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Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis

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Abstract

Purpose

Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000–48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain.

Methods

A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient’s clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported.

Results

A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments.

Conclusion

Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.

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Availability of data and materials

All data generated or analyzed during this study are included in this published article. SPSS data of the participant can be requested from the authors. Please write to the corresponding author if you are interested in such data.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Surgery, Shiraz University of Medical Sciences, Zand Avenue, P.O. Box 71345-1744, Shiraz, Iran

    R. Shekouhi, M. Sohooli, A. Abbasi, M. Razaghi, M. Sohrabi & M. H. Darabi

  2. Najafabad University of Medical Sciences, Isfahan, Iran

    F. Farz

  3. University of Chicago, Medical Center, Chicago, USA

    S. Mohammadi

  4. University of North Carolina at Charlotte, Charlotte, USA

    M. Fereydouni

  5. Department of Surgery, Lorestan University of Medical Sciences, Shiraz, Iran

    S.-A. Seyed-Alagheband

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  1. R. Shekouhi
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  2. F. Farz
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  3. M. Sohooli
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  4. S. Mohammadi
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Correspondence to M. H. Darabi.

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Shekouhi, R., Farz, F., Sohooli, M. et al. Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis. Hernia 27, 1363–1373 (2023). https://doi.org/10.1007/s10029-023-02861-5

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