Advertisement

Surgical Endoscopy

, Volume 33, Issue 12, pp 4102–4108 | Cite as

Perioperative factors associated with pain following open ventral hernia repair

  • Walker Ueland
  • Margaret A. PlymaleEmail author
  • Daniel L. Davenport
  • John Scott Roth
Article
  • 201 Downloads

Abstract

Background

Effective pain control following open ventral and incisional hernia repair (VHR) impacts all aspects of patient recovery. To reduce opioid use and enhance pain management, multimodal therapy is thought to be beneficial. The purpose of this study was to identify patient characteristics associated with perioperative patient-reported pain scores.

Methods

With IRB approval, surgical databases were searched for cases of open VHR performed over 3 years. Based on a retrospective chart review, modes of pain management and visual analog scale (VAS) pain scores were recorded in 12-h intervals to hospital discharge or to 8 days post-operation. Forward stepwise multivariable regression assessed the independent contribution of the perioperative factors to VAS pain scores.

Results

Included in the analyses were 175 patients that underwent VHR. Average age was 55 years (+/− 12.8), and half were female (50.9%). Factors independently associated with increased preoperative VAS pain scores included preoperative opioid use, preoperative open wound, CDC Wound Class II, and prior hernia repair(s). Patients with epidural for postoperative pain had significantly decreased VAS pain scores across the time continuum. Operative factors significantly associated with increased preoperative VAS pain score included median hernia defect size, concomitantly performed procedure(s), duration of operation, and estimated blood loss. Greater preoperative VAS pain score predicted increased pain at each postoperative time point (all p < .05).

Conclusions

Preoperative pain and opioid use are associated with increased pain postoperatively. Epidural analgesia effectively results in decreased patient-reported pain. Increased operative complexity is associated with increased preoperative pain scores.

Keywords

Ventral hernia repair Predictors of pain Preoperative pain Opioids Multimodal pain management Visual analog pain score 

Notes

Compliance with ethical standards

Disclosures

Walker Ueland, Margaret Plymale, and Daniel Davenport declare no conflicts of interest. John Scott Roth declares conflict of interest not directly related to the submitted work: grants, personal fees, and other from Bard; grants, personal fees, and other from Acelity; and grants from Miromatrix.

