Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment

Outcomes of quadratus lumborum blocks for pain control after open abdominal wall reconstruction: a single institution retrospective analysis

INTRODUCTION

Abdominal wall reconstruction (AWR) is associated with significant post-operative pain for which there is no standardized treatment regimen. Quadratus lumborum (QL) blocks have not been studied in open ventral hernia repair. This study reviews our institution's experience with QL blocks in open AWR.

METHODS

A retrospective review from October 2022 to October 2024 was completed. Patients undergoing elective, open abdominal wall reconstruction who received pre-operative QL blocks were included. Variables analyzed included patient demographics, comorbidities, operative technique, mesh type, daily opioid consumption reported as morphine milliequivalents (MMEs), and length of stay. The primary outcome was MMEs consumed in the first 24 h after surgery.

RESULTS

There were 102 patients included in the study. The first 24-hour median opioid MME consumption was 8 (IQR 0-67.5). The median MMEs peaked on day 2 at 47 (IQR 30-114) and then trended down each day. The median length of stay was 4.3 days (IQR 4.1-5.9). There were no complications related to the QL block procedure.

CONCLUSION

This is the first study to report on post-operative opioid consumption in patients receiving a quadratus lumborum block prior to open ventral hernia repair. We found patients consumed minimal MMEs in the first 24 h after surgery suggesting that QL blocks may provide analgesic benefit in abdominal wall reconstruction.

Primary ventral and incisional hernias: comprehensive review

BACKGROUND

Primary ventral and incisional hernias are frequent conditions that impact the quality of life of patients. Surgical techniques for ventral hernia repair are constantly evolving and abdominal wall surgery has turned into a highly specialized field.

METHODS

This is a narrative review of the most recent and relevant literature on the treatment of primary ventral and incisional hernias performed by eight experts in ventral hernia surgery from across the world and includes review of classification systems, preoperative measures, descriptions of surgical techniques, and postoperative complications.

RESULTS

Repairs of primary ventral and incisional hernias range from simple open procedures in healthy patients with small defects to complex procedures when patients are co-morbid and have large defects. Optimizing patient-related risk factors before surgery is important to decrease complication rates. Surgical repair techniques from open repairs to minimally invasive procedures are described in detail in the review. Minimally invasive techniques are technically more demanding and take longer, but decrease the risk of surgical-site infections and shorten the duration of hospital stay.

CONCLUSION

Treatment of ventral hernias aims to improve the quality of life of patients. The risks and benefits of procedures should be weighed against patients' complaints and co-morbidities. Optimizing patient-related risk factors before surgery is important.