Systematic review of neuropathic component in persistent post-surgical pain

2012 ◽  
Vol 3 (3) ◽  
pp. 184-184
Author(s):  
S. Haroutiunian ◽  
L. Nikolajsen ◽  
N.B. Finnerup ◽  
T.S. Jensen
Keyword(s):  
Systematic Review ◽  
Neuropathic Pain ◽  
Hernia Repair ◽  
Varicose Vein ◽  
Groin Hernia ◽  
Iliac Crest ◽  
Gynecologic Surgery ◽  
Groin Hernia Repair ◽  
Pain Mechanisms ◽  
Surgical Pain

Abstract Background/aim The aim of the current study was to assess the neuropathic component of persistent post-surgical pain (PPSP) following eleven types of surgery. Methods We performed a systematic PubMed, CENTRAL and EMBASE search to identify studies on PPSP following (i) thoracic surgery, (ii) breast surgery, (iii) groin hernia repair, (iv) prostatectomy, (v) major abdominal surgery, (vi) gynecologic surgery, (vii) iliac crest bone harvest, (viii) total hip arthroplasty (THA) or knee arthroplasty (TKA), (ix) varicose vein stripping or ablation, (x) mandibular sagittal split osteotomy and (xi) donor nephrectomy, and assessed the prevalence of Probable/Definite neuropathic pain using the recently published neuropathic pain probability grading criteria [1]. Results We included 291 relevant papers. Surgeries performed in the thoracic/breast area resulted in similarly high median PPSP prevalence of about 30–35%; bone and joint surgeries resulted in similar PPSP prevalence of about 20%; and surgeries on visceral organs resulted in lower PPSP prevalence of 10–14%. The reported ranges of PPSP prevalence were very wide, between 0 and 91%. The prevalence of Probable/Definite neuropathic pain among patients with PPSP was about 65% after thoracic and breast surgeries, about 32% after groin hernia repair and gynecologic surgery, and between 9 and 16% after bone and joint surgeries such as iliac crest bone harvest and THA/TKA. In varicose vein surgeries and mandibular sagittal split osteotomies more research is needed to investigate the contribution of neuropathic pain mechanisms. Conclusion PPSP after different surgeries is reported to be common and often neuropathic. This systematic review of the literature showed that reported PPSP prevalences range widely among studies, and only a minority of studies used methodology that enabled the estimation of Probable/Definite neuropathic pain prevalence.

scholarly journals Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Elisabeth Kjær Jensen ◽  
Emmanuel Bäckryd ◽  
Jørgen Hilden ◽  
Mads U. Werner
Keyword(s):  
Neuropathic Pain ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Groin Hernia Repair ◽  
Explanatory Variables ◽  
Delayed Onset ◽  
Pain Scores ◽  
Surgical Pain ◽  
Functional Assessments ◽  
Pain Trajectories

AbstractObjectivesSevere persistent post-surgical pain (PPSP) remains a significant healthcare problem. In the third most common surgical procedure in the U.K., groin hernia repair, including 85,000 surgeries, estimated 1,500–3,000 patients will annually develop severe PPSP. While the trajectory of PPSP is generally considered a continuation of the acute post-surgery pain, recent data suggest the condition may develop with a delayed onset. This study evaluated pain-trajectories in a consecutive cohort referred from groin hernia repair-surgeons to a tertiary PPSP-center. Potential explanatory variables based on individual psychometric, sensory, and surgical profiles were analyzed.MethodsPatients completed graphs on pain trajectories and questionnaires on neuropathic pain, pain-related functional assessments, and psychometrics. Surgical records and quantitative sensory testing profiles were obtained. Pain trajectories were normalized, and pre- and post-surgical segments were analyzed by a normalized area-under-the-curve (AUC) technique. Principal component analysis (PCA) was applied to the explanatory variables. Significant PCA-components were further examined using multiple logistic regression models.ResultsIn 95 patients, the AUC identified groups of post-surgical pain trajectories (p<0.0001): group I (n=48), acute high-intensity pain progressing to PPSP; group II (n=28), delayed onset of PPSP; group III (n=7), repeat-surgery gradually inducing PPSP. Data from groups IV (n=3) and V (n=9) were not included in the statistical analysis due to small sample size and data heterogeneity, respectively. The PCA/logistic analyses indicated that neuropathic pain scores, composite pain scores, and pain-related functional assessments were explanatory variables for groups I and II.ConclusionsPain trajectories in PPSP after groin hernia repair are heterogeneous but can be classified into meaningful groups. Examination of pain trajectories, mirroring the transition from acute to severe persistent post-surgical pain, has the potential of uncovering clinically relevant pathophysiological mechanisms.

