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Sensory disturbances and neuropathic pain after inguinal hernia surgery
Kirurgkliniken, Mora lasarett, Mora, Sweden.
Kirurgkliniken, Mora lasarett, Mora, Sweden.
Kirurgkliniken, Mora lasarett, Mora, Sweden.
Karolinska institutet, Stockholm, Sweden.
2010 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 1, no 2, p. 108-111Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to explore how the handling of nerves affects the risk for developing sensory disturbances (SDs) following groin hernia surgery.

Patients and methods: All patients 18 years or older undergoing surgery for inguinal hernia at Mora Hospital, Sweden, during an eight-month period in 2006, were eligible for inclusion. The surgical procedure was recorded prospectively according to a standardised protocol. One year postoperatively all patients were requested to answer the Inguinal Pain Questionnaire as well as a set of 18 sensory and affective pain descriptors. They were also invited to clinical examination including sensory testing.

Results: Of the 157 hernia repairs in Mora during the period of study, 128 repairs in 116 patients, were registered prospectively according to the study protocol. Laparoscopic total extraperitoneal (TEP) repair was performed in 36 (28%) of the patients. Ninety-two (79%) patients, including five patients operated bilaterally, underwent postoperative examination. SDs were found in 33 (34%) of the groins examined. No descriptor was found that significantly predicted the presence of altered examination findings. No significant association between the intraoperative handling of nerves and SD was seen. In the TEP-group, no SDs were seen. Infiltration of local anaesthetic agents and blockade of the ilioinguinal nerve prior to surgery were found to be significantly associated with SD more than 2 cm away from the  car (both p< 0.05). The presence of SD was not associated with significant pain.

Conclusions: SDs are common after open hernia surgery, but are not associated with persistent postoperative pain.

Place, publisher, year, edition, pages
2010. Vol. 1, no 2, p. 108-111
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-26073DOI: 10.1016/j.sjpain.2010.01.004OAI: oai:DiVA.org:oru-26073DiVA, id: diva2:557799
Available from: 2012-09-29 Created: 2012-09-29 Last updated: 2018-04-24Bibliographically approved
In thesis
1. Postoperative aspects of inguinal hernia surgery: pain and recurrences
Open this publication in new window or tab >>Postoperative aspects of inguinal hernia surgery: pain and recurrences
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Approximately one in four men will have surgery for ingunial hernia in their lifetime. In Sweden, 16 000 procedures are performed each year. To investigate the possible link between handling of nerves and sensory disturbance, 97 groins in 92 patients were examined one year after inguinal hernia surgery. Sensory disturbances were found to be common after open surgery (29 %), but were not seen after the laparoscopic procedures. No significant relationship between sensory disturbance and handling of nerves or pain was seen. The risk for recurrence has been significantly reduced due to the use of prosthetic meshes, but continued surveillance of this important outcome will always be necessary. In that context, the time frame in which recurrence develops in relation to possible risk factors can help our understanding of the underlying mechanisms. To explore such temporal relationships, 142,578 patients were included in a register study. A relative over-risk for early recurrence was seen after suture repair, laparoscopic repair, after postoperative complications, and after surgery for previous recurrence. Corticosteroids are known to decrease pain and nausea after several surgical procedures. In a randomised trial on open hernia surgery, 398 patients were randomised to treatment with 12 mg of betamethasone or placebo. Decreased levels of pain were seen on the day of surgery, the next day and after one month. No difference was seen on days 2-7 and after one year. Nausea was not common and did not differ between the groups. Reoperation is sometimes performed to correct a presumed structural defect thought to cause the long-term pain. In order to evaluate the result of such treatment, 111 cases were analysed based on register data, questionnaires and medical records. Sixty-two per-cent of the patients reported an improvement compared to before the reoperation, but a high level of pain remaining (42 %), and impaired quality of life was seen. There was no clear advantage for any surgical intervention over the other.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 56
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 78
Keywords
Inguinal hernia, surgery, pain, reoperation, recurrence, betamethasone, sensory disturbance, nerve, groin
National Category
Medical and Health Sciences Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-26054 (URN)978-91-7668-902-8 (ISBN)
Public defence
2012-12-07, Wilandersalen, Universitetssjukhuset, Örebro, (USÖ), Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2017-10-17Bibliographically approved

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