Cited by 412Hernia repair and managementAnesthesia and Pain ManagementPediatric Pain Management Techniques

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Predictive Risk Factors for Persistent Postherniotomy Pain

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Aasvang, Eske K., Gmaehle, Eliza, Hansen, Jeanette B., Gmaehle, Bjorn, Forman, Julie L., Schwarz, Jochen, Bittner, Reinhard, Kehlet, Henrik·2010·Anesthesiology

DOI 10.1097/aln.0b013e3181d31ff8

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Abstract

Background: Persistent postherniotomy pain (PPP) affects everyday activities in 5-10% of patients. Identification of predisposing factors may help to identify the risk groups and guide anesthetic or surgical procedures in reducing risk for PPP. Methods: A prospective study was conducted in 464 patients undergoing open or laparoscopic transabdominal preperitoneal elective groin hernia repair. Primary outcome was identification of risk factors for substantial pain-related functional impairment at 6 months postoperatively assessed by the validated Activity Assessment Scale (AAS). Data on potential risk factors for PPP were collected preoperatively (pain from the groin hernia, preoperative AAS score, pain from other body regions, and psychometric assessment). Pain scores were collected on days 7 and 30 postoperatively. Sensory functions including pain response to tonic heat stimulation were assessed by quantitative sensory testing preoperatively and 6 months postoperatively to assess nerve damage. Results: Four hundred sixty-four patients were included, whereof 442 were examined at 6 months (95.3% follow-up). Fifty-five patients (12.4%) had "moderate/severe" PPP at 6 months. Logistic regression analysis identified four risk factors for PPP: preoperative AAS score, preoperative pain to tonic heat stimulation, 30-day postoperative pain intensity, and sensory dysfunction in the groin at 6 months (nerve damage) (all P < 0.03). A risk prediction model of only preoperative factors and choice of surgical technique revealed increased preoperative AAS score, increased preoperative pain to heat stimulation, and open surgery to increase the risk for PPP (all P < 0.02). Conclusion: PPP is related to both patient and surgical factors. Patients with a high preoperative AAS score and high pain response to a standardized heat stimulus may preferably be treated using an operative technique with lowest risk for nerve damage.

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Authors: Aasvang, E. K., Gmaehle, E., Hansen, J. B., Gmaehle, B., Forman, J. L., Schwarz, J., Bittner, R., & Kehlet, H.
Affiliations: University of Copenhagen (DK)
Research Assistant.
Research Nurse.
Physician.
Agaplesion Bethesda Krankenhaus (DE)
ORCID: Aasvang, Eske K.
Forman, Julie L.
Bittner, Reinhard
Kehlet, Henrik
Venue: Anesthesiology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-04-01
Volume: 112
Issue: 4
Pages: 957-969
ISSN: 0003-3022 (ISSN-L)
DOI: 10.1097/aln.0b013e3181d31ff8
OpenAlex: W2023610081
Cited by: 412
References: 54
Citations by year: 2026: 12 · 2025: 13 · 2024: 18 · 2023: 18 · 2022: 27 · 2021: 23 · 2020: 24 · 2019: 28 · 2018: 34 · 2017: 27 · 2016: 27 · 2015: 34 · 2014: 29 · 2013: 35 · 2012: 23
FWCI: 33.11
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Anesthesiology (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Topics: Health Sciences › Medicine › Surgery › Hernia repair and management
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords: inguinal hernia repair, transabdominal preperitoneal repair, laparoscopic hernia repair, risk factors, quantitative sensory testing, nerve injury, postoperative pain, open versus laparoscopic surgery, risk prediction model
MeSH terms: Adult, Age Factors, Aged, Female, Forecasting, Germany, Groin, Humans, Erectile Dysfunction, Intraoperative Period, Male, Middle Aged, Motor Activity, Neurologic Examination, Pain Measurement, Pain, Postoperative, Postoperative Pain, Preoperative Care, Prospective Studies, Risk Factors, Socioeconomic Factors, Digestive System Surgical Procedures, Cohort Studies, Treatment Outcome, Sample Size, Endpoint Determination, Peripheral Nerve Injuries, Herniorrhaphy

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Predictive Risk Factors for Persistent Postherniotomy Pain

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