Management of Persistent Postsurgical Inguinal Pain

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2014 May 23

PMID 24849039

Citations 11

Authors

Mads U Werner

Affiliations

Soon will be listed here.

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.

Citing Articles

A single-center retrospective review of laparoscopic totally extraperitoneal versus robotic transabdominal preperitoneal inguinal hernia repair.

Baginski B, Tran D, Ogola G, Arnold D Proc (Bayl Univ Med Cent). 2024; 37(6):897-902.

PMID: 39440074 PMC: 11492716. DOI: 10.1080/08998280.2024.2398981.

Quantitative somatosensory assessments in patients with persistent pain following groin hernia repair: A systematic review with a meta-analytical approach.

Dubayev A, Jensen E, Andersen K, Bjurstrom M, Werner M PLoS One. 2024; 19(1):e0292800.

PMID: 38295051 PMC: 10830060. DOI: 10.1371/journal.pone.0292800.

Somatosensory Outcomes Following Re-Surgery in Persistent Severe Pain After Groin Hernia Repair: A Prospective Observational Study.

Jensen E, Ringsted T, Bischoff J, Petersen M, Moller K, Kehlet H J Pain Res. 2023; 16:943-959.

PMID: 36960467 PMC: 10030060. DOI: 10.2147/JPR.S384973.

A narrative review on the non-surgical treatment of chronic postoperative inguinal pain: a challenge for both surgeon and anaesthesiologist.

van Veenendaal N, Foss N, Miserez M, Pawlak M, Zwaans W, Aasvang E Hernia. 2022; 27(1):5-14.

PMID: 36315351 PMC: 9931782. DOI: 10.1007/s10029-022-02693-9.

A national center for persistent severe pain after groin hernia repair: Five-year prospective data.

Jensen E, Ringsted T, Bischoff J, Petersen M, Rosenberg J, Kehlet H Medicine (Baltimore). 2019; 98(33):e16600.

PMID: 31415351 PMC: 6831335. DOI: 10.1097/MD.0000000000016600.

References

Schmutz M, Schumacher P, Luyet C, Curatolo M, Eichenberger U . Ilioinguinal and iliohypogastric nerves cannot be selectively blocked by using ultrasound guidance: a volunteer study. Br J Anaesth. 2013; 111(2):264-70. DOI: 10.1093/bja/aet028. View

Corder G, Doolen S, Donahue R, Winter M, Jutras B, He Y . Constitutive μ-opioid receptor activity leads to long-term endogenous analgesia and dependence. Science. 2013; 341(6152):1394-9. PMC: 4440417. DOI: 10.1126/science.1239403. View

Lee C, Dellon A . Surgical management of groin pain of neural origin. J Am Coll Surg. 2000; 191(2):137-42. DOI: 10.1016/s1072-7515(00)00319-7. View

Aasvang E, Hansen J, Kehlet H . Pre-operative pain and sensory function in groin hernia. Eur J Pain. 2009; 13(10):1018-22. DOI: 10.1016/j.ejpain.2008.11.015. View

Keller J, Stefanidis D, Dolce C, Iannitti D, Kercher K, Heniford B . Combined open and laparoscopic approach to chronic pain after inguinal hernia repair. Am Surg. 2008; 74(8):695-700. View

Werner M, Bischoff J, Rathmell J, Kehlet H . Pulsed radiofrequency in the treatment of persistent pain after inguinal herniotomy: a systematic review. Reg Anesth Pain Med. 2012; 37(3):340-3. DOI: 10.1097/AAP.0b013e31824bea4e. View

Bischoff J, Petersen M, Uceyler N, Sommer C, Kehlet H, Werner M . Lidocaine patch (5%) in treatment of persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial. Anesthesiology. 2013; 119(6):1444-52. DOI: 10.1097/ALN.0b013e3182a2a243. View

Schott G . Delayed onset and resolution of pain: some observations and implications. Brain. 2001; 124(Pt 6):1067-76. DOI: 10.1093/brain/124.6.1067. View

Werner M, Kongsgaard U . I. Defining persistent post-surgical pain: is an update required?. Br J Anaesth. 2014; 113(1):1-4. DOI: 10.1093/bja/aeu012. View

10.

Chen D, Hiatt J, Amid P . Operative management of refractory neuropathic inguinodynia by a laparoscopic retroperitoneal approach. JAMA Surg. 2013; 148(10):962-7. DOI: 10.1001/jamasurg.2013.3189. View

11.

Amid P, Chen D . Surgical treatment of chronic groin and testicular pain after laparoscopic and open preperitoneal inguinal hernia repair. J Am Coll Surg. 2011; 213(4):531-6. DOI: 10.1016/j.jamcollsurg.2011.06.424. View

12.

Amid P . Causes, prevention, and surgical treatment of postherniorrhaphy neuropathic inguinodynia: triple neurectomy with proximal end implantation. Hernia. 2004; 8(4):343-9. DOI: 10.1007/s10029-004-0247-0. View

13.

Giger U, Wente M, Buchler M, Krahenbuhl S, Lerut J, Krahenbuhl L . Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery. Br J Surg. 2009; 96(9):1076-81. DOI: 10.1002/bjs.6623. View

14.

Campillo A, Cabanero D, Romero A, Garcia-Nogales P, Puig M . Delayed postoperative latent pain sensitization revealed by the systemic administration of opioid antagonists in mice. Eur J Pharmacol. 2011; 657(1-3):89-96. DOI: 10.1016/j.ejphar.2011.01.059. View

15.

Starling J, Harms B, Schroeder M, EICHMAN P . Diagnosis and treatment of genitofemoral and ilioinguinal entrapment neuralgia. Surgery. 1987; 102(4):581-6. View

16.

Starling J, Harms B . Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. World J Surg. 1989; 13(5):586-91. DOI: 10.1007/BF01658875. View

17.

Kehlet H, Roumen R, Reinpold W, Miserez M . Invited commentary: Persistent pain after inguinal hernia repair: what do we know and what do we need to know?. Hernia. 2013; 17(3):293-7. DOI: 10.1007/s10029-013-1109-4. View

18.

Stokvis A, van der Avoort D, van Neck J, Hovius S, Coert J . Surgical management of neuroma pain: a prospective follow-up study. Pain. 2010; 151(3):862-869. DOI: 10.1016/j.pain.2010.09.032. View

19.

Bischoff J, Linderoth G, Aasvang E, Werner M, Kehlet H . Dysejaculation after laparoscopic inguinal herniorrhaphy: a nationwide questionnaire study. Surg Endosc. 2011; 26(4):979-83. DOI: 10.1007/s00464-011-1980-y. View

20.

Gerdesmeyer L, Wagenpfeil S, Birkenmaier C, Veihelmann A, Hauschild M, Wagner K . Percutaneous epidural lysis of adhesions in chronic lumbar radicular pain: a randomized, double-blind, placebo-controlled trial. Pain Physician. 2013; 16(3):185-96. View