title: TEP under general anesthesia is superior to Lichtenstein under local anesthesia in terms of pain 6 weeks after surgery: results from a randomized clinical trial.
abstract: BACKGROUND
  Persistent pain is common after inguinal hernia repair. The methods of surgery and anesthesia influence the risk. Local anesthesia and laparoscopic procedures reduce the risk for postoperative pain in different time perspectives. The aim of this study was to compare open Lichtenstein repair under local anesthesia (LLA) with laparoscopic total extraperitoneal repair (TEP) with respect to postoperative pain.
  
  
  METHODS
  Between 2006 and 2010, a total of 389 men with a unilateral primary groin hernia were randomized, in an open-label study, to either TEP (n = 194) or LLA (n = 195). One patient in the TEP group and four in the LLA group were excluded due to protocol violation. Details about the procedure and patient and hernia characteristics were registered. Patients completed the Inguinal Pain Questionnaire (IPQ) 6 weeks after surgery. [The study is registered in ClinicalTrials.gov (No. NCT01020058)].
  
  
  RESULTS
  A total of 378 (98.4 %) patients completed the IPQ. One hundred forty-eight patients (39.1 %) reported some degree of pain, 22 of whom had pain that affected concentration during daily activities. Men in the TEP group had less risk for pain affecting daily activities (6/191 vs. 16/187; odds ratio [OR] 0.35; 95 % CI 0.13-0.91; p = 0.025). Pain prevented participation in sporting activities less frequently after TEP (4.2 vs. 15.5 %; OR 0.24; 95 % CI 0.09-0.56; p < 0.001). Twenty-nine patients (7.7 %) reported sick leave exceeding 1 week due to groin pain, with no difference between the treatment groups.
  
  
  CONCLUSIONS
  Patients who underwent the laparoscopic TEP procedure suffered less pain 6 weeks after inguinal hernia repair than those who underwent LLA. Groin pain affected the LLA patients' ability to perform strenuous activities such as sports more than TEP patients.
authors.affiliation: CLINTEC, Karolinska Institutet, Stockholm, Sweden, ursula.dahlstrand@ki.se.
authors.forename: Ursula
authors.initials: U
authors.lastname: Dahlstrand
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.forename: Mikael
authors.initials: M
authors.lastname: Ljungdahl
authors.forename: Staffan
authors.initials: S
authors.lastname: Wollert
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D020127:Recovery of Function; D013177:Sports; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal