3 8
S U P P L E M E N T T O O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M O N T H 2 0 1 4
the repair site, since antibiotics are able to infiltrate the material. Laparoscopic
devices are available to assist learners and experienced hands alike in insertion,
positioning and placing mesh faster, more accurately and more efficiently with
minimal tissue handling.
If mesh is incorrectly implanted, it can cause foreign body reactions or other
complications, and some implanted meshes may feel less flexible than others,
but there is no correlation between the specific type of mesh used and the inci-
dence of post-hernia-surgery pain.
On the other hand, the extent of the surgery and the manner in which the
mesh is fixed to surrounding tissue can often be correlated to post-op pain. A
large hernia will require a large mesh placement, and some methods of attach-
ment may result in more pain than others. For example, tacks, staples and other
permanent or absorbable mesh fasteners have been known to cause more post-
op pain than sutures do, but it's a trade-off. The fasteners are quicker and more
convenient to use than sutures during laparoscopic cases, which results in less
post-op pain and accelerated recoveries, as compared with open hernia repairs.
During open repairs, there's plenty of access for suturing, although fastening
devices are still often used, due to their efficiency.
4. Avoid complications
There is a growing consensus that patients' exposure to narcotics should be lim-
ited in favor of multimodal pain management regimens, even after hernia repairs.
Multimodal's proponents urge providers not to let their own patient care
complicate recoveries. A nurse who doses a post-surgical patients with IV
hydromorphone may have quelled their pain, they argue, but has also likely
lowered their blood pressure, made them groggy or dizzy, potentially nause-
ated them and prolonged their stay in PACU.
Narcotics are good for managing deep abdominal pain, but they're not that
good at controlling incisional pain. Injections at the incision site or pain
pumps are better. Try administering a bolus from a pain pump before resorting
H E R N I A R E P A I R
1403_AbdominalSurgeryGuide_Layout 1 2/24/14 10:36 AM Page 38
