197: Duloxetine Prevent Chronic Postsurgical Pain After Inguinal Hernia Repair in Patients at High Risk?

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Pharmacological treatments

Background and Aims: We aim to conduct a randomized placebo-controlled trial comparing the usefulness of a medical strategy for preventing the development of chronic postsurgical pain (CPSP) after inguinal open hernia repair. This is a continuation of our previous studies in which we established a presurgical model (GENDOLCAT) to identify patients at high risk for CPSP (1). The risk model is based on six clinical predictors: surgical procedure, age, physical health (Short Form Health Survey-12 [SF-12]), mental health (SF-12), preoperative pain in the surgical field, and preoperative pain in another area; and was then externally validated after the development study (2).

Methods: Prospective, multicenter, double-blind randomized controlled trial. We use GENDOLCAT risk model to identify patients scheduled for inguinal open hernia repair, in 14 Spanish hospitals, who have at least a 16% risk for CPSP. Patients will be randomized to 2 groups (147 in each) to receive 30 mg/d of duloxetine for 2 weeks prior to surgery and 1 week after surgery or placebo. Patients who report pain 3 months after surgery will be scheduled for an appointment at their hospital's pain clinic to confirm the CPSP diagnosis and to assess pain intensity, characteristics, and degree of interference with daily living.

Results: So far, 112 patients have been recruited, of whom 64 have completed follow-up. We believe that by the date of this congress, we could have the final results for 150 patients.

Conclusions: The expected impacts of the findings are of 2 types: 1) we expect to be able to recommend treatments that can prevent CPSP, a complication that has repercussions on public health and our national health services, and 2) we will further demonstrate the usefulness of the risk model, encouraging further research into preventive therapies to apply in individuals at high risk of developing CPSP after other types of surgery.

References: 1. Montes A. Genetic and Clinical Factors Associated with Chronic Postsurgical Pain after Hernia Repair, Hysterectomy, and Thoracotomy. A Two-year Multicenter Cohort Study. Anesthesiology 2015. PMID: 25985024.
2. Montes A. Presurgical risk model for Chronic Postsurgical Pain based on 6 clinical predictors: a prospective external validation. Pain 2020. PMID: 32541391.

Presenting Author: Antonio Montes
Submitting Author: ANTONIO MONTES

Senior Author: Antonio Montes

IASP 2026 Global Year theme of Neuropathic Pain: No

• David Bande: MD - Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Hospital del Mar. Barcelona. Spain (2) IMIM (Hospital del Mar Medical Research Institute). Barcelona.
• Olga Comps: MD - Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Hospital del Mar. Barcelona. Spain (2) IMIM (Hospital del Mar Medical Research Institute). Barcelona.
• Luis Molto: MD, PhD - Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Hospital del Mar. Barcelona. Spain (2) IMIM (Hospital del Mar Medical Research Institute). Barcelona.