Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

Abstract

Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient's profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome.

Effects of anaesthesia and analgesia on long-term outcome after total knee replacement

“…We had previously investigated the association of the background inflammatory state and PPSP in minor surgery, 28 , 29 and this was confirmed here. Inflammation is a key mechanism in postoperative pain and central sensitisation.…”

Continuous wound infusion with chloroprocaine in a pig model of surgical lesion: drug absorption and effects on inflammatory response

“…Postoperative analgesia still remains a challenge, 1 , 2 and the importance of targeted treatments has often been stressed. 3 , 4 Pain involves different mechanisms (peripheral nociception, central modulation and primary and secondary hyperalgesia), with nociceptor’s activation being the trigger for all. Inflammation is the major background factor acting both peripherally and centrally on neural structures, leading to hyperalgesia and probably acting as a main factor toward the development of persistent pain after surgery.…”

Changes in total plasma and serum N-glycome composition and patient-controlled analgesia after major abdominal surgery

“…Major surgery provokes a vigorous inflammatory response with important clinical implications 9 10 . However, the factors influencing incidence and severity of clinical outcomes associated with the inflammatory response (including life-threatening perioperative complications), are currently not well understood, even though the connection between inflammation and pain has already been investigated 10 and inflammatory background may even influence the response to therapies 11 . Furthermore, the level of perceived pain varies significantly between individuals undergoing very similar surgery 12 and genetics may be helpful in predicting postoperative pain and morphine consumption 13 14 15 .…”