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Langenbeck's Archives of Surgery

, Volume 399, Issue 5, pp 559–569 | Cite as

Management of persistent postsurgical inguinal pain

  • Mads U. Werner
Review Article

Abstract

Purpose

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.

Keywords

Analgesics Inguinal hernia repair Local anesthetic nerve block Neuromodulation Persistent postsurgical pain Surgical techniques 

Notes

Acknowledgments

The author is indebted to Joakim M. Bischoff M.D. for valuable help and discussions of the manuscript.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Multidisciplinary Pain Center, Neuroscience Center, RigshospitaletCopenhagen University HospitalsCopenhagenDenmark

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