English

Abstract

BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of chronic pain. MATERIAL AND METHODS: Patients undergoing elective inguinal hernioplasty in Victoria hospital from November2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for follow up at end of six months. A detailed preoperative, intraoperative and post-operative details of cases were recorded according to proforma. The postoperative pain and pain at two, seven days and at end of six months were recorded on a VAS scale. RESULTS: Chronic pain at six month follow up was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7 % of patients with preoperative pain developed chronic pain. Patients with significant preoperative pain had higher chances of developing chronic pain (p<.0001). Preemptive analgesia failed to show statistical significance in development of chronic pain (p=0.079). Nerve injury were present in 22 of cases it was found that nerve injury significantly affected development of chronic pain (p=0.001).Post-operative infiltration of local anesthesia was practiced in 16.3 % of cases and it was found that local infiltration at incision site significantly reduced incidence of chronic pain (p=0.001).Postoperative complications in the form of hematoma, seroma or infection was present in 8.5 % of cases. It was found that post-operative complication not only increased early post-operative pain but also increased chances of development of chronic pain.(p=0.001). Post-operative pain at one two and seven days significantly affected development of chronic pain (p=0.000). On multivariate analysis it was found that development of chronic pain following hernia surgery was dependent upon factors like preoperative pain, type of anesthesia, nerve injury, post-operative local infiltration, and post-operative complication and most importantly the early post-operative pain. CONCLUSIONS: The present study we found that chronic pain following inguinal hernia repair causes significant morbidity to patients and should not be ignored. Young people with preoperative pain of long duration were more prone to development of chronic pain. Preemptive analgesia and operation under local anesthesia significantly affect pain. Intraoperative identification and preservation of all inguinal nerves is very important. All measures must be taken to suppress early post-operative pain and prevent complications as these lead to development of chronic pain. Early diagnosis and management of chronic pain can remove suffering of the patient.