(Acta Anaesth. Belg., 2020, 7], 45-56) Pain management after open inguinal hernia repair: an updated 1 systematic review and procedure-specific postoperative pain management (PROSPECT/ESRA) 1 recommendations (*), S. COPPENS’ (j, J. GTDTS P. HUYNEN Ci. M. VAN DE VELDE (°), G. P. JOSHI (‘j. on behalf of the PROSPECT Working Group collaboration 0. P. Josin, E. POGATZKI-ZAH\, M. VANDE VELDE. S. :; SCE-ItJO,H. KEULET, F. BONNET, N. RAWAL, A. DELBOS, P. LAVAND’HOMME, H. BELOEIL, J. RAEDER, A. SAUTER, E. ALURECHT. P. LIRK. D. LoBo, S. FREYS

Abstract : Backgiound: Open inguinal hernia repair role of navel regional analgesic techniques such as can he associated wilh moderate-to-severe postoperative erector spinae blocks and to cunfirni the influence of the pain. w]iich can delay return to activities of daily living. recommended analgesic regimen on postoperalive pain The ainl of this systematic review was to update the relief in an enhanced recovery setting. available lilerature and develop recommendations for

optimal pain management after open inguinal hernia Keywords Open inguinal hernia repair ; pain ; analge

repair. A syslematic review utilizing PROcedure sia ; systematie review evidence-based medicine. r SPECiflcPostoperativePainManagemenT(PROSPECT) k* methodology was tindertaken. ‘v[ethods Randomised controlled trials published in Recommen4ations the English language between January Ist 2009 and August 3lst 2019, evaluating the effects of analgesic, 1. Systemic analgesia should include paracetatnol anesthetic, and surgical interventions were retrieved from and a non-steroidal anti-infiammatory drug or cyclo MEDLINE, EMBASE and Cochrane Databases. Of 203 oxygenase-2 selective inhibitor administered pre eligible studies ideritifted, 37 studies met the inelusion operatively or intra-operatively and continued post criteria. operatively Resnils lnterventions that improved postoperative 2. Local anesthetic infiltration and/or regional analgesia pain relief ineluded paraeetarnol and nonsteroidal anti techniquc(ilio-hypogastric/ilio-inguinalnervebloeksor aflamtnatory drugs or eyclooxygenase-2 seleetive inhihitors, as well as local anesthetie infiltration and S. Coass’, MD; 3. GDTS’.MD: R HcYNEN. MD; M. V,s 0E VELDE. MD, PhD : G. P. Josu’. MD. PhD on hehalfoftlie :egional analgesia teehniques such as ilio-hypogaslrie/ PROSPECT Working Group collahoration. ilio-inguinal nerve bloeks and transversus abdominis S. Coppens and 3. Gidis equally share first auihorship lane bloeks. Although effeetive, epidural analgesia or f9 Depariment of Cardiovascuiar Sciences, Section paravertehral hlocks are considered invasive and harrnful. Anesthesio’.ogy. KU Leuver. and L’niversHy Hespital and thus not recommeoded. Insufficient evidence was Leuven, Belgium (*9 Deparitnent of Anesthesiology and Pain Management, found for psoas black, extended release local anesthetics. Llniversity of Texas Southwestem Medical Center. Dallas, wound infiltration using non-steroidal anti-infianirnatory Texas, LSA drugs. elonidine or opioids, topical conventional non- Corresponding author Mate Van de Veide, Department steroidal anti-infiammatory drugs, systemic clonidine, of Cardiovascular Sciences. Section Anesthesiolugy, KL corticosteroids and ketamine, otravenous lidocaine Leuven and Universiry Hospital Leuven, Belgium E-rnail niarc.-andeveideïcuzleuven,be 1- inftision, cryoanalgesia techniques, and nerve section. Inconsistent evidenee was found for the use of Peper s,,b,,,itted en Mây 25, 2020 end accepted ei, 2,1ev26, gabapentinoids. 2020. Conclusion The analgesic regimen for open inguinal Conflict of interest PROSPECT1s srcpportedhv cm,,nresr,-icled herniarepairshould inelude paracetarnol and nonsteroidal g;znt from the Eutvpean Society of Regional Anesihesia and Pain Therapy (ESRA,).In the past, PROSPECT het anti-inflarnmatory drug or cyclooxygenase-2 selective received imrestricled grants from Pfizer mc. New York.N inhibitor administered pre-operatively or intra USA and Grunenthal, Aachen, Gertnany GPJ has ,-eceived operatively and continued post-operatively. In addition, honorariafivm Boxter and Pacira Pharmaceuticc.Lv.MVdV local anesthetic infiltration and/or a regional analgesia her ,-eceived honoraria fivm Sintetica, Grunenthal, Vfor technique (ilio-inguinal nerve blocks or transversus Pharma, MSD, Nordic Pharma, , He,vn Therapeutics and Aquettant. EP-Z has teceived abdominis plane bloeks), with opioids as used rescue honoraria from Mimdipharma, Gr,menthal, MSD, Janssen analgesies. Further studies are required to assess the GmbJ-J,Freseniz,s Kabi andAceiRs,

