The review of this procedure is currently in progress and will be published by end of 2021

Knowledge Key:

Overall PROSPECT Recommendations

PROSPECT recommendations for postoperative pain management following herniorraphy

Overall PROSPECT Recommendations

Recommended
Pre-/intra-operative	Local anaesthesia ± sedation OR general anaesthesia in combination with local anaesthetic techniques (inguinal nerve block/field block/infiltration) Long-acting local anaesthetics in preference to short-acting local anaesthetics Open or laparoscopic surgery, depending on factors other than postoperative pain Mesh techniques in preference to non-mesh techniques
Postoperative 0–6 hours (including the post anaesthetic care unit [PACU])	For postoperative analgesia in addition to that provided by intra-operative local anaesthetics: Base medication: conventional NSAIDs or COX-2-selective inhibitors (use weak opioids when conventional NSAIDs/COX-2-selective inhibitors are contraindicated), combined with paracetamol Add weak opioid when VAS>30<50* Add strong opioid when VAS³50*
Postoperative Beyond 6 h	Continue base medication: conventional NSAIDs or COX-2-selective inhibitors (use weak opioids when conventional NSAIDs/COX-2-selective inhibitors are contraindicated), combined with paracetamol Add weak opioid when VAS>30<50* Add strong opioid when VAS³50*

VAS³50, on a scale of 1–100 mm = high-intensity pain
VAS>30<50, on a scale of 1–100 mm = moderate-intensity pain
VAS£30, on a scale of 1–100 mm = low-intensity pain

Not recommended

Spinal anaesthesia
Epidural anaesthesia
Systemic clonidine, corticosteroid, gabapentin/pregabalin or ketamine
Epinephrine as part of a local anaesthetic solution
Intra-operative wound instillation with local anaesthetic
Paravertebral nerve block
Postoperative single/repeat wound injection, or postoperative continuous wound infusion, with local anaesthetic
Wound infiltration using conventional NSAIDs, clonidine or strong opioids
Topical conventional NSAIDs
Nerve section, cryoanalgesia techniques or TENS