{"id":3132,"date":"2021-05-19T13:40:08","date_gmt":"2021-05-19T10:40:08","guid":{"rendered":"https:\/\/www.esrahellas.gr\/?page_id=3132"},"modified":"2021-07-14T19:32:54","modified_gmt":"2021-07-14T16:32:54","slug":"herniorraphy","status":"publish","type":"page","link":"https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/herniorraphy\/","title":{"rendered":"Herniorraphy"},"content":{"rendered":"  <div id=\"page-header-1520211531\" class=\"page-header-wrapper\">\n  <div class=\"page-title dark featured-title\">\n\n    \n    <div class=\"page-title-inner container align-center flex-row medium-flex-wrap\" >\n              <div class=\"title-wrapper flex-col text-left medium-text-center\">\n          <h1 class=\"entry-title mb-0\">\n            Herniorraphy          <\/h1>\n        <\/div>\n                    <div class=\"title-content flex-col flex-right text-right medium-text-center\">\n        <div class=\"title-share pt-half pb-half\"><div class=\"social-icons share-icons share-row relative icon-style-fill\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/herniorraphy\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/herniorraphy\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=Herniorraphy&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fprospect-recommendations%2Fherniorraphy%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/prospect-recommendations\/herniorraphy\/&title=Herniorraphy\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div>      <\/div>\n    <\/div>\n\n     \n<style>\n#page-header-1520211531 {\n  margin-bottom: 20px;\n}\n<\/style>\n  <\/div>\n    <\/div>\n  \n<div class=\"row align-middle\"  id=\"row-1329220068\">\n\n\t<div id=\"col-639155378\" class=\"col medium-4 small-12 large-4\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\t<div class=\"img has-hover x md-x lg-x y md-y lg-y\" id=\"image_720449425\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"66\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/05\/LOGO-PROSPECT-1.jpg\" class=\"attachment-large size-large\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_720449425 {\n  width: 100%;\n}\n<\/style>\n\t<\/div>\n\t\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-466547263\" class=\"col medium-8 small-12 large-8\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<h3>Herniorraphy- PROSPECT<\/h3>\n<p>GUIDELINES &#8211; RECOMMENDATIONS<br \/>Procedure Specific Postoperative Pain Management<\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row\"  id=\"row-216144330\">\n\n\t<div id=\"col-964337434\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>GUIDELINES &#8211; RECOMMENDATIONS<\/strong><\/p>\n<p><strong>Procedure Specific Postoperative Pain Management<\/strong><\/p>\n<p><a href=\"http:\/\/www.postoppain.org\/\">www.postoppain.org<\/a><\/p>\n<p><strong>HERNIORRAPHY<\/strong><\/p>\n<p><strong>SUMMARY RECOMMENDATIONS<\/strong><\/p>\n<p>Algorithm for the Management of Postoperative Pain:\u00a0<a href=\"http:\/\/www.postoppain.org\/content.aspx?nid=64595\">click here<\/a><\/p>\n<p>Patient Advice:\u00a0<a href=\"http:\/\/www.postoppain.org\/content.aspx?nid=63722\">click here<\/a><\/p>\n<p>Patient Assessment:\u00a0<a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=31\">click here<\/a><\/p>\n<p>The recommendations of the\u00a0<strong>PROSPECT Working Group<\/strong>\u00a0are graded A \u2013 D, based on the level of evidence from the studies, which is in accordance with the Oxford Centre for Evidence &#8211; Based Medicine (<a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=9\">CEBM website accessed Dec 2003, Sackett 2000<\/a>). In the context of\u00a0<strong>PROSPECT,<\/strong>Recommendations based on procedure &#8211; specific evidence are grade A (randomiZed clinical trials), those based on transferable evidence are grade B (randomiZed clinical trials) or grade C (retrospective studies or case series) and those based on clinical practice are grade D. (<a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=10\">Click here for further information on levels of evidence and grades of recommendation<\/a>).