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

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202 B.J. Dunkin Table 14.2. Common opioids used in the USA. Opioid Clinical “strength” Morphine Strong Oxycodone Strong Hydromorphone Strong Meperidine Strong Fentanyl Strong Methadone Strong Hydrocodone Weak Codeine Weak Tramadol Weak few common opioids used in the USA for surgical pain. It should be noted that the most common weak opioid prescribed in the USA is hydrocodone, which is available only in formulations that combine it with APAP. This must be kept in mind when using IV or oral APAP as part of a multimodal pain management strategy in order to avoid APAP overdose. Ketamine Ketamine is a nonopioid, centrally acting dissociative anesthetic. At subanesthetic doses, it provides rapid and highly potent analgesia without many of the adverse effects observed with opioids. It binds to and antagonizes the NMDA receptors in the central nervous system. Ketamine is particularly useful in opioid-tolerant patients. However, major complications can be associated with its use, including hyperdynamic cardiovascular responses and psychomimetic reactions. Perioperative Pain Management Strategies The choice of anesthetic technique as well as preoperative, intraoperative, and postoperative management of medications, affects postoperative pain. Proper management of all three phases of the perioperative experience will lead to a better surgical experience for the patient. The following is a summary of pain management strategies based on review of the literature by the authors of this chapter and by consensus
14. Perioperative Pain Management Multi-modalities to Prevent… 203 recommendation by PROSPECT (PROcedure SPECific postoperative pain management consortium; http://www.postoppain.org/ ) and the Surgical Pain Consortium ( http://surgicalpainconsortium.com/ ) [ 6 , 7 ]. Preoperative Pain Management Eighty-five percent of hernia surgery is done as outpatient. As a result, coordination of preoperative preparation of patients for surgery requires clear communication with the patient and all members of both the preoperative care unit and the operative team. Recommended Preoperative Strategies • Systemic analgesics – COX-2-selective NSAIDs . Preoperative administration of a COX-2 inhibitor (celecoxib or meloxicam in the USA) 1 h before incision is recommended for its analgesic efficacy and minimal effect on platelet aggregation. Use must include an assessment of individual patient risks (contraindicated in patients with cardiovascular morbidity, actual or recent gastroduodenal ulcer history, renal or hepatic dysfunction, or aspirin-sensitive asthma). – Acetaminophen (APAP) . APAP may be given orally or IV. Because of the rapid and more predictable achievement of plasma concentrations, the IV formulation is often preferred in the perioperative setting. IV APAP seems to have a better analgesic effect when given preemptively 30–60 min before incision. Because many hernia surgery patients receive a weak opioid combined with APAP orally (e.g., Lortab—hydrocodone plus APAP) for postoperative pain control, the timing and use of APAP perioperatively must be carefully considered to avoid overdosing. • Local anesthetics – Inguinal nerve block including TAP block/field block/infiltration . Studies of local anesthetic administration for inguinal hernia repair do not clearly differentiate between inguinal nerve block versus field block. As a result, either can be used for anesthetic infiltration. Local anesthetics can be injected preoperatively or intraoperatively with the same control of early postoperative pain. Long-acting local anesthetics are recommended over short-acting.
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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144 M. Hibner and C. Coyne present
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146 M. Hibner and C. Coyne Table 11
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148 M. Hibner and C. Coyne Once the
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19. Radiologic Evaluation for Posto
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19 Radiologic Evaluation for Postop
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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286 R. Álvarez Subsequently, we mu
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288 R. Álvarez G : Granuloma H : H
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290 R. Álvarez Fig. 21.14. Same pa
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292 R. Álvarez 6. Lermite E, Arnau
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294 K.A. Seymour and J.S. Yoo Table
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296 K.A. Seymour and J.S. Yoo repro
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298 K.A. Seymour and J.S. Yoo Recur
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23. Mesh Removal for Chronic Pain:
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23. Mesh Removal for Chronic Pain
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320 I.T. MacQueen et al. inguinodyn
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322 I.T. MacQueen et al. Fig. 24.2.
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324 I.T. MacQueen et al. Timing and
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326 I.T. MacQueen et al. Fig. 24.4.
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328 I.T. MacQueen et al. Posthernio
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330 I.T. MacQueen et al. never be e
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25. Laparoscopic Triple Neurectomy
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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476 S. Towfigh The patient’s loca
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478 S. Towfigh Fig. 39.2. Diagram o
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480 S. Towfigh periphery. He is 2+
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482 S. Towfigh References 1. Matthi
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484 N.A. Al-Enazi and B.P. Jacob
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486 N.A. Al-Enazi and B.P. Jacob Fi
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488 N.A. Al-Enazi and B.P. Jacob pu
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42. Patient with Chronic Pelvic Pai
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42. Patient with Chronic Pelvic Pai
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43. Thoracolumbar Syndrome James A.
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43. Thoracolumbar Syndrome 497 The
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43. Thoracolumbar Syndrome 499 Groi
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44. Patient with Referred Hip Pain
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44. Patient with Referred Hip Pain
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45. Value-Based Clinical Quality Im
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46. Patient Care Manager Perspectiv
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47. Workers’ Compensation: An Occ
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532 Index Athletic pubalgia (cont.)
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534 Index Chronic post-herniorrhaph
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536 Index Groin pain (cont.) magnet
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538 Index Ilioinguinal nerve (IIN)
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540 Index Local anesthetics (cont.)
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542 Index Peripheral nerve entrapme
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544 Index S Sacroiliac (SI) joint d
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546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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