Management of Groin Herniorrhaphy-Related Chronic Postsurgical Pain: General Surgeons’ Understanding, Attitudes, and Experiences

Yıl 2022, Cilt: 5 Sayı: 3, 317 - 324, 31.12.2022

Selin Balta , Muharrem Öztaş , Alpaslan Şahin

https://doi.org/10.36516/jocass.1153146

Öz

Aim: Groin herniorrhaphy is a common surgical procedure worldwide. Groin herniorrhaphy-related chronic postsurgical pain (GHCPSP) has a negative effect on quality of life. This survey evaluated general surgeons’ knowledge, attitudes, and experiences with GHCPSP.
Methods: A survey on GHCPSP was designed by two experienced general surgeons and a pain physician and reviewed by an experienced hernia surgeon. The survey included four questions to assess demographic characteristics of the respondents; four questions related to understanding of pain characteristics of GHCPSP and the effectiveness of pain treatments for GHCPSP; five questions about attitudes towards management of early postoperative pain and GHCPSP; five questions related to experience of surgical techniques for groin herniorrhaphy, consultation rates to pain and psychiatry clinics for multidisciplinary management of GHCPSP, and working collaboration with a pain clinic. The survey was emailed to all members of the Turkish Surgical Society.
Results: The study included 259 respondents. The majority (248/95.8%) of respondents prescribed non-opiod medications for early postoperative pain control. A validated scale or questionnaire was used to assess GHCPSP by 20% of the respondents. 42% of the respondents favored paracetamol and/or NSAIDs for GHCPSP, and 42.9% favored multimodal agents for GHCPSP. The average consultation rates of respondents to pain and psychiatry clinics for GHCPSP was 30% and 1%, respectively.
Conclusions: General surgeons have sufficient understanding of early herniorrhaphy-related pain but poor understanding of evaluating pain severity in CPSP and its management, suggesting a multidisciplinary approach to GHCPSP should be promulgated to general surgeons.

Anahtar Kelimeler

herniorrhaphy, chronic postsurgical pain, neuropathic pain, multidisciplinary management, pain medicine

Destekleyen Kurum

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Proje Numarası

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Teşekkür

Advice given by Prof. Dr. Hakan KULACOGLU, MD, FACS help to improve the questionnaire.

İnguinal Herniyorafi ile İlişkili Cerrahi Sonrası Kronik Ağrının Yönetimi: Genel Cerrahların Anlayışları, Tutumları ve Deneyimleri

Öz

Amaç: İnguinal herniorafi dünya çapında yaygın bir cerrahi işlemdir. İnguinal herniyorafi ile ilişkili cerrahi sonrası kronik ağrı (GHCPSP), yaşam kalitesi üzerinde olumsuz bir etkiye sahiptir. Bu çalışmada, genel cerrahların GHCPSP ile ilgili bilgilerinin, tutumlarının ve deneyimlerinin değerlendirilmesi amaçlandı.
Yöntemler: GHCPSP ile ilgili bir anket iki deneyimli genel cerrah ve bir ağrı doktoru tarafından tasarlandı ve deneyimli bir fıtık cerrahı tarafından gözden geçirildi. Anket, yanıtlayanların demografik özelliklerini değerlendirmek için dört soru; GHCPSP'nin ağrı özelliklerinin anlaşılması ve GHCPSP için ağrı tedavilerinin etkinliği ile ilgili dört soru; erken postoperatif ağrı ve GHCPSP yönetimine yönelik tutumlar hakkında beş soru; kasık fıtığı için cerrahi tekniklerin deneyimi ile GHCPSP'nin multidisipliner yönetimi için ağrı ve psikiyatri kliniklerine konsültasyon/işbirliği hakkında beş soru içeriyordu. Anket, Türk Cerrahi Derneği'nin tüm üyelerine e-posta ile gönderildi.
Bulgular: Çalışma 259 katılımcıyı içeriyordu. Katılımcıların çoğunluğu (%248/95.8) erken postoperatif ağrı kontrolü için opiod olmayan ilaçlar reçete ettiğini, %20'si GHCPSP'yi değerlendirmek için doğrulanmış bir ölçek veya anket kullanıldığını belirtti. GHCPSP tedavisinde ankete katılanların %42'si parasetamol ve/veya NSAID'leri ve %42.9'u multimodal ajanları tercih ettiğini belirtti. Genel cerrahların belirttiğine göre, GHCPSP’li hastaları ağrı ve psikiyatri kliniklerine yönlendirme oranları ortalaması sırasıyla %30 ve %1 idi.
Sonuçlar: Genel cerrahlar, erken dönemde herniorafi ile ilişkili ağrı hakkında yeterli bilgiye sahip iken GHCPSP'yi değerlendirme ve yönetme konusunda daha fazlasına ihtiyaçları vardır. Genel cerrahların, GHCPSP'ye multidisipliner yaklaşım konusunda bilgilendirilme ihtiyaçları vardır.

