Chronic pain after hernia surgery--an informed consent issue.

Area of Science:

• Surgery
• Pain Management
• Gastroenterology

Background:

• Chronic severe pain is a significant complication after open inguinal hernia repair.
• The exact causes and evidence-based treatments for this post-operative pain remain challenging.
• Effective management strategies are needed for this common surgical complication.

Purpose of the Study:

• To investigate the incidence of chronic severe pain following open inguinal hernia repair.
• To identify potential causes and evaluate treatment outcomes for post-hernia repair pain.
• To assess the efficacy of therapeutic injections for managing chronic pain.

Main Methods:

• Retrospective review of 146 patients undergoing open inguinal hernia repair (suture vs. mesh) between 1995-2000.
• Analysis of patients diagnosed with chronic severe pain post-surgery.
• Evaluation of treatments including nerve blocks, local injections, and medication.

Main Results:

• Nine percent (13/146) of patients developed chronic severe pain, with a higher incidence in the mesh repair group (p = 0.004).
• Maximal tenderness was often localized to the genitofemoral or ilioinguinal nerve distributions.
• Therapeutic injections into the point of maximal tenderness resulted in 77% of patients becoming pain-free at a median follow-up of 45 months.

Conclusions:

• Chronic severe pain occurs in approximately 9% of patients after primary open inguinal hernia repair.
• Therapeutic injections targeting the site of maximal tenderness are highly effective in managing post-hernia repair pain.
• This approach provides a successful treatment strategy for a significant post-operative complication.