Page 81 - International guidelines for groin hernia management

Hernia

a preoperative informative video before hernia surgery on Pain treatment
postoperative quality of life. A benefit was noted at
3-month follow-up, but no difference was detectable at Chronic postoperative pain treatment after inguinal hernia
6 months. 225 The effect of music and music combined with repair
therapeutic suggestions was studied in a prospective ran-
domized manner in day case varicose vein and IH surgery. Introduction
Either intervention demonstrated a modest effect on Chronic pain is a significant complication after IH surgery
patients’ pain in the immediate postoperative period. Long- leading to disability, dissatisfaction, and impaired produc-
term effects were not studied. 226 The effect of postopera- tivity and quality of life. Despite a wide array of general
tive education after hernia surgery was studied in a pain treatment options, management of this burdensome
prospective randomized fashion. No difference in postop- condition remains challenging. Due to a paucity of evi-
erative pain or return-to-work interval was found, but a dence-based data of the subject and heterogeneous patient
small statistically significant benefit on pain-when-moving populations and pathologies, expert opinion plays a vital
was found on postoperative day #7. However, the study role in decision-making. For this reason, nearly all state-
authors found no reason to recommend a change in stan- ments in the section below are only weakly supported but
dard practice regarding postoperative counseling. 227 do represent a blend of an exhaustive literature review and
expert opinion. The recommendations reflect current state-
Discussion of-the-art and are important for clinicians and patients
The perioperative use of medications to prevent chronic dealing with chronic pain.
pain has focused mainly on blocking central sensitization
and the development of neuropathic pain. Gabapentin is the Key question
best studied and has a documented short-term benefit. In
general, these benefits fade after 1–6 months. Pregabalin, KQ19T.a How should inguinal hernia repair patients with
though less well studied, has a similar effect. Capsaicin and immediate, severe, postoperative pain be treated?
etanercept have no proven long-term effect on chronic

pain. So-called ‘‘preventive analgesia’’ through multimodal Evidence in literature
approaches is predicated on the assumption that the only There is clear evidence that acute postoperative pain is a
way to prevent central sensitization is to completely block risk factor for chronic pain development. Early adequate
any painful input from the surgical wound from time-of- pain management is vital to reduce the risk of conversion to
incision to final wound healing. 211, 212 chronic pain. 228, 229 The existing guidelines of prevention
Preoperative psychological predispositions toward the and chronic pain management after IH repair address the
development of chronic pain have been investigated in issue of whether immediate reoperation is necessary. 147
several surgical disciplines. This field remains poorly No studies exist on the appropriate treatment of acute
studied. The limited data available suggest only minor severe pain after IH repair. In particular, no studies address
short-term effects on postoperative pain and no benefit in whether early reoperation with neurectomy prevents
chronic pain prevention. chronic pain. From a purely pragmatic perspective;

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