Anahtar Kelimeler

inguinal herniorafi, cerrahi sonrası kronik ağrı, nöropatik ağrı, multidisipliner yönetim, algoloji

Proje Numarası

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Kaynakça

• Meara JG, Hagander L, Leather A. Surgery and global health: a Lancet Commission. Lancet. 2014;383(9911):12-13.
• Meara JG, Hagander L, Leather A. Surgery and global health: a Lancet Commission. Lancet. 2014;383(9911):12-13.
• Macrae WA. Chronic post-surgical pain: 10 years on. British Journal of Anaesthesia. 2008;101(1):77-86.
• Macrae WA. Chronic post-surgical pain: 10 years on. British Journal of Anaesthesia. 2008;101(1):77-86.
• Alfieri S, Amid P, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Springer; 2011.
• Alfieri S, Amid P, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Springer; 2011.
• Aasvang EK, Gmaehle E, Hansen JB, et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010;112(4):957-69.
• Aasvang EK, Gmaehle E, Hansen JB, et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010;112(4):957-69.
• Andresen K, Burcharth J, Fonnes S, et al. Chronic pain after inguinal hernia repair with the ONSTEP versus the Lichtenstein technique, results of a double-blinded multicenter randomized clinical trial. 2017;402(2):213-218.
• Andresen K, Burcharth J, Fonnes S, et al. Chronic pain after inguinal hernia repair with the ONSTEP versus the Lichtenstein technique, results of a double-blinded multicenter randomized clinical trial. 2017;402(2):213-218.
• Courtney CA, Duffy K, Serpell MG, et al. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002;89(10):1310-4.
• Courtney CA, Duffy K, Serpell MG, et al. Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg. 2002;89(10):1310-4.
• Varley R, Lo C, Alkhaffaf B. Litigation claims following laparoscopic and open inguinal hernia repairs. Hernia. 2020;24(5):1113-1120.
• Varley R, Lo C, Alkhaffaf B. Litigation claims following laparoscopic and open inguinal hernia repairs. Hernia. 2020;24(5):1113-1120.
• International guidelines for groin hernia management. Hernia. 2018;22:1-165.
• International guidelines for groin hernia management. Hernia. 2018;22:1-165.
• Singh AN, Bansal VK, Misra MC, et al. Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc. 2012;26(5):1304-17.
• Singh AN, Bansal VK, Misra MC, et al. Testicular functions, chronic groin pain, and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial. Surg Endosc. 2012;26(5):1304-17.
• Tan WH, Yu J, Feaman S, et al. Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use. Journal of the American College of Surgeons. 2018;227(2):203-211.
• Tan WH, Yu J, Feaman S, et al. Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use. Journal of the American College of Surgeons. 2018;227(2):203-211.
• Madras BK. The Surge of Opioid Use, Addiction, and Overdoses Responsibility and Response of the US Health Care System. Jama Psychiatry. 2017;74(5):441-442.
• Madras BK. The Surge of Opioid Use, Addiction, and Overdoses Responsibility and Response of the US Health Care System. Jama Psychiatry. 2017;74(5):441-442.
• Wijayasinghe N, Ringsted TK, Bischoff JM, et al. The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade. Br J Anaesth. 2016;116(6):829-37.
• Wijayasinghe N, Ringsted TK, Bischoff JM, et al. The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade. Br J Anaesth. 2016;116(6):829-37.