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PAIN MANAGEMENT AFTER OPEN INGUINAL HERNIA REPA1R 49

TahieS2 SummarYof key resuits from studies evaluating systemic analgesics, analgesics adjuncls, regional anesthesia, and surgical procedures used to support the recommended interventions in patients afler open inguinal hernia repair

Soidy Study denEn Pain Scores Cumulative opioid done Rascline Analgeaia 1 p,-e.ope-otil-e SvsÎetltiCatolt’Opioldottet!gesics

Schnrr Met al. 2009 (13) Roferosib 50 nsg or placeho 1 hoor Signiflcantly lower ratings for No dinèrence in milligrams Palients were gi’en prior to suegery and oncc daily on east pain in patients vith COX-2 hydrocodotte bitartrate hydrocodone bitartrate as needed postoperato e day -4. inhibitor intake os the opeestive eonsnmed. postoperative. day.

SL’rnri7n1et al. 2017 (14) Etoricoc,b ‘20 Ing or ptaceho 1 hoor signiflcanlly lower pais scores in Amount of rescue analgesic \Vhen VA5ESIat PACU l-Smg preoperalt’e paltenls with COX-2 ishibitor at dosca ofmorphine boluses of morphine eere itsed

16. 24 t and ets discharge, in rest (mg) within 24 h “ere until a response of t en a verbat and wilt active atraighl leg raisc. signiflcantly lower in COX-2 poiosdescripttve seate of 5 was inhibitor group. achie’ed, ,,-a- opeWire Jhpica/ottdnIltgICO/ tilt’ ofihrtsaoostsi,Ü eelenclrd—rrijceue’/oco! eittca(/te/tcs

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rop:t aeatne. end ssouad mnfiltiatior. No difterenee ar 6 and 12 h after - ite0ècttvc, intravcnoas Lctoroiac oOit 10 nL of 075% ropis aaine aurserv and” ith inoventent. (30 net and, whencvcr tieressa 0, versos no bik nar wo:tnd infiltratiur. intrasenoos tialbuphmne (3 mg), “ere added. Sa:ed?,tetat.2015 f22) tIiohpoeastrie and lioingtttttai bbck Nledian \‘AS “-as lo;ner in the Not nsentior:ed. only ttrne for VAS>3, on dentand paracetatnol

12nt 0.75% ropivacainel and incision - tntene;ttton group. - dcrnand first done aatalgesia I000nag and if necessarv 75 mg

irifiltratior. erior to mcidon - dirlofcnae sodiuttt. - Baaren:zen F er ah 2012 Ilro-hypogastric and ilio’ingutnat Significarst lower pEn scores at No smgnificant ditferenee /

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Okur Oct al. 2017 (26) TAP block serstis ilio-hypogastrie and Pain scores “ere signifleantly No significant diftèrenee Aceratramnoptren 10—15 tttg e erstts in additicoal anaigesie kg onee ever 6 t and salvage tt:o-tngurtral nen hork no Io»-er al Ei time poinls of the i bloek- R:oekç ere done w th 20 nat study groups ‘erarts placcbo. Only reqttiretaent was foorrd anaigesia of intravenous tramadol of 0.25% tsoharic hatpi aeattae. al 21 h tisere was a aigniflear.lly betwcen study groups- hydrochioride 50 me. dtfTeretrcehertveen TAP and HIN in 0-er olTAP.

MosailiV ei al. 20:927, Dust TAP-block and \.1S at 12 1 and 45 h were A higher nunber of parierts Fenrarryt 0.5 reAg and, r1er 2 itiohvpogasrrie bloek veralla stsnitiearativ los er is Duat TAP- cecuired resetre anEgesies in h if the pain pers:sls tAS score

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Razavizadeh MR et al. Additionof desamethasone S mg to Onsetfdurslton of aneslhesia Not mentioned. Not mentioned. 2017 (30) eptdur-atblock into epidural space “-as aigni0çantly more espid and versus ptaeebo (satinc 2m11. longer in the desamethasone grOnp. Poat-operative U-1P-bloek .AkyolBC er al. 2018(31) ltttrasenous anatgesie regimen Pain scores signifieantly lower in NRS-aeore >4 reeeived as During close-up ofthe surgery,

(group II sersus aubeostal TAP- group II eompared with group Ir additional dose of 1 mglkg patients II bolh groupa were bloek poaloperativcly in addition to poatoperative 151h-minute; Ist-, Irarnadol IV. given tOOmgtramadol and an intrasenous anatgcsie regimen 6th-, 121h-,and 24th-hour; lSth- l000mg paraeetamol IV. (group II) day and lst’month NRS values. NS no signifleant differenee between groups. on = Poatoperstive Day.

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to PAIN MANAGEMENT AETER OPEN INGIjINAL HERNIA REPAIR 55

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