scholarly journals P113 SPIN IS PRESENT IN THE MAJORITY OF THE ARTICLES EVALUATING ROBOT-ASSISTED GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Danni Hansen ◽  
Siv Fonnes ◽  
Jacob Rosenberg
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Data Extraction ◽  
Database Search ◽  
Groin Hernia Repair ◽  
Robot Assisted ◽  
Traditional Methods ◽  
Interpretation Of Results

Abstract Aim The number of articles published each year are increasing, resulting in greater competition to get work published. Spin is defined as specific reporting strategies used to distort the readers’ interpretation of results so that they are viewed more favourable. However, prevalence of spin in studies comparing robot-assisted groin hernia repair with traditional methods is unknown. The aim of the study was to determine the frequency and extent of misrepresentation of results, spin, in studies assessing robot-assisted groin hernia repair. Methods This systematic review was reported according to PRISMA guidelines, and a protocol was registered at PROSPERO before data extraction. Database search included PubMed, EMBASE and Cochrane Central. Results Of 35 included studies, spin was present in 57%. Within these, 95% had spin present in the abstract and 80% in the conclusion of the article. There was no association between study size and spin (p &gt; 0.05). However, presence of spin in studies positively minded towards robot-assisted hernia repair was higher (p &lt; 0.001) compared with those against or being neutral in their view of the procedure. Furthermore, being funded by or receiving grants from Intuitive Surgical were associated with a higher prevalence of spin (p &lt; 0.01) compared with those who were not. Conclusion Spin was found to be common in articles reporting on robot-assisted groin hernia repair, and presence of spin was higher in studies funded by or receiving grants from the robot company. This suggests that readers should be cautious when reading similar literature.

scholarly journals O25 MORTALITY AFTER EMERGENCY VERSUS ELECTIVE GROIN HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Ann Hou Saeter ◽  
Siv Fonnes ◽  
Jacob Rosenberg ◽  
Kristoffer Andresen
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Bowel Resection ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Groin Hernia Repair ◽  
Emergency Repair ◽  
Elective Repair ◽  
Meta Analyses

Abstract Aim This systematic review and meta-analysis aimed to investigate 30- and 90-day postoperative mortality in patients undergoing emergency or elective groin hernia repair. Material and Methods This review is reported after the PRISMA 2020 guidelines. A protocol (CRD42021244412) was registered to PROSPERO. Three databases (PubMed, EMBASE, and Cochrane CENTRAL) were searched in April 2021. The identified studies were screened for eligibility and included if they reported 30- and/or 90-day mortality following emergency or elective groin hernia repair. Meta-analyses were conducted when possible, and a subgroup analysis on patients undergoing bowel resection was made. Results We included 37 studies with a total of 30,740 patients receiving emergency repair and 457,253 receiving elective repair. Meta-analyses could not be conducted for the two repair settings separately due to heterogeneity. However, the 30-day mortality ranged from 0.0–1.7% following elective repair and 0.0–11.8% following emergency repair. The risk of 30-day mortality following emergency repair was estimated to be 26-fold higher than after elective repair. A subgroup meta-analysis on bowel resection in emergency repair estimated 30-day mortality to be 7.9%. Conclusions Emergency groin hernia remains a challenging and potentially fatal surgical emergency. This review emphasizes the importance of performing hernia repair in an elective setting to prevent a potential acute presentation with acute surgical intervention. Patients presenting with symptoms of emergency groin hernias should receive particular attention to minimize the high risk of mortality and morbidity following emergency repair.

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