• Montpied CG, Besançcon F, Unit C, et al. Radiofrequency neurolysis versus local nerve infiltration in 42 patients with refractory chronic inguinal neuralgia. 2012;15:237-244.
• Montpied CG, Besançcon F, Unit C, et al. Radiofrequency neurolysis versus local nerve infiltration in 42 patients with refractory chronic inguinal neuralgia. 2012;15:237-244.
• Makharita MY, Amr YM. Pulsed Radiofrequency for Chronic Inguinal Neuralgia. Pain Physician. 2015;18(2):E147-E155.
• Makharita MY, Amr YM. Pulsed Radiofrequency for Chronic Inguinal Neuralgia. Pain Physician. 2015;18(2):E147-E155.
• Chan SK, Chui PT, Lee A, et al. Surgeons' attitudes and perception of an acute pain service. Hong Kong Med J. 2008;14(5):342-7.
• Chan SK, Chui PT, Lee A, et al. Surgeons' attitudes and perception of an acute pain service. Hong Kong Med J. 2008;14(5):342-7.
• Poobalan AS, Bruce J, Smith WC, et al. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19(1):48-54.
• Poobalan AS, Bruce J, Smith WC, et al. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19(1):48-54.
• Bande D, Molto L, Pereira JA, et al. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg. 2020;20(1):147.
• Bande D, Molto L, Pereira JA, et al. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg. 2020;20(1):147.
• Nienhuijs SW, Boelens OB, Strobbe LJ. Pain after anterior mesh hernia repair. J Am Coll Surg. 2005;200(6):885-9.
• Nienhuijs SW, Boelens OB, Strobbe LJ. Pain after anterior mesh hernia repair. J Am Coll Surg. 2005;200(6):885-9.
• Franneby U, Gunnarsson U, Andersson M, et al. Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. British Journal of Surgery. 2008;95(4):488-493.
• Franneby U, Gunnarsson U, Andersson M, et al. Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. British Journal of Surgery. 2008;95(4):488-493.
• Heniford BT, Walters AL, Lincourt AE, et al. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg. 2008;206(4):638-44.
• Heniford BT, Walters AL, Lincourt AE, et al. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg. 2008;206(4):638-44.
• McCarthy Jr M, Chang C-H, Pickard AS, ve ark. Visual analog scales for assessing surgical pain. Journal of the American College of Surgeons. 2005;201(2):245-252.
• McCarthy Jr M, Chang C-H, Pickard AS, ve ark. Visual analog scales for assessing surgical pain. Journal of the American College of Surgeons. 2005;201(2):245-252.
• Hadi MA, Alldred DP, Briggs M, et al. 'Treated as a number, not treated as a person': a qualitative exploration of the perceived barriers to effective pain management of patients with chronic pain. BMJ open. 2017;7(6)
• Hadi MA, Alldred DP, Briggs M, et al. 'Treated as a number, not treated as a person': a qualitative exploration of the perceived barriers to effective pain management of patients with chronic pain. BMJ open. 2017;7(6)
• Giusti EM, Lacerenza M, Manzoni GM, et al. Psychological and psychosocial predictors of chronic postsurgical pain: a systematic review and meta-analysis. Pain. 2021;162(1):10-30.
• Giusti EM, Lacerenza M, Manzoni GM, et al. Psychological and psychosocial predictors of chronic postsurgical pain: a systematic review and meta-analysis. Pain. 2021;162(1):10-30.
• Weinrib AZ, Azam MA, Birnie KA, et al. The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain. 2017;11(4):169-177.
• Weinrib AZ, Azam MA, Birnie KA, et al. The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain. 2017;11(4):169-177.