Patient-reported opioid analgesic requirements after elective inguinal hernia repair: A call for procedure-specific opioid-administration strategies

Mylonas, Konstantinos S.; Reinhorn, Michael; Ott, Lauren R.; Westfal, Maggie L.; Masiakos, Peter T.

doi:10.1016/j.surg.2017.06.017

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…13 While the optimal rate of shortterm opioid prescribing in the VHA is unknown, the dose and number of supply days dispensed should be minimized when prescribed, and non-opioid alternatives should be employed when clinically appropriate. [13][14][15] Minimizing opioid prescribing for acute pain is important not only for reducing risk among patients to whom they are dispensed, but also in reducing the overall opioid supply distributed and available *Total morphine equivalents (MEQ) dispensed, in millions of milligrams 10 †Time-weighted mean daily dose over the course of the year, expressed in milligrams of morphine equivalents per day 10 to the public at large. In keeping with this concept, mean supply per prescription decreased by 2.7 days among shortterm opioid users in the VHA from 2010 to 2016, and decreased by 2.5 days among all users.…”

Section: Discussionmentioning

confidence: 99%

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010–2016

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010–2016

et al. 2018

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“…There is a public health concern in the US over excessive prescribing and utilization of opioid medications for managing acute and chronic pain. Strategies to impact prescribing practices and minimize opioid use and/or abuse for primary IHR include using local anesthetic medications perioperatively as well as prescribing nonsteroidal anti-inflammatory drugs with minimal (or no) low-dose opioid postoperatively [ 14 ]. In addition to these strategies to minimize use of opioid analgesic medications for APGP, other important factors such as preoperative pain level, operative approach, inclusion of neurectomy, mesh choice, mesh fixation strategy, surgical site occurrence, and hernia recurrence may influence patients’ perception of groin pain and activity disruption after IHR [ 15 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Bittner

Cesnik

Kirwan³

et al. 2018

J Robotic Surg

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Few publications describe the potential benefit of robotic-assisted inguinal hernia repair on acute postoperative groin pain (APGP). This study compared patients’ perceptions of APGP, activity limitation, and overall satisfaction after robotic-assisted- (R), laparoscopic (L), or open (O) inguinal hernia repair (IHR). Random samples of patients from two web-based research panels and surgical practices were screened for patients who underwent IHR between October 28, 2015 and November 1, 2016. Qualified patients were surveyed to assess perceived APGP at 1 week postoperatively, activity disruption, and overall satisfaction. Three cohorts based on operative approach were compared after propensity matching. Propensity scoring resulted in 83 R-IHR matched to 83 L-IHR respondents, while 85 R-IHR matched with 85 O-IHR respondents. R-IHR respondents recalled less APGP compared to respondents who had O-IHR (4.1 ± 0.3 vs 5.6 ± 0.3, p < 0.01) but similar APGP compared to L-IHR (4.0 ± 0.3 vs 4.4 ± 0.3, p = 0.37). Respondents recalled less activity disruption 1 week postoperatively after R-IHR versus O-IHR (6.1 ± 0.3 vs. 7.3 ± 0.2, p < 0.01) but similar levels of activity disruption after R-IHR and L-IHR (6.0 ± 0.3 vs. 6.6 ± 0.27, p = 0.32). At the time of the survey, respondents perceived less physical activity disruption after R-IHR compared to O-IHR (1.4 ± 0.2 vs. 2.8 ± 0.4, p < 0.01) but similar between R-IHR and L-IHR (1.3 ± 0.2 vs 1.2 ± 0.2, p = 0.94). Most respondents felt satisfied with their outcome regardless of operative approach. Patient perceptions of pain and activity disruption differ by approach, suggesting a potential advantage of a minimally invasive technique over open for IHR. Further studies are warranted to determine long-term outcomes regarding pain and quality of life after IHR.

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“…This is clearly a clinical benefit for all concerned and it is of interest to note that in a study of 185 patients undergoing inguinal herniorrhaphy solely under LA, the majority did not require opioid analgesics. 8 It is undeniable that any simple clinical intervention that leads to less demand for the prescription of opioids is worthy of further scrutiny. 9 Finally, despite evidence that pre-emptive analgesia does not affect pain scores at later postoperative times (≥24 hours), 10 our study has shown the value of this easily administered peri-incisional LA infiltration in GA day cases.…”

Section: Discussionmentioning

confidence: 99%

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

Radwan

Gardner

Jayamanne

et al. 2018

annals

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Introduction The open prosthetic repair of inguinal hernias under local anaesthesia (LA) is well established, with the concept of intraoperative 'pre-emptive analgesia' evolving so that patients are as comfortable as possible. We used a peri-incisional LA solution in patients undergoing day-case inguinal hernioplasty under general anaesthesia (GA) and recorded use of analgesia in the immediate postoperative period. Methods In this observational cohort study, 100 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 75 underwent repair under GA and 25 with peri-incisional LA solution (equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline). Analgesia prescribed at induction, for maintenance and after cessation of anaesthesia was scored in accordance with the World Health Organization (WHO) analgesic ladder. Results The median age in the GA group was 59 years (range: 25-89 years) and in the GA+LA group, it was 62 years (range: 27-88 years). Of the 100 patients, 82 underwent a mesh plug repair by seven surgeons whereas 18 underwent a flat (Lichtenstein) mesh repair by two surgeons. WHO analgesic induction and postoperative scores were significantly lower in the GA+LA group (p=0.034 and p<0.001 respectively). There was also a significant difference in use of postoperative antiemetics (23% vs 0% in the GA only and GA+LA cohorts respectively, p=0.020). Six patients (8%) in the GA group failed day-case discharge criteria. Conclusions Patients undergoing contemporary day-case GA inguinal hernioplasty with pre-emptive LA solution infiltration require lower levels of postoperative opioid analgesia and antiemetics. These cases are less likely to fail discharge criteria for planned day surgery.

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Patient-reported opioid analgesic requirements after elective inguinal hernia repair: A call for procedure-specific opioid-administration strategies

Cited by 21 publications

References 23 publications

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010–2016

Decline in Prescription Opioids Attributable to Decreases in Long-Term Use: A Retrospective Study in the Veterans Health Administration 2010–2016

Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

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