Perioperative Local Cooling Reduce Significantly Early Pain after Open Inguinal Hernia Repair: A Prospective Randomized Study


Pain and local complications are the major determinants of outcome after inguinal hernia repair. To evaluate the respective impact of peri-operative cooling of surgical site and usual care after open inguinal hernia repair, we performed a prospective randomized study. Methods: One hundred and eight consecutive patients with primary unilateral inguinal hernia were included the study. Repair was performed by local direct access during ambulatory surgery. The first study group underwent standard pre- and postoperative local care (control group). In the second group (cold compress group), a single-use disposable sterile cold compress was applied on the surgical site for at least 30 minutes before and 2 hours after surgery. Primary endpoints were immediate postoperative pain using a visual analogue scale, and local complications. Secondary endpoints included: analgesic drug consumption, length of hospital stay, delay to return to normal activity and patient satisfaction. Results: There was no difference concerning operative time (36.3 ± 14.0 vs 39.6 ± 7.2 minutes) and early (one-week) complications, although there was a non significant reduced incidence of hematoma and ecchymosis (0/54 versus 4/54) for the cold compress group. Analgesic drug consumption was significantly (p = 0.01) reduced. During the day of surgery and the first postoperative day, the visual analogue scale was significantly lower after cooling. There was a non-significant reduction in length of hospital stay (150 ± 37 versus 210 ± 47 min), and time to return to normal activity was shorter in the cold compress group. Conclusion: For open inguinal hernia repair, immediate pre- and post operative surgical site cooling, targeting a controlled temperature between 12?C and 15?C significantly reduced postoperative pain, analgesic drug consumption and resulted in improved immediate outcomes. This technique is safe, simple, easy to use, inexpensive and well tolerated by the patient.

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Champault, G. , Paolino, L. , Valenti, A. and Barrat, C. (2014) Perioperative Local Cooling Reduce Significantly Early Pain after Open Inguinal Hernia Repair: A Prospective Randomized Study. Pain Studies and Treatment, 2, 113-120. doi: 10.4236/pst.2014.23018.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Collins, N.C. (2008) Is Ice Right? Does Cryotherapy Improve Outcomes for Acute Soft Tissue Injury? Emergency Medicine Journal, 25, 65-68.
[2] Hubbard, T.J. and Denegar, C.R. (2004) Does Cryotherapy Improve Outcomes with Soft Tissue Injury? Journal of Athletic Training, 39, 278-279.
[3] Abramson, D.I., Chu, L.S., Tuch Jr., S., Lee, S.W., Richardson, G. and Levin, M. (1966) Effect of Tissue Temperature and Blood Flow on Motor Nerve Conduction Velocity. JAMA, 198, 1082-1088.
[4] Chesterton, L.S., Foster, N.E. and Ross, L. (2002) Skin Temperature Response to Cryotherapy. Archives of Physical Medicine and Rehabilitation, 83, 543-549.
[5] Zachariassen, Z.E. (1991) Hypothermia and Cellular Physiology. Arctic Medical Research, 50, 13-17.
[6] Miserez, M., Alexandre, J.H., Campanelli, G.P., Corcione, F., Cuccurullo, D., Hidalgo Pascal, M., et al. (2007) The European Hernia Society Groin Hernia Classification: Simple and Easy to Remember. Hernia, 11, 113-116.
[7] Simons, M.P., Angenacker, T., Bay Nielsen, H., Bouillot, J.L., Campanelli, G.P., Conze, J., et al. (2009) European Hernia Society Guidelines on the Treatment of Inguinal Hernia in Adult Patients. Hernia, 13, 343-403.
[8] Bay Nielsen, H., Perkins, F.M. and Kehlet, H. (2001) Danish Hernia Data Base: Pain and Functional Impartment 1 Year after Inguinal Herniorraphy: A Nationwide Questionnaire Study. Annals of Surgery, 233, 1-7.
[9] Champault, G., Torcivia, A., Paolino, L., Chaddad, W., Lacaine, F. and Barrat, C. (2011) A Self Adhering Mesh for Inguinal Hernia Repair: Result of a Prospective Multicentric Study. Hernia, 15, 635-641.
[10] McGrath, B., Elgendy, H., Chung, F., Kamming, D., Curti, B. and King, S. (2004) Thirty Percent of Patients Have Moderate to Severe Pain 24 h after Ambulatory Surgery: A Survey of 5703 Patients. Canadian Journal of Anaesthesia, 51, 886-891.
[11] McHugh, G.A. and Thoms, G.M. (2002) The Management of Pain Following Day-Case Surgery. Anaesthesia, 57, 270-275.
[12] Ready, L.F. (1990) Patient Controlled Analgesia : Does It Provides More than Comfort? Canadian Journal of Anaes- thesia, 37, 719-721.
[13] Mentes, O. and Bager, M. (2009) Post Operative Pain Management after Inguinal Hernia Repair: Lornoxicain versus Tramadol. Hernia, 13, 427-430.
[14] Schun, M.J. and Faucher, L.D. (2009) A Prospective Randomized, Comparative Trial of a Cox-2 Selective Non Ster- oidal Anti-Inflammatory Drug versus Placebo in Inguinal Herniorraphy Patients. Hernia, 13, 491-497.
[15] Peterson, N. and Emanuelson, B.M. (1998) High Dose Ropivacaine Wound Infiltration for Pain Relief after Inguinal Hernia Repair. A Clinical and Pharmacokinetic Evaluation. Regional Anesthesia and Pain Medicine, 23, 189-196.
[16] Barnard, D. (1980) The Effects of Extreme Cold on Sensory Nerves. Annals of the Royal College of Surgeons of Eng- land, 62, 182-187.
[17] McMeeken, J., Murray, L. and Cocks, S. (1984) Effect of Cooling with Stimulated Ice on Skin Temperature and Nerve Conduction Velocity. Australian Journal of Physics, 30, 111-114.
[18] Wotte, J., Menick, M.A., Ingersoll, C.D. and Cordoca, M.L. (2002) Subcutaneous Adipose Tissue Thrickness Alters Cooling Time during Cryotherapy. Archives of Physical Medicine and Rehabilitation, 83, 1501-1505.
[19] Jutte, L.S., Merrick, M.A., Ingersill, C.D. and Edwards, J.E. (2001) The Relationship between Intramuscular Tem- perature, Skin Temperature and Adipose Thickness during Cryotherapy and Rewarming. Archives of Physical Medi- cine and Rehabilitation, 82, 845-850.
[20] Koc, M., Tez, M., Yoldas, O., Dizen, H. and Goemen, E. (2006) Cooling for the Reduction of Post Operative Pain: Prospective Randomized Study. Hernia, 10, 184-186.
[21] Leff, D.R., Worthley, M., Dong, V. and Bhutiani, R.P. (2007) The Effect of Local Cooling on Pain Perception during Infiltration of Local Anesthetic Agents; a Prospective Randomised Controlled Trial. Anaesthesia, 62, 677-682.
[22] Smoo, R.L.T., Oderich, G.S., Tana, C.B., Creenlie, S.M., Larson, D.R., Cragum, E.B. and Farley, D.R. (2008) Post Operative Hematoma Following Inguinal Herniorraphy: Patient Characteristics Leading the Increased Risk. Hernia, 12, 261-265.

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