Effect of postoperative analgesia on acute and persistent postherniotomy pain: A randomized study

Dario Bugada, Patricia Lavand'Homme, Andrea Luigi Ambrosoli, Catherine Klersy, Antonio Braschi, Guido Fanelli, Gloria M R Saccani Jotti, Massimo Allegri, Marco Baciarello, Silvia Bettinelli, Lorenzo Cobianchi, Manuela De Gregori, Maria Di Matteo, Silvia Guarisco, Pavla Krizova, Fabio Marangoni, Cristina E. Minella, Thekla Niebel, Andrea Peloso, Francesca Repetti

Research output: Contribution to journalArticle

Abstract

Study objective The study objective is to identify differences in postoperative pain management according to different analgesic treatments, targeting 2 main pathways involved in pain perception. Design The design is a randomized, parallel groups, open-label study. Setting The setting is in an operating room, postoperative recovery area, and surgical ward. Patients There are 200 patients undergoing open inguinal hernia repair (IHR) with tension-free technique (mesh repair). Interventions The intervention is a randomization to receive ketorolac (group K) or tramadol (group T) for 3 days after surgery. Measurements The measurements are differences in analgesic efficacy (numeric rating scale [NRS]) in the postoperative (up to 5 days) period, chronic pain incidence (1 and 3 months), side effects, and complications. Main results We found no differences in analgesic efficacy (NRS value ≥ 4 in the first 96 hours: 26% in group K vs 32% in group T, P =.43); the proportion of patients with NRS ≥ 4 was similar in both groups, and the time trajectories were not significantly different (P for interaction =.24). Side effects were higher (12% vs 6%) in the tramadol group, although not significantly (P =.14), with a case of bleeding in the ketorolac group and higher incidence of constipation in tramadol group. One patient in each group developed chronic pain. Conclusions Ketorolac or weak opioids are equally effective on acute pain and on persistent postsurgical pain development after IHR, and drug choice should be based on their potential side effects and patient's comorbidities. Further studies are needed to standardize the most rational approach to prevent persistent postsurgical pain after IHR.

Original languageEnglish
Pages (from-to)658-664
Number of pages7
JournalJournal of Clinical Anesthesia
Volume27
Issue number8
DOIs
Publication statusPublished - Dec 1 2015

Keywords

  • Hernia surgery
  • Inflammation
  • Persistent pain
  • Postherniotomy pain
  • Postoperative pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Bugada, D., Lavand'Homme, P., Ambrosoli, A. L., Klersy, C., Braschi, A., Fanelli, G., Saccani Jotti, G. M. R., Allegri, M., Baciarello, M., Bettinelli, S., Cobianchi, L., De Gregori, M., Di Matteo, M., Guarisco, S., Krizova, P., Marangoni, F., Minella, C. E., Niebel, T., Peloso, A., & Repetti, F. (2015). Effect of postoperative analgesia on acute and persistent postherniotomy pain: A randomized study. Journal of Clinical Anesthesia, 27(8), 658-664. https://doi.org/10.1016/j.jclinane.2015.06.008