studied two frequently used pain rating scales (VAS and four-point VRS) for scale
failure and to determine which test performs better in patients with groin henna

repair. They concluded that four pomt VRS scale perform better than VAS, but to
convert VAS into VRS scores, cut off points are mandatory. They suggest four
categones of VRS corresponded to VAS categones were as follows:

0-8 = no pain,
9-32 = mild,
33-71 = moderate,

>71 = severe pain. [110]
In our study Visual Analog Score describe by patients from range 0 to 10, considering
rounding and above cut of points, we have redefined Verbal rating scale m our study, which

are as follows:
P0 VAS Score 0 - No pam
PI VAS Score 1-3 - Mild
P2 VAS Score 4-6 - Moderate
P3 VAS Score 7-10 - Severe

Many other studies had used self defined criteria.
• Verstraete et al had used pain and discomfort as tool where they defined, ' ‘Pain ’ ’ was
defined as a subjective, invalidating sensation in the groin or upper thigh, with or

without need for analgesics; “discomfort” as a non continuous, not invalidating
sensation m the groin or upper thigh, without need for analgesics and expressed as “ I
sometimes feel it when.. They found pam in 8% patients at 3 months and 4% after
3 years.[114]

Factors associated with chronic pain:
Various studies performed to look at the difference in chrome groin pam rates with and
different associated factors e.g. nerve identification, isolation, preservation; nerve excision;

heavyweight or lightweight mesh; and mesh fixation.[115] Others have studied associated
factors like age, preoperative pain, socioeconomic status, open and laparoscopic hernia, non
mesh sutures, early post operative pain, genital complication etc.[14]

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