Overall PROSPECT Recommendations

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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