Mads U Werner1. 1. Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Blegdamsvej 9, 2100, Copenhagen, Denmark, mads.u.werner@gmail.com.
Abstract
PURPOSE: Severe persistent pain is a major postsurgical complication affecting 2-4 % of patients following inguinal hernia repair and may cause critical physical and socioeconomic disability. This review introduces relevant criteria and analyses the current evidence base underlying recommended management strategies. RESULTS: Development of persistent postsurgical pain (PPP) following inguinal hernia repair cannot automatically be considered to follow a simple trajectory from acute to chronic pain. Surgical management comprising neurectomy with or without meshectomy was described in 25 studies. Local anesthetic blocks, pharmacological management, and treatment with sensory stimulation methods were presented in seven studies. In spite of shortcomings, the data on surgical management demonstrate that neurectomy with or without mesh removal may provide long-lasting analgesic effects in most patients with severe PPP following inguinal hernia repair. The evidence base for other management methods is still fragile, although promising results appear in the neuromodulation studies. CONCLUSIONS: There is a need for improved study designs and, launching of large multicenter collaborative studies supplying the necessary long-term data for recommendation of future management strategies.
PURPOSE: Severe persistent pain is a major postsurgical complication affecting 2-4 % of patients following inguinal hernia repair and may cause critical physical and socioeconomic disability. This review introduces relevant criteria and analyses the current evidence base underlying recommended management strategies. RESULTS: Development of persistent postsurgical pain (PPP) following inguinal hernia repair cannot automatically be considered to follow a simple trajectory from acute to chronic pain. Surgical management comprising neurectomy with or without meshectomy was described in 25 studies. Local anesthetic blocks, pharmacological management, and treatment with sensory stimulation methods were presented in seven studies. In spite of shortcomings, the data on surgical management demonstrate that neurectomy with or without mesh removal may provide long-lasting analgesic effects in most patients with severe PPP following inguinal hernia repair. The evidence base for other management methods is still fragile, although promising results appear in the neuromodulation studies. CONCLUSIONS: There is a need for improved study designs and, launching of large multicenter collaborative studies supplying the necessary long-term data for recommendation of future management strategies.
Authors: Martin McCarthy; Olga Jonasson; Chih-Hung Chang; A Simon Pickard; Anita Giobbie-Hurder; James Gibbs; Perry Edelman; Robert Fitzgibbons; Leigh Neumayer Journal: J Am Coll Surg Date: 2005-08 Impact factor: 6.113
Authors: Christopher G Goetz; Joanne Wuu; Michael P McDermott; Charles H Adler; Stanley Fahn; Curt R Freed; Robert A Hauser; Warren C Olanow; Ira Shoulson; P K Tandon; Sue Leurgans Journal: Mov Disord Date: 2008-04-15 Impact factor: 10.338
Authors: Elisabeth Kjær Jensen; Thomas K Ringsted; Joakim M Bischoff; Morten A Petersen; Jacob Rosenberg; Henrik Kehlet; Mads U Werner Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817