A Randomized Controlled Study Evaluating Pre-operative Etanercept on the Severity of Postoperative Pain After Inguinal Hernia Surgery.
Overview
- Phase
- Not Applicable
- Intervention
- Etanercept
- Conditions
- Inguinal Hernia
- Sponsor
- Johns Hopkins University
- Enrollment
- 77
- Locations
- 1
- Primary Endpoint
- Numerical Rating Scale Pain Score
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
Inguinal hernia repair is one of the most frequently performed operations in young men. Persistent pain after inguinal surgery represents a significant cause of disability, occurring in between 15%-35% of cases. In a majority of these patients, their groin pain persisted after a previous hernia repair. The main type of chronic postsurgical pain is neuropathic, caused by injured nerves. One of the principal components in the pathophysiology of postsurgical pain is cytokines, specifically tumor necrosis factor (TNF). In animal studies, injecting TNF inhibitors before nerve injury can reduce pain behaviors and neuropathology. Finding a way to reduce the incidence of postsurgical pain after hernia repair could enhance function, and reduce the need for opioids and other analgesics. The investigators intend to conduct the first randomized, controlled study evaluating whether preemptive administration of a tumor necrosis inhibitor can reduce postoperative pain and opioid consumption after hernia repair. This is important because the degree and intensity of postsurgical pain is a major predictor for the development of chronic postsurgical pain.
Detailed Description
76 patients with an inguinal hernia scheduled for surgical repair will be randomized in a 1:1 ratio to receive either subcutaneous etanercept or saline before skin incision. The study will be double-blind (i.e. neither the surgeon, anesthesiologist, nor the person administering the injection will know which group they were assigned to). Group I will receive 50 mg of subcutaneous etanercept mixed in 1 ml sterile water 90-120" before skin incision. Group II will receive 1 ml of sterile water 90-120" before skin incision. The anesthesia and surgical procedures will be standardized. For the next 24 hours, patients will keep a q4 hour pain diary recording their average pain on a 0-10 numerical rating scale. They will also record the number of Percocet tablets they took. All patients will be seen 1 month after their surgery, where their average pain score, work status, and analgesic intake (if any) will be recorded. Patients will then be followed with a telephone follow-up 3, 6 and 12-months post-procedure, where the same variables will be recorded.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Demonstrable hernia evident using ultrasound, computed tomography, or on physical exam.
- •Pt scheduled for unilateral inguinal hernia repair.
- •Symptoms present for \< 6 months.
Exclusion Criteria
- •Non-elective surgery.
- •Previous hernia repair at the same site, or surgery near the site of the hernia.
- •Demyelinating neurological disease.
- •Current or recent (\< 6 years) history of substance abuse.
- •Pregnancy, which will be ruled out by a urine pregnancy test in women of childbearing age.
- •Pre-existing untreated psychiatric condition that could preclude an optimal treatment response (e.g. untreated posttraumatic stress disorder).
- •Unstable medical condition (e.g. unstable angina or congestive heart failure or severe).
- •Rheumatoid arthritis, or other systemic conditions that might respond to TNF inhibitors.
- •Pt is immunosuppressed or is taking other drugs (e.g. corticosteroids) that might suppress the immune system.
- •Systemic infection.
Arms & Interventions
1
Etanercept 50 mg preoperatively
Intervention: Etanercept
2
Subcutaneous saline preoperatively
Intervention: Saline
Outcomes
Primary Outcomes
Numerical Rating Scale Pain Score
Time Frame: 24 hours
0-10 pain score through 24-hours post-surgery. 0 is no pain and 10 is the worse pain imaginable. The primary outcome reported measure is the average of 4 scores, each comprised of 6-hour time intervals during the 24hour period.
Secondary Outcomes
- Chronic Post-surgical Pain(Up to 12 months)
- Analgesic Usage(24 hours)