Management of persistent postsurgical inguinal pain.
OBJECTIVE
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.
Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Blegdamsvej 9, 2100, Copenhagen, Denmark, mads.u.werner@gmail.com.
Mads U
MU
Werner
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome
D000779:Anesthetics, Local