Femoral hernia medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Femoral hernia}} | {{Femoral hernia}} | ||
{{CMG}} {{AE}} | {{CMG}};{{AE}} {{MKA}} | ||
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==Overview== | ==Overview== | ||
The definitive [[therapy]] for femoral hernia is [[surgery]]. Medical [[therapy]] is given to patients in preparation for [[surgery]] and postoperatively to [[Prevention (medical)|prevent]] complications. Patients with pre and post operative [[pain]] should be treated with [[NSAIDs|non-streoidal anti-inflammatory drugs]] ([[Non-steroidal anti-inflammatory drug|NSAID]]<nowiki/>s) as baseline [[analgesia]]. Patients with [[Strangulated hernia|strangulated]] femoral hernia should be given broad spectrum [[antibiotics]] that cover both [[Aerobic bacteria|aerobic]] and [[Anaerobic bacteria|anaerobic]] [[Gram-negative bacteria|gram negative organisms]]. | |||
==Medical Therapy== | |||
The definitive therapy for femoral hernia is [[surgery]]. Medical therapy is given to patients in preparation for [[surgery]] and postoperatively to prevent complications. | |||
*Medical therapy is given as supportive care and treatment is primarily aimed at ameliorating the most common postoperative complications such as [[pain]], [[fever]], [[nausea and vomiting]], and in a few cases [[ileus]]. Patients with pre and post operative [[pain]] should be treated with [[Non-steroidal anti-inflammatory drug|NSAID]] as baseline [[analgesia]]. Use of [[opiates]] such as [[morphine]] should be avoided as it can predispose to development of postoperative [[ileus]]. Patients with [[Strangulated hernia|strangulated]] femoral hernia should be given broad spectrum [[antibiotics]] that cover both [[aerobic]] and [[Anaerobic organism|anaerobic]] [[Gram-negative bacteria|gram negative organisms]].<ref name="pmid28121028">{{cite journal |vauthors=Boonchan T, Wilasrusmee C, McEvoy M, Attia J, Thakkinstian A |title=Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery |journal=Br J Surg |volume=104 |issue=2 |pages=e106–e117 |year=2017 |pmid=28121028 |pmc=5299528 |doi=10.1002/bjs.10441 |url=}}</ref><ref name="pmid27819748">{{cite journal |vauthors=Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML |title=Topical antibiotics for preventing surgical site infection in wounds healing by primary intention |journal=Cochrane Database Syst Rev |volume=11 |issue= |pages=CD011426 |year=2016 |pmid=27819748 |doi=10.1002/14651858.CD011426.pub2 |url=}}</ref><ref name="pmid22983696">{{cite journal |vauthors=Kalles V, Mekras A, Mekras D, Papapanagiotou I, Al-Harethee W, Sotiropoulos G, Liakou P, Kastania A, Piperos T, Mariolis-Sapsakos T |title=De Garengeot's hernia: a comprehensive review |journal=Hernia |volume=17 |issue=2 |pages=177–82 |year=2013 |pmid=22983696 |doi=10.1007/s10029-012-0993-3 |url=}}</ref><ref name="pmid16283073">{{cite journal |vauthors=Alimoglu O, Kaya B, Okan I, Dasiran F, Guzey D, Bas G, Sahin M |title=Femoral hernia: a review of 83 cases |journal=Hernia |volume=10 |issue=1 |pages=70–3 |year=2006 |pmid=16283073 |doi=10.1007/s10029-005-0045-3 |url=}}</ref> | |||
*Pharmacologic medical therapies for patients with post-operative repair of femoral hernia include: | |||
** '''1. Pain reliever''' | |||
***Preferred regimen (1): [[Non-steroidal anti-inflammatory drugs]][[Non-steroidal anti-inflammatory drug|(NSAIDs)]] 400mg PO q12h PRN | |||
***Alternative regimen (1)[[: Gabapentin]] 300 mg PO q 8h PRN | |||
***Alternative regimen (2): [[Pregabalin]] 300 mg PO q 8h PRN | |||
***Alternative regimen (3): [[Duloxetine]] 30 mg PO q 24h for 1 week | |||
***Alternative regimen (4): [[Venlafaxine]] 75-225 mg PO q 24h for 1 week | |||
***Alternative regimen (5): [[Opioids]] 2-10 mg IV q 2-4h PRN | |||
***Alternative regimen (6): [[Tramadol]] 50-100 mg PO q 4-6h PRN | |||
** '''2. Antibiotics''' | |||
***Preferred regimen (1): [[Cefazolin]] 2 g IV for 7 days | |||
***Alternative regimen (1): [[Clindamycin]] 900 mg q 8h for 7 days | |||
***Alternative regimen (2): [[Vancomycin]] 15 mg/kg IV for 7-10 days | |||
***Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV for 10 days | |||
***Alternative regimen (4): [[levofloxacin]] 500 mg IV for 5 days | |||
***Alternative regimen (5): [[Aztreonam]] 2 g IV q 6-8h (not to exceed 8g/day) | |||
**'''3. Topical medications''' | |||
***[[Lidocaine]] | |||
***[[Capsaicin]]’s [[analgesic]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category: | [[Category:Surgery]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Up-To-Date]] | |||
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[[Category:Emergency medicine]] | |||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} | ||
Latest revision as of 17:21, 15 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
The definitive therapy for femoral hernia is surgery. Medical therapy is given to patients in preparation for surgery and postoperatively to prevent complications. Patients with pre and post operative pain should be treated with non-streoidal anti-inflammatory drugs (NSAIDs) as baseline analgesia. Patients with strangulated femoral hernia should be given broad spectrum antibiotics that cover both aerobic and anaerobic gram negative organisms.
