None listed
Conditions
Brief summary
The operation of inguinal herniorraphy is associated with long term pain in 10-12% of patients.There are various factors that might influence the development of chronic post surgical pain after inguinal herniorrhaphy. Using quantitative sensory testing maybe a way to predict the occurrence of chronic post surgical pain syndrome
Interventions
All patients receive standard analgesic management. Intraoperatively; 40 mg of intravenous parecoxib and intra and postoperative intravenous morphine to be titrated to achieve a numercial rating scale (NRS) pain intensity rating of less than 4 in the post anaesthesia care unit.
Postoperatively; oral sustained release oxycodone of 10 miligrams twice per day plus as required immediate release oxycodone 5 -10 mg every 2 hours if required, together with celecoxib administered at a dose of 200 mg t
All patients receive standard analgesic management. Intraoperatively; 40 mg of intravenous parecoxib and intra and postoperative intravenous morphine to be titrated to achieve a numercial rating scale (NRS) pain intensity rating of less than 4 in the post anaesthesia care unit. Postoperatively; oral sustained release oxycodone of 10 miligrams twice per day plus as required immediate release oxycodone 5 -10 mg every 2 hours if required, together with celecoxib administered at a dose of 200 mg twice per day daily Pre and post operative (2 months) sensory testing of wind up using electrical stimulation and observation of pain using NRS. Early postoperative measurements will include 24 hour and 7 daily NRS pain intensity ratings and LANSS, weekly NRS pain intensity and LANSS for a total of 8 weeks, as well as opioid and NSAID consumption. The 2 month review will include information regarding pain intensity, opioid, NSAID and other analgesic requirement, short form Brief Pain Inventory questionnaire (BPI), anxiety assessment according to profile of moods scale, Pittsburgh Sleep Quality Index, LANSS and the presence of numbness and allodynia over site of surgery.
Sponsors
Dr Alex Konstantatos
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
1. Patients who are 18-80 years of age presenting for elective hernia surgery 2. First operation for unilateral inguinal hernia 3. Absence of strangulated or incarcerated tissue in hernial sac.
Exclusion criteria
1. Unable to provide consent 2. Current diagnosis of persistent pain syndrome 3. Current use of opioid medication or tramadol or nonsteroidal antiinflammatories to treat persistent pain 4. Complaint of hernia site pain at rest 5. Allergy or contraindication to use of morphine or oxycodone 6. Allergy or contraindication to use of nonsteroidal antiiflammatories 7. Current use of carbamazepine, phenytoin, sodium valproate, tricyclic antidepressant medications, gabapentin, pregabalin 8. Presence of significant liver impairment (aspartate aminotransferase, alanine aminotransferase, or both >40u/L) or Presence of significant renal impairment (creatinine >140 micromol/litre) 9. Presence of significant vascular, neurological or dermal disease affecting the upper extremities 10. Presence of uncontrolled hypertension defined by a blood pressure of greater than 150/90 mmHg on screening.
Outcome results
None listed