Widder A, Bucher H, Reinhold A K, Maroske L, Meyer T, Wiegering A, Lock J F, Germer C -T, Rittner H L, Schlegel N, Meir Michael
Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital of Wuerzburg, Wuerzburg, Germany.
Center for Interdisciplinary Pain Medicine, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, University Hospital of Wuerzburg, Wuerzburg, Germany.
Hernia. 2025 Jan 6;29(1):62. doi: 10.1007/s10029-024-03245-z.
Surgical treatment of inguinal hernias in children is one of the most common operative procedures worldwide. During surgery for inguinal hernias in adults, chronic pain develops in approximately 10% of all cases. In children, there has been limited research to determine whether they may also develop this chronic postsurgical inguinal pain (CPIP). The aim of this study was to investigate the prevalence of CPIP in children after open inguinal hernia surgery and to identify possible risk factors and protective factors for the development of CPIP.
A single center retrospective analysis of patients aged 4 to 15 years who underwent inguinal hernia repair from 2020 to 2022 was performed. A detailed analysis based on the local database was used to analyze existing pre-existing conditions, perioperative information and the use of a cauda epidural block. A standardized follow-up questionnaire was used to evaluate the prevalence of CPIP and the duration of postoperative analgesic medication.
A total of 176 cases were included in the detailed analysis. 3.4 % of the children complained CPIP 3 months after surgery with a mean follow-up period of 26.4 months. At the time of the survey, 50% of CPIP patients reported a resolving from chronic pain. Our analyzes showed a potential higher CPIP rate in females (83.3%; p=0.040), older children (8.3 years vs. 5 years; p=0.006) and chronic pain history (16.7% vs. 2.4%; p=0.038).Furthermore, Children mitght profit from a intraoperative cauda epidural block since we observed a lower rate of CPIP (66.7% (4/6) vs. 97% (164/170); p=0.019) in these patients.
We were able to identify initial risk factors such as female gender, older patient age and a history of chronic pain. In addition, we were able to obtain information on possible protective factors such as an intraoperative cauda epidural block and adequate postoperative analgesia. However, further studies are required to clarify the pathogenesis and to confirm predictors and protective factors in order to improve therapeutic approaches.
小儿腹股沟疝的外科治疗是全球最常见的手术操作之一。在成人腹股沟疝手术中，约10%的病例会出现慢性疼痛。在儿童中，关于他们是否也会发生这种慢性术后腹股沟疼痛（CPIP）的研究有限。本研究的目的是调查小儿开放性腹股沟疝修补术后CPIP的患病率，并确定CPIP发生的可能危险因素和保护因素。
对2020年至2022年期间接受腹股沟疝修补术的4至15岁患者进行单中心回顾性分析。基于本地数据库进行详细分析，以分析现有的既往疾病、围手术期信息和马尾硬膜外阻滞的使用情况。使用标准化的随访问卷评估CPIP的患病率和术后镇痛药物的使用时间。
共有176例病例纳入详细分析。3.4%的儿童在术后3个月主诉CPIP，平均随访期为26.4个月。在调查时，50%的CPIP患者报告慢性疼痛有所缓解。我们的分析显示，女性（83.3%；p=0.040）、年龄较大的儿童（8.3岁对5岁；p=0.006）和有慢性疼痛病史（16.7%对2.4%；p=0.038）的CPIP发生率可能更高。此外，儿童可能从术中马尾硬膜外阻滞中获益，因为我们观察到这些患者的CPIP发生率较低（66.7%（4/6）对97%（164/170）；p=0.019）。
我们能够确定初始危险因素，如女性性别、患者年龄较大和慢性疼痛病史。此外，我们能够获得有关可能的保护因素的信息，如术中马尾硬膜外阻滞和充分的术后镇痛。然而，需要进一步研究以阐明发病机制并确认预测因素和保护因素，以改进治疗方法。
