The Effect of an Individualized Education Intervention versus Usual Care on Pain following Ambulatory Inguinal Hernia Repair

Inguinal hernia repair (IHR) is a common ambulatory surgery procedure performed in Canada, after which many patients experience moderate to severe pain. Limited research has been found that examines interventions to reduce pain following ambulatory surgery, and none specifically for patients undergoing IHR. This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following this ambulatory surgery. Participants (N= 82) were randomized to either the intervention or usual care group pre-operatively in the pre-admission clinic. The HREI included a booklet about managing pain and face-to-face session to discuss its content, and two telephone support calls (before surgery and 24 hours after surgery). The primary outcome was WORST 24 hour pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain–related interference with activities, pain quality, analgesics taken, and adverse effects at post-operative days 2 and 7. At day 2, the intervention group reported significantly lower scores for all pain intensity outcomes, including WORST 24hr pain on movement (t (df) = 4.7 (73), p< 0.001), WORST 24 hr pain at rest (t (df) = 3.8 (73), p < 0.001), pain NOW at rest (t (df) = 3.3 (73), p = 0.001) and on movement (t (df) = 3.4 (73), p = 0.001). Also on day 2, pain-related interference scores for the intervention group were lower than the usual care group but not significantly different with the bonferroini correction (t (df) = 2.1 (73), p=0.04). The intervention group took significantly fewer opioids on day 2 (t (df) = 3.0 (73), p=0.004). Although there were no differences in any of the pain or interference outcomes on day 7, 36% (n=26) of the total sample reported moderate-severe pain at day 7. Constipation was the adverse effect identified most often, by both groups, on both days 2 and 7.This intervention was effective at post-operative day 2 but revisions need to be made to the intervention to assess for outcomes over a longer period of time.Ph