W. R. Ueland1, M. Plymale1, D. Davenport1, J. Roth1 1University Of Kentucky,Lexington, KY, USA
Introduction: Effective pain control following open ventral and incisional hernia repair (VHR) impacts all aspects of patient recovery. To reduce opioids and enhance pain control, multimodal pain management including use of epidural analgesia, muscle relaxants, and non-opioid analgesics are thought to be beneficial. The purpose of this study was to identify perioperative characteristics associated with patient-reported pain scores.
Methods: After obtaining IRB approval, surgical databases were searched for open VHR cases performed by one surgeon over three years. Modes of pain management and visual analog scale (VAS) pain scores were recorded in twelve-hour intervals to hospital discharge or up to eight days post-operation. Patient characteristics were determined by medical record review. Forward stepwise multivariable regression (p for entry < .05; exit > .10) was used to assess the independent contribution to VAS scores of the preoperative, operative and postoperative factors.
Results: One hundred and seventy-five patients underwent elective open VHR with mesh implantation and were included in the analyses. Average patient age was 55.1 years (+/- 12.8 years) and slightly over half of the patients were female (50.9%). Just over one in ten patients were morbidly obese (BMI ≥40 kg/m2). No significant (p < .01) associations were found between VAS pain scores at any time point based on gender, ASA class, BMI, smoking status, history of cancer, heart disease or COPD. Patient factors independently associated with increased preoperative VAS scores included: preoperative opioid use, open wound, CDC Wound Class II and prior hernia repair(s). Patients with epidural for postoperative pain had significantly decreased VAS pain scores across the time continuum. Operative factors significantly associated with increased preoperative VAS pain score included: median hernia defect size, concomitantly performed procedure(s), duration of operation and estimated blood loss (EBL). Hospital length of stay and postoperative surgical site occurrence were associated with increased VAS pain scores at the preoperative and 0-11 hour postoperative time points. Greater preoperative VAS pain score predicted increased pain at each postoperative time point (all p < .05).
Conclusion: Preoperative pain status and opioid use are associated with increased VAS pain scores postoperatively. Epidural analgesia effectively results in decreased patient-reported pain. Increased preoperative VAS pain scores are reflected in increased operative complexity measured by operative duration and EBL.