Medical Therapy
The definitive therapy for femoral hernia is surgery. Medical therapy is given to patients in preparation for surgery and postoperatively to prevent complications.
- Medical therapy is given as supportive care and treatment is primarily aimed at ameliorating the most common postoperative complications such as pain, fever, nausea and vomiting, and in a few cases ileus. Patients with pre and post operative pain should be treated with NSAID as baseline analgesia. Use of opiates such as morphine should be avoided as it can predispose to development of postoperative ileus. Patients with strangulated femoral hernia should be given broad spectrum antibiotics that cover both aerobic and anaerobic gram negative organisms.[1][2][3][4]
- Pharmacologic medical therapies for patients with post-operative repair of femoral hernia include:
- 1. Pain reliever
- Preferred regimen (1): Non-steroidal anti-inflammatory drugs(NSAIDs) 400mg PO q12h PRN
- Alternative regimen (1) Gabapentin 300 mg PO q 8h PRN
- Alternative regimen (2): Pregabalin 300 mg PO q 8h PRN
- Alternative regimen (3): Duloxetine 30 mg PO q 24h for 1 week
- Alternative regimen (4): Venlafaxine 75-225 mg PO q 24h for 1 week
- Alternative regimen (5): Opioids 2-10 mg IV q 2-4h PRN
- Alternative regimen (6): Tramadol 50-100 mg PO q 4-6h PRN
- 1. Pain reliever
- 2. Antibiotics
- Preferred regimen (1): Cefazolin 2 g IV for 7 days
- Alternative regimen (1): Clindamycin 900 mg q 8h for 7 days
- Alternative regimen (2): Vancomycin 15 mg/kg IV for 7-10 days
- Alternative regimen (3): Ciprofloxacin 400 mg IV for 10 days
- Alternative regimen (4): levofloxacin 500 mg IV for 5 days
- Alternative regimen (5): Aztreonam 2 g IV q 6-8h (not to exceed 8g/day)
- 3. Topical medications
- 2. Antibiotics
References
- ↑ Boonchan T, Wilasrusmee C, McEvoy M, Attia J, Thakkinstian A (2017). "Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery". Br J Surg. 104 (2): e106–e117. doi:10.1002/bjs.10441. PMC 5299528. PMID 28121028.
- ↑ Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML (2016). "Topical antibiotics for preventing surgical site infection in wounds healing by primary intention". Cochrane Database Syst Rev. 11: CD011426. doi:10.1002/14651858.CD011426.pub2. PMID 27819748.
- ↑ Kalles V, Mekras A, Mekras D, Papapanagiotou I, Al-Harethee W, Sotiropoulos G, Liakou P, Kastania A, Piperos T, Mariolis-Sapsakos T (2013). "De Garengeot's hernia: a comprehensive review". Hernia. 17 (2): 177–82. doi:10.1007/s10029-012-0993-3. PMID 22983696.
- ↑ Alimoglu O, Kaya B, Okan I, Dasiran F, Guzey D, Bas G, Sahin M (2006). "Femoral hernia: a review of 83 cases". Hernia. 10 (1): 70–3. doi:10.1007/s10029-005-0045-3. PMID 16283073.