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

23. Mesh Removal for Chronic Pain…
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One other aspect to consider is pain management in the postoperative
period as mentioned previously. Some texts suggest that good pain control
initially may help to reduce the development of chronic pain by
preventing chronic pain pathways from developing through sensitization
and neuroplasticity. For this reason, we have developed a multimodal
pain treatment protocol in conjunction with our anesthesiologists that
includes TAP blocks and controlling nausea to prevent emesis immediately
postoperative to reduce strain on newly reconstructed groins.
Improvements in preoperative preparation and maximizing bowel function
can also help improve outcomes. A summary of perioperative multimodal
management strategies is presented in Table 23.1 .
Incorporating Systems Science Solutions into
the Management of Chronic Groin Pain After
Inguinal Hernia Repair
The attempts to isolate and improve one variable and the limited success
with this strategy highlight the fact that chronic pain is a complex
problem that can rarely be solved with a simple solution. Complex
problems require a systems approach that includes identifying and defining
processes and variables, including outcomes that measure value
(including quality and satisfaction measures as well as costs for the
entire cycle of care). It is important to remember that each person is different
and that what works for one may have deleterious effects on
another; it may have no benefit or cause harm and therefore may be
wasteful.
In our approach to treatment using principles of systems and complexity
science, we have built a team around hernia disease, with the
ultimate goal of creating more teams around other definable patient
groups. This places all the focus on the patient process and value-based
outcomes generated by the process.
Currently, our hernia team includes surgeons, anesthesiologists,
nurses, a patient care manager, care coordinators, a clinical quality
improvement manager, a biologic/materials engineer, a mechanical
engineer, residents, and other team members. Former patients and their
family members participate and help provide care for current patients