Effect of postoperative analgesia on acute and persistent postherniotomy pain: a randomized study.
The study objective is to identify differences in postoperative pain management according to different analgesic treatments, targeting 2 main pathways involved in pain perception.



The design is a randomized, parallel groups, open-label study.



The setting is in an operating room, postoperative recovery area, and surgical ward.



There are 200 patients undergoing open inguinal hernia repair (IHR) with tension-free technique (mesh repair).



The intervention is a randomization to receive ketorolac (group K) or tramadol (group T) for 3 days after surgery.



The measurements are differences in analgesic efficacy (numeric rating scale [NRS]) in the postoperative (up to 5 days) period, chronic pain incidence (1 and 3 months), side effects, and complications.



We found no differences in analgesic efficacy (NRS value ≥4 in the first 96 hours: 26% in group K vs 32% in group T, P = .43); the proportion of patients with NRS ≥4 was similar in both groups, and the time trajectories were not significantly different (P for interaction = .24). Side effects were higher (12% vs 6%) in the tramadol group, although not significantly (P = .14), with a case of bleeding in the ketorolac group and higher incidence of constipation in tramadol group. One patient in each group developed chronic pain.



Ketorolac or weak opioids are equally effective on acute pain and on persistent postsurgical pain development after IHR, and drug choice should be based on their potential side effects and patient's comorbidities. Further studies are needed to standardize the most rational approach to prevent persistent postsurgical pain after IHR.
Department of Surgical Sciences, University of Parma, Parma, Italy. Electronic address: dariobugada@gmail.com.
Dario
D
Bugada
Department of Anesthesia and Perioperative Medicine, Catholic University of Louvain, St Luc Hospital, 10 Ave Hippocrate, 1200 Brussels, Belgium. Electronic address: Patricia.Lavandhomme@uclouvain.be.
Patricia
P
Lavand'homme
Day Surgery Unit, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Polo Universitario, Via Lazio, Varese, Italy. Electronic address: andrealuigi.ambrosoli@gmail.com.
Andrea Luigi
AL
Ambrosoli
Service of Biometry & Statistics, Foundation IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy. Electronic address: klersy@smatteo.pv.it.
Catherine
C
Klersy
Department of Anesthesia and Intensive Care, Foundation IRCCS Policlinico San Matteo, P.le Golgi 19, 27100, Pavia, Italy; Department of Surgical, Medical, Diagnostic and Pediatric Science, University of Pavia, P.le Golgi 19, 27100, Pavia, Italy. Electronic address: a.braschi@smatteo.pv.it.
Antonio
A
Braschi
Department of Anesthesia, Intensive Care and Pain Therapy, University of Parma, Viale Gramsci, 14-43126, Parma, Italy. Electronic address: gfanelli@parmanesthesia.com.
Guido
G
Fanelli
Department of Biomedical, Biotechnological & Translational Sciences, Faculty of Medicine, University of Parma, Parma, Italy. Electronic address: gloria.saccani@unipr.it.
Gloria M R
GM
Saccani Jotti
Department of Anesthesia, Intensive Care and Pain Therapy, University of Parma, Viale Gramsci, 14-43126, Parma, Italy. Electronic address: massimo.allegri@unipv.it.
Massimo
M
Allegri
D059787:Acute Pain / Q000188:drug therapy; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D016037:Single-Blind Method; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage* / Q000009:adverse effects
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014147:Tramadol; D020910:Ketorolac
Hernia surgery; Inflammation; Persistent pain; Postherniotomy pain; Postoperative pain