Publication Date:
2016
abstract:
The prevention of pain requires that surgeons should take care not only during the entire surgical procedure but also before and after, following these steps:
1. Preoperative patient selection: preoperative pain, preoperative pain response to heat, intraoperative nerve injury, early postoperative pain intensity, younger age, and open surgery are risk factors for postoperative chronic pain.
2. Anesthesia: local anesthesia seems to be followed by less postoperative pain.
3. Approach: open anterior for all primary inguinal hernias.
4. Identification and respect of the three nerves when possible, otherwise pragmatic neurectomy.
5. Choice of the prosthesis: light- or medium-weight polypropylene flat mesh for “normal” patients.
6. Choice of fixation: sutureless or fibrin glue fixation should be advised.
7. Always provide proper postoperative therapy.
1. Preoperative patient selection: preoperative pain, preoperative pain response to heat, intraoperative nerve injury, early postoperative pain intensity, younger age, and open surgery are risk factors for postoperative chronic pain.
2. Anesthesia: local anesthesia seems to be followed by less postoperative pain.
3. Approach: open anterior for all primary inguinal hernias.
4. Identification and respect of the three nerves when possible, otherwise pragmatic neurectomy.
5. Choice of the prosthesis: light- or medium-weight polypropylene flat mesh for “normal” patients.
6. Choice of fixation: sutureless or fibrin glue fixation should be advised.
7. Always provide proper postoperative therapy.
Iris type:
Capitolo di Libro
Keywords:
Preoperative selection; Local anesthesia; Nerve Identification of nerves; Neurectomy; Lightweight; Heavyweight; Fixation; Postoperative therapy
List of contributors:
Campanelli, GIAMPIERO GIORGIO SALVATORE CIRO; Cavalli, Marta; Bruni, Piero; Morlacchi, Andrea; Pavoni, Gianni Maria; Cavalli, Marta
Book title:
The SAGES manual of groin pain