The prevention of pain requires that surgeons should take care not only during the entire surgical procedure but also before and after, following these steps: 1. Preoperative patient selection: preoperative pain, preoperative pain response to heat, intraoperative nerve injury, early postoperative pain intensity, younger age, and open surgery are risk factors for postoperative chronic pain. 2. Anesthesia: local anesthesia seems to be followed by less postoperative pain. 3. Approach: open anterior for all primary inguinal hernias. 4. Identification and respect of the three nerves when possible, otherwise pragmatic neurectomy. 5. Choice of the prosthesis: light- or medium-weight polypropylene flat mesh for “normal” patients. 6. Choice of fixation: sutureless or fibrin glue fixation should be advised. 7. Always provide proper postoperative therapy.
Prevention of pain: optimizing the open primary inguinal hernia repair technique
CAMPANELLI, GIAMPIERO GIORGIO SALVATORE CIRO;CAVALLI, MARTA
2016-01-01
Abstract
The prevention of pain requires that surgeons should take care not only during the entire surgical procedure but also before and after, following these steps: 1. Preoperative patient selection: preoperative pain, preoperative pain response to heat, intraoperative nerve injury, early postoperative pain intensity, younger age, and open surgery are risk factors for postoperative chronic pain. 2. Anesthesia: local anesthesia seems to be followed by less postoperative pain. 3. Approach: open anterior for all primary inguinal hernias. 4. Identification and respect of the three nerves when possible, otherwise pragmatic neurectomy. 5. Choice of the prosthesis: light- or medium-weight polypropylene flat mesh for “normal” patients. 6. Choice of fixation: sutureless or fibrin glue fixation should be advised. 7. Always provide proper postoperative therapy.
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