BJA Advance Access originally published online on November 5, 2004
British Journal of Anaesthesia 2005 95(1):69-76; doi:10.1093/bja/aei019
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org
REVIEW ARTICLE |
Chronic postoperative pain: the case of inguinal herniorrhaphy
Section of Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
* Corresponding author. E-mail: henrik.kehlet@rh.dk
Keywords: complications, hernia, inguinal; pain, postoperative; pain, chronic; surgery, abdominal
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Introduction |
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That surgical injury can lead to chronic pain is now well established.8 21 29 41 50 From these reviews and studies using a systematic collection of data, the estimated incidences of chronic pain after various procedures are: leg amputation about 60%, thoracotomy about 50%, breast surgery about 30%, cholecystectomy 10–20%, and inguinal herniorrhaphy about 10%. Predictive risk factors for chronic postoperative pain are: preoperative pain, repeat surgery, psychological vulnerability, workers compensation, a surgical approach with risk of nerve damage, moderate or severe intensity of acute postoperative pain, radiation therapy, neurotoxic chemotherapy, depression, neuroticism, and anxiety.29 41
All these factors should be assessed in any study of chronic postoperative pain; however, this has rarely been the case. Thus, a detailed understanding of the relative role of the mechanisms responsible for the development of chronic postoperative pain is not available and further complicated by the many possible pathogenic mechanisms. As patients undergoing inguinal hernia repair do not
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Methods |
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Results |
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Time course
Age
Preoperative pain
Gender
Body mass index
Operation for a recurrent hernia
Employment status
Open vs laparoscopic repair
Mesh vs non-mesh repair
Neurological testing and nerve lesions
Early postoperative pain
Influence of chronic pain on daily activities and socioeconomic consequences
Genital complications
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Discussion |
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