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Betamethasone in hernia surgery: a randomized controlled trial
Landstinget i Dalarna.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Kirurgkliniken, Mora lasarett.
Landstinget i Dalarna.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: postoperative pain and nausea may be a problem in day-case surgery. This study aims to investigate the effect of betamethasone on pain and nausea in inguinal hernia surgery.

Methods: patients aged 18-70 years scheduled for open inguinal hernia surgery at two Swedish hospitals, March 2005-December 2009, were eligible for inclusion. Patients were randomised, to either treatment with 12 mg betamethasone intravenously, or placebo. Postoperative pain was assessed using a VAS scale on the recovery ward, each day the first postoperative week and at 1 month after surgery. One year after surgery residual pain was estimated by the Inguinal Pain Questionnaire.

Results: a total of 398 patients were included (21 women, 377 men).

Pain at rest (p<0.05) on the day of surgery was significantly lower in the treatment group. The pain was also significantly lower in the treatment group the day after surgery (p=0.035), but not during the remaining part of the first postoperative week. Bleeding complications were reported by 17 patients (8.5%) in the Betamethasone group and 7 (3.5%) in the placebo group (p=0.028).

One month after surgery, 21/173 (12%) in the betamethasone group still had pain, compared to 33/159 (21%) in the placebo arm (p=0.049). After one year, no significant difference in pain was seen.

Conclusion: 12 mg betamethasone reduced pain during the first 24 hours and at 1 month after inguinal hernia surgery. If combined with diclofenac, however, this dose may increase the risk for bleeding complications.

National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-26075OAI: oai:DiVA.org:oru-26075DiVA, id: diva2:557802
Available from: 2012-09-29 Created: 2012-09-29 Last updated: 2017-10-17Bibliographically 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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Magnusson, Niklas

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