References

  1. 1.
    Courtney CA, Lee AC, Wilson C, O’Dwyer PJ (2003) Ventral hernia repair: a study of current practice. Hernia 7:44–46PubMedGoogle Scholar
  2. 2.
    Apfelbaum JL, Chen C, Mehta S, Gan TJ (2003) Postoperative pain experience: results from a national survey suggesting postoperative pain continues to be undermanaged. Anesth Analg 97:534–540CrossRefGoogle Scholar
  3. 3.
    Merkow RP, Ju MH, Chung JW, Hall BL, Cohen ME, Williams MV, Tsai TC, Ko CY, Bilimoria KY (2015) Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 313:483–495CrossRefGoogle Scholar
  4. 4.
    Nguyen MT, Li LT, Hicks SC, Davila JA, Suliburk JW, Leong M, Kao LS, Berger DH, Liang MK (2013) Readmission following open ventral hernia repair: incidence, indications, and predictors. Am J Surg 206:942–949CrossRefGoogle Scholar
  5. 5.
    Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA (2009) Psychosocial predictors and correlates for chronic post-surgical pain (CPSP)—a systematic review. Eur J Pain 13:719–730CrossRefGoogle Scholar
  6. 6.
    Bleier J, Resnick AS (2009) Complications of incisional hernia repair. Semin Colon Rectal Surg. 20:125–130CrossRefGoogle Scholar
  7. 7.
    Misra MC, Bansal VK, Kulkarni MP, Pawar DK (2006) Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 20:1839–1845CrossRefGoogle Scholar
  8. 8.
    Ross SW, Wormer BA, Kim M, Oommen B, Bradley JF, Lincourt AE, Augenstein VA, Heniford BT (2015) Defining surgical outcomes and quality of life in massive ventral hernia repair: and international multicenter prospective study. Am J Surg 210:801–813CrossRefGoogle Scholar
  9. 9.
    Ramshaw B, Dean J, Gamenthaler A et al. Impact of opioid use on outcomes after laparoscopic ventral hernia repair. SAGES. 2017; Abstract presentationGoogle Scholar
  10. 10.
    Alvarez MP, Foley KE, Zebley DM, Fassler SA (2015) Comprehensive enhanced recovery pathway significantly reduces postoperative length of stay and opioid usage in elective laparoscopic colectomy. Surg Endosc 29:2506–2511CrossRefGoogle Scholar
  11. 11.
    Tsirline VB, Colavita PD, Belyansky I, Zemlyak AY, Lincourt AE, Heniford BT (2013) Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair. Am Surg 79:829–836PubMedGoogle Scholar
  12. 12.
    Wu CL, Richman JM (2004) Postoperative pain and quality of recovery. Curr Opin Anaesthesiol 17:455–460CrossRefGoogle Scholar
  13. 13.
    Kehlet H, Jensen T, Woolf C (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367:1618–1625CrossRefGoogle Scholar
  14. 14.
    Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery: a review of predictive factors. Anesthesiology 93:1123–1133CrossRefGoogle Scholar
  15. 15.
    Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T (2011) Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair. Dan Med Bull 58:A4322PubMedGoogle Scholar
  16. 16.
    Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res 63:S240–S252CrossRefGoogle Scholar
  17. 17.
    Bradshaw P, Hariharan S, Chen D (2016) Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean. Br J Pain 10:108–115CrossRefGoogle Scholar
  18. 18.
    Chakour MC, Gibson SJ, Bradbeer M, Helme RD (1996) The effects of age on Adelta and C-fiber thermal pain perception. Pain 64:143–152CrossRefGoogle Scholar
  19. 19.
    Ip HY, Abrishami A, Peng PW, Wong J, Chung F (2009) Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 111:657–677CrossRefGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention (2016) Wide-ranging online data for epidemiologic research (WONDER). Atlanta: CDC, National Center for Health Statistics. http://wonder.cdc.gov
  21. 21.
    Chang H, Daubresse M, Kruszewski S, Alexander GC (2014) Prevalence and treatment of pain in emergency departments in the United States, 2000–2010. Am J Emerg Med 32:421–431CrossRefGoogle Scholar
  22. 22.
    Daubresse M, Chang H, Yu Y, Viswanathan S, Shah ND, Stafford RS, Kruszewski SP, Alexander GC (2013) Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care 51:870–878CrossRefGoogle Scholar
  23. 23.
    Warren JA, Stoddard C, Hunter AL, Horton AJ, Atwood C, Ewing JA, Pusker S, Cancellaro VA, Walker KB, Cobb WS, Carbonell AM, Effect of multimodal analgesia on opioid use after ventral hernia repair. J Gastrointest Surg 21:1692–1699Google Scholar
  24. 24.
    Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J (2017) Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. JAMA 318:1661–1667CrossRefGoogle Scholar
  25. 25.
    Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298CrossRefGoogle Scholar
  26. 26.
    Dowell D, Haegerich TM, Chou R (2016) CDC Guideline for prescribing opioids for chronic pain–United States, 2016. JAMA 315:1624–1645CrossRefGoogle Scholar
  27. 27.
    Chou R, Gordon DB, Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL (2016) Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anasethesia, exective committee and administrative council. J Pain 17:131–157CrossRefGoogle Scholar
  28. 28.
    Prabhu AS, Krpata DM, Perez A, Phillips S, Huang LC, Haskins IN, Rosenblatt S, Poulose BK, Rosen MJ (2018) Is it time to reconsider postoperative epidural analgesia in patients undergoing elective ventral hernia repair? An AHSQC analysis. Ann Surg 267:971–976.  https://doi.org/10.1097/SLA.0000000000002214 CrossRefPubMedGoogle Scholar
  29. 29.
    Gherghinescu MC, Copotoiu C, Lazar AE, Popa D, Mogoanta SS, Molnar C (2017) Continuous local analgesia is effective in postoperative pain treatment after medium and large incisional hernia repair. Hernia 21:677–685CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of General Surgery, Department of SurgeryUniversity of Kentucky College of MedicineLexingtonUSA
  2. 2.University of Kentucky College of MedicineLexingtonUSA
  3. 3.Department of SurgeryUniversity of Kentucky College of MedicineLexingtonUSA

Personalised recommendations