Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

Abstract

Field block with, or without wound infiltration, either as a sole anaesthetic/analgesic technique or as an adjunct to general anaesthesia, is recommended to reduce postoperative pain. Continuous local anaesthetic infusion of a surgical wound provides a longer duration of analgesia. Conventional non-steroidal anti-inflammatory drugs or cyclo-oxygenase 2-selective inhibitors in combination with paracetamol, administered in time to provide sufficient analgesia in the early recovery phase, are optimal. In addition, weak opioids are recommended for moderate pain, and strong opioids for severe pain, on request.

Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients

“…A systematic review of RCTs up to March 2009 [52] emphasises the use of a pre-or intraoperative field block (ilioinguinal, iliohypogastric, genitofemoral nerve) with or without local wound infiltration for all patients undergoing open inguinal hernia surgery. It is unclear if the use of ultrasonography adds substantially vs. blind administration of these blocks.…”

Bloqueio dos nervos ílio‐hipogástrico/ilioinguinal em correção de hérnia inguinal para tratamento da dor no pós‐operatório: comparação entre a técnica de marcos anatômicos e a guiada por ultrassom

“…A técnica anestésica ideal é identificada como aceitável para o paciente, adequada para a cirurgia, simples e segura, com baixo risco de morbidade e de baixo custo. 21 A anestesia geral pode apresentar algumas complicações, como dificuldades respiratórias, instabilidade cardíaca, náu-sea, vômito, retenção urinária e internação prolongada por causa da demora na recuperação da anestesia. 22 Em nosso estudo, não observamos qualquer complicação relacionada à anestesia geral.…”

Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair

“…Local anesthetic infiltration anesthesia is considered useful because the patient can ambulate soon after surgery [1][2][3][4] but its disadvantages include occasional pain from surgery and needle sticks for infiltration of acidic local anesthetic solution [5]. Both general and spinal anesthesia provide excellent anesthesia for surgery but they may be associated with intraoperative hemodynamic instability, nausea, and the occurrence of postoperative urinary retention [6][7][8].…”

“…Both general and spinal anesthesia provide excellent anesthesia for surgery but they may be associated with intraoperative hemodynamic instability, nausea, and the occurrence of postoperative urinary retention [6][7][8]. Occurrence of postoperative urinary retention has been the main reason why the use of spinal anesthesia for inguinal hernia repair has fallen into disrepute [4,9,10] Bupivacaine seems to have maintained its popularity as the spinal anesthetic for inguinal hernia repair but unnecessarily large doses have often been used [6,11] prolonging the motor block and increasing the risk for problems with urinary bladder function.…”