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Mediators of Inflammation
Volume 2016 (2016), Article ID 5830347, 7 pages
Research Article

Effect of Preoperative Inflammatory Status and Comorbidities on Pain Resolution and Persistent Postsurgical Pain after Inguinal Hernia Repair

1Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43126 Parma, Italy
2SIMPAR Group (Study in Multidisciplinary Pain Research Group), Via Gramsci 14, 43126 Parma, Italy
32° Anestesia, Rianimazione e Terapia Antalgica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
4Department of Anesthesia and Perioperative Medicine, Catholic University of Louvain, St Luc Hospital, 10 Avenue Hippocrate, 1200 Brussels, Belgium
5Day Surgery Unit, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Polo Universitario, Viale Luigi Borri 57, 21100 Varese, Italy
6Department of Anesthesia, Istituto Ortopedico G. Pini, Piazza Cardinale Andrea Ferrari 1, 20122 Milan, Italy
7Department of Biomedical, Biotechnological & Translational Sciences (S.Bi.Bi.T), Faculty of Medicine, University of Parma, Via Gramsci 14, 43126 Parma, Italy
8Department of Clinical and Experimental Medicine, University of Parma, Via Gramsci 14, 43126 Parma, Italy

Received 9 September 2015; Revised 4 December 2015; Accepted 8 December 2015

Academic Editor: Marc Pouliot

Copyright © 2016 Dario Bugada et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Poor acute pain control and inflammation are important risk factors for Persistent Postsurgical Pain (PPSP). The aim of the study is to investigate, in the context of a prospective cohort of patients undergoing hernia repair, potential risk factors for PPSP. Data about BMI, anxious-depressive disorders, neutrophil-tolymphocyte ratio (NLR), proinflammatory medical comorbidities were collected. An analysis for correlation between comorbidities and PPSP was performed in those patients experiencing chronic pain at 3 months after surgery. Tramadol resulted less effective in pain at movement in patients with a proinflammatory status. Preoperative hypertension and NLR > 4 were correlated with PPSP intensity. Regional anesthesia was significantly protective on PPSP when associated with ketorolac. Patients with pain at 1 month were significantly more prone to develop PPSP at 3 months. NSAIDs or weak opioids are equally effective on acute pain and on PPSP development after IHR, but Ketorolac has better profile in patients with inflammatory background or undergoing regional anesthesia. Drug choice should be based on their potential side effects, patient’s profile (comorbidities, preoperative inflammation, and hypertension), and type of anesthesia. Close monitoring is necessary to early detect pain conditions more prone to progress to a chronic syndrome.