Pain and Sensory Dysfunction 6 to 12 Months After Inguinal Herniotomy

Abstract

Inguinal hernia repair is associated with a 5%-30% incidence of chronic pain, but the pathogenesis remains unknown. We therefore evaluated pain and sensory dysfunction by quantitative sensory testing 6-12 mo after open hemiorrhaphy. Before sensory testing, all patients (n = 72) completed a short-form McGill Pain Questionnaire and a functional impairment questionnaire. Sensory dysfunction in the incisional area was evaluated by quantification of thermal and mechanical thresholds, by mechanical pain responses (von Frey/pressure algometry), and by areas of pinprick hypoesthesia and tactile allodynia. The incidence of chronic pain was 28% (20 of 72). Quantitative sensory testing and pressure algometry did not demonstrate differences between the pain and nonpain groups, except for a small but significant increase in pain response to von Frey hair and brush stimulation in the pain group. Hypoesthesia, or tactile allodynia, in the incisional area was observed in 51% (37 of 72) of the patients, but the incidence did not differ significantly between the pain group and the nonpain group (14 of 20 versus 23 of 52; P > 0.3). We concluded that cutaneous hypoesthesia, or tactile allodynia, is common after inguinal hemiotomy but has a low specificity for chronic postherniotomy pain. Factors other than nerve damage may be involved in the development of chronic posthemiotomy pain.

Lidocaine Patch (5%) in Treatment of Persistent Inguinal Postherniorrhaphy Pain

“…A neuropathic pain component in PIPP 4,5 is corroborated in the current study by baseline S-LANSS scores suggesting pain of predominantly neuropathic origin in 76% of patients. The study did not show significant differences between lidocaine and placebo patches, for the primary outcome parameter, pain relief.…”

Surgical interventions for the management of chronic groin pain after hernia repair (postherniorrhaphy inguinodynia) in adults

“…The incidence of chronic pain following repair with use of a mesh, like the Lichtenstein technique, varies between 5% and 54% (Poobalan 2003;Loos 2007a;Kehlet 2008), with a pooled incidence of 11% to 16.8% (Perkins 2000;Nienhuijs 2007;Simons 2009;Koning 2013). Some 2% to 6% of patients experience significant restrictions in social and daily activities as a consequence of CPIP, leading to an impairment of health status or 'quality of life' (QoL) (Callesen 1999;Poobalan 2001;Bozuk 2003;Aasvang 2005a).…”

Clinical study of pain after inguinal hernia repair

“…18,19 In a comparable study design no significantly lower pain scores were reported when a mesh was fixated with staples instead of sutures. 20 The postoperative interval to pain assessment influences the outcome. Lower pain levels are found when followup is longer.…”