Femoral hernia medical therapy: Difference between revisions
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**Patients with pre and post operative pain should be treated with NSAID as a baseline analgesia. Use of opiates such as morphine should be avoided as it can predispose to development of postoperative ileus. | **Patients with pre and post operative pain should be treated with NSAID as a 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 non aerobic gram negative organisms. | **Patients with strangulated femoral hernia should be given broad spectrum antibiotics that cover both aerobic and non aerobic gram negative organisms. | ||
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*Pharmacologic medical therapies for patients with post-operative repair of femoral hernia include:<ref name="pmid24920934">{{cite journal |vauthors=Bjurstrom MF, Nicol AL, Amid PK, Chen DC |title=Pain control following inguinal herniorrhaphy: current perspectives |journal=J Pain Res |volume=7 |issue= |pages=277–90 |year=2014 |pmid=24920934 |pmc=4045265 |doi=10.2147/JPR.S47005 |url=}}</ref><ref name="pmid23302973">{{cite journal |vauthors=Cohen SP, Galvagno SM, Plunkett A, Harris D, Kurihara C, Turabi A, Rehrig S, Buckenmaier CC, Chelly JE |title=A multicenter, randomized, controlled study evaluating preventive etanercept on postoperative pain after inguinal hernia repair |journal=Anesth. Analg. |volume=116 |issue=2 |pages=455–62 |year=2013 |pmid=23302973 |doi=10.1213/ANE.0b013e318273f71c |url=}}</ref><ref name="pmid23450576">{{cite journal |vauthors=Derry S, Sven-Rice A, Cole P, Tan T, Moore RA |title=Topical capsaicin (high concentration) for chronic neuropathic pain in adults |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD007393 |year=2013 |pmid=23450576 |doi=10.1002/14651858.CD007393.pub3 |url=}}</ref><ref name="pmid19801049">{{cite journal |vauthors=O'Connor AB, Dworkin RH |title=Treatment of neuropathic pain: an overview of recent guidelines |journal=Am. J. Med. |volume=122 |issue=10 Suppl |pages=S22–32 |year=2009 |pmid=19801049 |doi=10.1016/j.amjmed.2009.04.007 |url=}}</ref> | *Pharmacologic medical therapies for patients with post-operative repair of femoral hernia include:<ref name="pmid24920934">{{cite journal |vauthors=Bjurstrom MF, Nicol AL, Amid PK, Chen DC |title=Pain control following inguinal herniorrhaphy: current perspectives |journal=J Pain Res |volume=7 |issue= |pages=277–90 |year=2014 |pmid=24920934 |pmc=4045265 |doi=10.2147/JPR.S47005 |url=}}</ref><ref name="pmid23302973">{{cite journal |vauthors=Cohen SP, Galvagno SM, Plunkett A, Harris D, Kurihara C, Turabi A, Rehrig S, Buckenmaier CC, Chelly JE |title=A multicenter, randomized, controlled study evaluating preventive etanercept on postoperative pain after inguinal hernia repair |journal=Anesth. Analg. |volume=116 |issue=2 |pages=455–62 |year=2013 |pmid=23302973 |doi=10.1213/ANE.0b013e318273f71c |url=}}</ref><ref name="pmid23450576">{{cite journal |vauthors=Derry S, Sven-Rice A, Cole P, Tan T, Moore RA |title=Topical capsaicin (high concentration) for chronic neuropathic pain in adults |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD007393 |year=2013 |pmid=23450576 |doi=10.1002/14651858.CD007393.pub3 |url=}}</ref><ref name="pmid19801049">{{cite journal |vauthors=O'Connor AB, Dworkin RH |title=Treatment of neuropathic pain: an overview of recent guidelines |journal=Am. J. Med. |volume=122 |issue=10 Suppl |pages=S22–32 |year=2009 |pmid=19801049 |doi=10.1016/j.amjmed.2009.04.007 |url=}}</ref> | ||
** '''1. Pain reliever''' | ** '''1. Pain reliever''' | ||
***Preferred regimen: [[Non-steroidal anti-inflammatory drugs]](NSAIDs) 400mg PO q12h PRN | ***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 (1)[[: Gabapentin]] 300 mg PO q 8h PRN | ||
***Alternative regimen (2): [[Pregabalin]] 300 mg PO q 8h PRN | ***Alternative regimen (2): [[Pregabalin]] 300 mg PO q 8h PRN | ||
| Line 27: | Line 26: | ||
***Alternative regimen (4): [[Venlafaxine]] 75-225 mg PO q 24h for 1 week | ***Alternative regimen (4): [[Venlafaxine]] 75-225 mg PO q 24h for 1 week | ||
** '''2. Antibiotics''' | ** '''2. Antibiotics''' | ||
***Preferred regimen: [[Cefazolin]] 2 g IV for 7 days | ***Preferred regimen (1): [[Cefazolin]] 2 g IV for 7 days | ||
***Alternative regimen (1): [[Clindamycin]] 900 mg q 8h 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 (2): [[Vancomycin]] 15 mg/kg IV for 7-10 days | ||
Revision as of 17:20, 6 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Medical Therapy
- The definite 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 a 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 non aerobic gram negative organisms.
- Pharmacologic medical therapies for patients with post-operative repair of femoral hernia include:[1][2][3][4]
- 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 (5): Opioids 2-10 mg IV q 2-4h PRN
- Alternative regimen (6): Tramadol 50-100 mg PO q 4-6h 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
- 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
- 1. Pain reliever
References
- ↑ Bjurstrom MF, Nicol AL, Amid PK, Chen DC (2014). "Pain control following inguinal herniorrhaphy: current perspectives". J Pain Res. 7: 277–90. doi:10.2147/JPR.S47005. PMC 4045265. PMID 24920934.
- ↑ Cohen SP, Galvagno SM, Plunkett A, Harris D, Kurihara C, Turabi A, Rehrig S, Buckenmaier CC, Chelly JE (2013). "A multicenter, randomized, controlled study evaluating preventive etanercept on postoperative pain after inguinal hernia repair". Anesth. Analg. 116 (2): 455–62. doi:10.1213/ANE.0b013e318273f71c. PMID 23302973.
- ↑ Derry S, Sven-Rice A, Cole P, Tan T, Moore RA (2013). "Topical capsaicin (high concentration) for chronic neuropathic pain in adults". Cochrane Database Syst Rev (2): CD007393. doi:10.1002/14651858.CD007393.pub3. PMID 23450576.
- ↑ O'Connor AB, Dworkin RH (2009). "Treatment of neuropathic pain: an overview of recent guidelines". Am. J. Med. 122 (10 Suppl): S22–32. doi:10.1016/j.amjmed.2009.04.007. PMID 19801049.