Inguinal Hernia Repair 2019

Open inguinal hernia repair-specific evidence

Data table: Paracetamol and NSAIDs/COX-2-selective inhibitors for pain management after open inguinal hernia repair

Arguments for…

• A placebo-controlled RCT evaluated the effects of rofecoxib 50 mg given one hour pre-operatively followed by once daily for 4 days after surgery (Schurr 2009; n=55). Rofecoxib reduced pain scores on the first postoperative day, but opioid requirements remained similar to placebo. Note: rofecoxib is a COX-2-selective inhibitor that has been withdrawn from the market due to potential cardiac complications.
• A placebo-controlled RCT evaluated the effects of oral etoricoxib 120 mg given 1 hour pre-operatively (Somri 2017; n=60). Pain scores at rest and on straight leg raise were significantly lower in the etoricoxib group at 16 and 24 hours, and on discharge.
• One RCT reported no difference in pain scores 12 and 24 hours after surgery, between lornoxicam (an NSAID administered at the end of the operation and 12 hours post-operatively) and tramadol (Mentes 2009; n=160). However, the tramadol group experienced more nausea.

PROSPECT Recommendations

• Systemic analgesia should include paracetamol (Grade D) and NSAID or COX-2-selective inhibitor (Grade D) administered pre-operatively or intra-operatively and continued post-operatively.
• Paracetamol, NSAIDs and COX-2-selective inhibitors have been shown to provide excellent analgesia and reduce opioid requirements (Joshi 2019).

Open inguinal hernia repair-specific evidence

Arguments for…

• No new evidence about use of systemic opioids was identified in the current review.
• Limited procedure-specific evidence was found in the previous review (Joshi 2012).

PROSPECT Recommendations

• Opioids are recommended as rescue analgesics in the post-operative period (Grade D).

Open inguinal hernia repair-specific evidence

• No new evidence about use of TENS was identified in the current review.
• Limited procedure-specific evidence, showing no analgesic benefit, was found in the previous review (Archive: Herniorraphy 2004).

PROSPECT Recommendations

• TENS is not recommended due to lack of procedure-specific evidence.