NERVE MANAGEMENT AND CHRONIC PAIN AFTER OPEN INGUINAL HERNIA REPAIR: A PROSPECTIVE STUDY

Abstract

Background: Chronic postoperative inguinal pain (CPIP) is a prevalent complication following open inguinal hernia repair, significantly impacting patient quality of life. The incidence of CPIP varies widely across studies, with risk factors including nerve injury, preoperative pain intensity, and surgical technique. Effective perioperative nerve management strategies may play a crucial role in reducing chronic pain. However, the relationship between specific nerve handling techniques and long-term pain outcomes remains unclear. This study investigates the impact of different nerve management strategies on CPIP incidence.

Objective: To evaluate the effects of perioperative nerve identification, preservation, and adjunctive interventions on chronic pain outcomes six months after open inguinal hernia repair.

Methods: A prospective cohort study was conducted from September 2022 to March 2024 at the Department of Surgery, CMH Rawalpindi. A total of 57 patients undergoing elective open inguinal hernia repair were enrolled through consecutive sampling. Perioperative nerve management strategies, including identification, preservation, neurolysis, and neurectomy, were assessed. Pain levels were measured using the Visual Analog Scale (VAS) at multiple time points, with standardized assessments conducted by blinded evaluators. Follow-ups were performed at six months and one year postoperatively. The primary outcome was the incidence of CPIP at six months, with secondary outcomes including postoperative pain severity, nerve identification rates, and pain medication usage.

Results: At six months, chronic pain was reported in 14 patients (24.6%), while 43 patients (75.4%) remained pain-free. Preoperative pain severity was significantly associated with CPIP development (p = .03), with 50.0% of chronic pain cases having reported very strong preoperative pain. Strong postoperative pain at one week (VAS 7–10) was more frequent in patients with CPIP (64.3% vs. 30.2%, p = .04). Nerve identification showed a significant correlation with reduced CPIP incidence, with the iliohypogastric (p = .01) and ilioinguinal nerves (p = .02) identified more frequently in patients without chronic pain. However, no significant association was found between CPIP and the type of anesthesia (p > .05) or specific nerve management techniques such as neurolysis and neurectomy (p > .05).

Conclusion: CPIP remains a prevalent concern after open inguinal hernia repair, with preoperative and early postoperative pain severity emerging as significant risk factors. Nerve identification during surgery was associated with a lower incidence of CPIP, emphasizing the need for meticulous intraoperative nerve management. The findings support a patient-centered approach incorporating preoperative pain assessment, early postoperative pain control, and careful nerve preservation strategies to optimize surgical outcomes and minimize chronic pain.