Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

14. Perioperative Pain Management:
Multi- modalities to Prevent
Postoperative Chronic Pain
Brian J. Dunkin
Introduction
Inguinal hernia surgery is the most common operation done by a
general surgeon with approximately 770,000 repairs performed in 2003.
Among the most feared complications of this common surgery is the
chronic pain that occurs in 11 % of patients, one-third of whom report
limitations in daily leisure activities [ 1 ]. One component of this problem
may be inadequate control of acute pain [ 2 ]. As a result, it is important
that surgeons employ excellent pain management strategies for their
hernia patients not only to ensure a good perioperative experience but
also to avoid long-term problems.
This chapter describes the concept of multimodal pain therapy and
provide examples of medications that can be used in this approach. It
will also provide recommendations for pain management in the pre-,
intra-, and postoperative periods.
Multimodal Pain Therapy
In order to understand how to use multiple modalities to treat postoperative
pain, we must first understand how surgical pain is perceived. The
process begins when noxious stimuli activate specialized nerve cells (nociceptors)
at the site of surgery. Nociceptive pain is so intense that it elicits
an autonomic response resulting in a withdrawal reflex. There are four
types of nociceptive pain (heat, cold, intense mechanical force, chemical
irritants), but in surgery, it is the intense mechanical force pathway that is
activated (Fig. 14.1 ). The nociceptors transmit a signal along the nociceptive
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_14
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