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Management of Chronic Post-Herniorrhaphy Pain: A Systematic Review
Gema Ruiz Lopez Del Prado1, Antonio Ferreiro2, Martin Avellanal1
1Pain Clinic, University Hospital Sanitas La Moraleja, Madrid, Spain.
Pain Physician
|December 3, 2025
Summary
Chronic post-herniorrhaphy inguinal pain (CPIP) is a common complication. Minimally invasive treatments like nerve blocks show high efficacy, suggesting they should precede surgical neurectomy for better patient outcomes.
Area of Science:
- Pain Management
- Surgical Complications
- Neuropathic Pain
Background:
- Chronic post-herniorrhaphy inguinal pain (CPIP) affects 2-5% of patients post-hernia repair.
- Characterized by persistent pain (>3 months) often involving neuropathic mechanisms.
- Significantly impacts patient quality of life, with challenging management.
Purpose of the Study:
- Evaluate recent literature on CPIP interventions and outcomes.
- Suggest an evidence-based algorithmic approach for managing post-herniorrhaphy chronic pain.
Main Methods:
- Systematic literature review following PRISMA guidelines (Jan 2012 - Feb 2023).
- Qualitative data synthesis of randomized controlled trials, prospective/retrospective studies, case series, and reports.
- Analysis of 10 studies involving 152 patients.
Main Results:
- Nerve blocks/pulsed radiofrequency showed highest efficacy (up to 98.1% pain relief).
- Neurostimulation/ablation techniques reported approximately 92.8% pain relief.
- Neurectomy demonstrated variable success and higher invasiveness.
Conclusions:
- No universally accepted treatment algorithm for CPIP exists.
- Minimally invasive techniques (nerve blocks, pulsed radiofrequency, neurostimulation) show promise.
- Prioritize minimally invasive options before considering neurectomy; multidisciplinary evaluation is key.
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