title: Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair.
abstract: Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome.
authors.affiliation: Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43126 Parma, Italy; SIMPAR Group (Study in Multidisciplinary Pain Research Group), Via Gramsci 14, 43126 Parma, Italy; 2° Anestesia, Rianimazione e Terapia Antalgica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy.
authors.forename: Dario
authors.identifier: 0000-0002-8363-6674
authors.initials: D
authors.lastname: Bugada
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Catholic University of Louvain, St Luc Hospital, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lavand'homme
authors.affiliation: Day Surgery Unit, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Polo Universitario, Viale Luigi Borri 57, 21100 Varese, Italy.
authors.forename: Andrea Luigi
authors.initials: AL
authors.lastname: Ambrosoli
authors.affiliation: Department of Anesthesia, Istituto Ortopedico G. Pini, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cappelleri
authors.affiliation: Department of Biomedical, Biotechnological & Translational Sciences (S.Bi.Bi.T), Faculty of Medicine, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
authors.forename: Gloria Mr
authors.initials: GM
authors.lastname: Saccani Jotti
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
authors.forename: Tiziana
authors.identifier: 0000-0002-7538-6863
authors.initials: T
authors.lastname: Meschi
authors.affiliation: Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43126 Parma, Italy; 2° Anestesia, Rianimazione e Terapia Antalgica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Fanelli
authors.affiliation: Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43126 Parma, Italy; SIMPAR Group (Study in Multidisciplinary Pain Research Group), Via Gramsci 14, 43126 Parma, Italy; 2° Anestesia, Rianimazione e Terapia Antalgica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Allegri
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy*; D015897:Comorbidity; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy; D020910:Ketorolac / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D014147:Tramadol / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D014147:Tramadol; D020910:Ketorolac