<\/p>\n<p>\u039f\u03b9 \u03c0\u03c1\u03bf\u03c4\u03b5\u03b9\u03bd\u03cc\u03bc\u03b5\u03bd\u03b5\u03c2 \u03a3\u03c5\u03c3\u03c4\u03ac\u03c3\u03b5\u03b9\u03c2 \u03c4\u03b7\u03c2 \u039f\u03bc\u03ac\u03b4\u03b1\u03c2 \u0395\u03c1\u03b3\u03b1\u03c3\u03af\u03b1\u03c2 \u03c4\u03b7\u03c2 PROSPECT &#8220;\u03b2\u03b1\u03b8\u03bc\u03bf\u03bb\u03bf\u03b3\u03bf\u03cd\u03bd\u03c4\u03b1\u03b9&#8221; \u03b1\u03bd\u03ac\u03bb\u03bf\u03b3\u03b1 \u03bc\u03b5 \u03c4\u03bf \u03c3\u03c5\u03bd\u03bf\u03bb\u03b9\u03ba\u03cc \u03b5\u03c0\u03af\u03c0\u03b5\u03b4\u03bf \u03b5\u03c0\u03b9\u03c3\u03c4\u03b7\u03bc\u03bf\u03bd\u03b9\u03ba\u03ae\u03c2 \u03c4\u03b5\u03ba\u03bc\u03b7\u03c1\u03af\u03c9\u03c3\u03b7\u03c2 &#8211; \u03b1\u03c0\u03cc\u03b4\u03b5\u03b9\u03be\u03b7\u03c2 (\u039fverall Level of Evidence &#8211; LoE), \u03c3\u03c4\u03bf \u03bf\u03c0\u03bf\u03af\u03bf \u03ba\u03b1\u03b9 \u03c3\u03c4\u03b7\u03c1\u03af\u03b6\u03bf\u03bd\u03c4\u03b1\u03b9 \u03ba\u03b1\u03b9 \u03c4\u03bf \u03bf\u03c0\u03bf\u03af\u03bf \u03ba\u03b1\u03b8\u03bf\u03c1\u03af\u03b6\u03b5\u03c4\u03b1\u03b9 \u03b1\u03c0\u03cc \u03c4\u03b7\u03bd \u03c0\u03bf\u03b9\u03cc\u03c4\u03b7\u03c4\u03b1 \u03ba\u03b1\u03b9 \u03c4\u03b9\u03c2 \u03c0\u03b7\u03b3\u03ad\u03c2 \u03b1\u03c0\u03cc \u03c4\u03b9\u03c2 \u03bf\u03c0\u03bf\u03af\u03b5\u03c2 \u03c0\u03c1\u03bf\u03ad\u03c1\u03c7\u03bf\u03bd\u03c4\u03b1\u03b9 \u03bf\u03b9 \u03b5\u03c0\u03b9\u03c3\u03c4\u03b7\u03bc\u03bf\u03bd\u03b9\u03ba\u03ad\u03c2 \u03c0\u03bb\u03b7\u03c1\u03bf\u03c6\u03bf\u03c1\u03af\u03b5\u03c2\u00a0<a href=\"http:\/\/www.postoppain.org\/extraPage.aspx?epid=46\">(Levels of \u0395vidence and Grades of Recommendation in PROSPECT reviews from 2006)<\/a>.<\/p>\n<p>PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.The following pre-, intra- and postoperative interventions have been evaluated for the management of postoperative pain following herniorraphy:<\/p>\n<p><strong>PREOPERATIVE PERIOD<\/strong><\/p>\n<p><strong>Recommended<\/strong><\/p>\n<p><em>Systemic<\/em><\/p>\n<ul>\n<li>Conventional NSAIDs (Grade A) or COX-2 selective inhibitors (Grade A)<\/li>\n<\/ul>\n<p><em>Local Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Inguinal Nerve Block \/ Field Block \/ Infiltration, pre-operatively and \/ or intra-operatively (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Long &#8211; Acting Local Anaesthetics (Grade D)<\/li>\n<\/ul>\n<p><strong>Not Recommended<\/strong><\/p>\n<p><em>Systemic<\/em><\/p>\n<ul>\n<li>Clonidine (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Corticosteroid (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Gabapentin \/ Pregabalin (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Ketamine (Grade D)<\/li>\n<\/ul>\n<p><em>Local Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Epinephrine (Grade A), Dextran (Grade D) or Corticosteroid (Grade D) as part of a Local Anaesthetic Solution<\/li>\n<\/ul>\n<ul>\n<li>Paravertebral Nerve Block (Grade D)<\/li>\n<\/ul>\n<p><em>Other Local Analgesics<\/em><\/p>\n<ul>\n<li>Wound Infiltration with Clonidine (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Wound Infiltration with Conventional NSAIDs (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Topical Conventional NSAIDs (Grade D)<\/li>\n<\/ul>\n<p><strong>INTRAOPERATIVE PERIOD<\/strong><\/p>\n<p><strong>Recommended<\/strong><\/p>\n<p><em>Local Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Inguinal Nerve Block \/ Field Block \/ Infiltration, pre-operatively and \/ or intra-operatively (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Long &#8211; Acting Local Anaesthetics (Grade D)<\/li>\n<\/ul>\n<p><em>Operative Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Local Anaesthesia \u00b1 Sedation OR General Anaesthesia in combination with Local Anaesthetic Techniques (Inguinal Nerve Block \/ Field Block \/ Infiltration) (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Long &#8211; Acting Local Anaesthetics (Grade D)<\/li>\n<\/ul>\n<p><em>Operative Techniques<\/em><\/p>\n<ul>\n<li>Open or Laparoscopic Surgery (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Mesh Techniques (Grade A) \u2013 No Recommendations for one particular open Mesh Technique, Prosthesis Type or Mesh Fixation Technique over another due to limited available Pain Data<\/li>\n<\/ul>\n<p><strong>Not Recommended<\/strong><\/p>\n<p><em>Systemic<\/em><\/p>\n<ul>\n<li>Clonidine (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Gabapentin \/ Pregabalin (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Ketamine (Grade D)<\/li>\n<\/ul>\n<p><em>Local Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Epinephrine (Grade A), Dextran (Grade D) or Corticosteroid (Grade D) as part of a Local Anaesthetic Solution<\/li>\n<\/ul>\n<ul>\n<li>Local Anaesthetic Instillation (no needles) at closure (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Extraperitoneal Instillation of Local Anaesthetic during Laparoscopic Surgery (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Paravertebral Nerve Block (Grade D)<\/li>\n<\/ul>\n<p><em>Other Local Analgesics<\/em><\/p>\n<ul>\n<li>Wound Infiltration with Clonidine (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Wound Infiltration with Conventional NSAIDs (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Wound Infiltration with Strong Opioid (Grade A)<\/li>\n<\/ul>\n<p><em>Operative Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Epidural Anaesthesia (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Spinal Anaesthesia (Grade D)<\/li>\n<\/ul>\n<p><em>Operative Techniques<\/em><\/p>\n<ul>\n<li>Open Non &#8211; Mesh Surgery (Grade A)<\/li>\n<\/ul>\n<p><em>Nerve Section \/ Cryoanalgesia Techniques<\/em><\/p>\n<ul>\n<li>Surgical Division of the Ilioinguinal Nerve (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Cryoanalgesia (Grade A)<\/li>\n<\/ul>\n<p><strong>POSTOPERATIVE PERIOD<\/strong><\/p>\n<p><strong>Recommended<\/strong><\/p>\n<p><em>Systemic<\/em><\/p>\n<ul>\n<li>Conventional NSAIDs (grade A) or COX-2 Selective Inhibitors (grade A)<\/li>\n<\/ul>\n<ul>\n<li>Paracetamol, for routine pain therapy in combination with conventional NSAIDs \/ COX-2 selective inhibitors (Grade B)<\/li>\n<\/ul>\n<ul>\n<li>Weak Opioids for moderate intensity pain when conventional NSAIDs \/ COX-2 selective inhibitors plus paracetamol are not sufficient or are contraindicated (Grade B)<\/li>\n<\/ul>\n<ul>\n<li>Strong Opioids as rescue analgesia only (for high &#8211; intensity pain), in addition to non &#8211; opioid analgesia (Grade B)<\/li>\n<\/ul>\n<p><strong>Not Recommended<\/strong><\/p>\n<p><em>Systemic<\/em><\/p>\n<ul>\n<li>Gabapentin \/ Pregabalin (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Ketamine (Grade D)<\/li>\n<\/ul>\n<p><em>Local Anaesthetic Techniques<\/em><\/p>\n<ul>\n<li>Continuous Infusion with Local Anaesthetic by a Catheter in the Wound (Grade D)<\/li>\n<\/ul>\n<ul>\n<li>Single \/ Repeat Dose of Local Anaesthetic by a Catheter in the Wound (Grade A)<\/li>\n<\/ul>\n<ul>\n<li>Postoperative Subcutaneous Infiltration with Local Anaesthetic (Grade D)<\/li>\n<\/ul>\n<p><em>Non &#8211; Pharmacological Techniques<\/em><\/p>\n<ul>\n<li>TENS (Grade A)<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row row-collapse row-solid\"  id=\"row-813256800\">\n\n\t<div id=\"col-1087705882\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>HERNIORRAPHY<\/strong><\/p>\n<p><strong>OVERALL PROSPECT RECOMMENDATIONS<\/strong><\/p>\n<p><strong><span>RECOMMENDATIONS<\/span><\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1126033162\" class=\"col medium-3 small-12 large-3\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>Preoperative Intraoperative<\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-617937826\" class=\"col medium-9 small-12 large-9\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<ul>\n<li><strong>Local Anaesthesia \u00b1 Sedation<\/strong><br \/>OR \u00a0<strong>General Anaesthesia in Combination with Local Anaesthetic Techniques<\/strong><br \/>(Inguinal Nerve Block \/ Field Block \/ Infiltration)<\/li>\n<li><strong>Long &#8211; Acting Local Anaesthetics<\/strong><br \/>in preference to Short &#8211; Acting Local Anaesthetics<\/li>\n<li><strong>Open or Laparoscopic Surgery<\/strong><br \/>depending on factors other than\u00a0<strong>Postoperative Pain<\/strong><\/li>\n<li><strong>Mesh Techniques<\/strong>\u00a0in preference to Non &#8211; Mesh Techniques<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-807921015\" class=\"col medium-3 small-12 large-3\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>Postoperative 0\u20136 hours (including PACU)<\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-815246194\" class=\"col medium-9 small-12 large-9\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>For Postoperative Analgesia in addition to that provided by Intraoperative Local Anaesthetics<\/strong><\/p>\n<ul>\n<li><strong>Base Medication<\/strong><br \/>Conventional NSAIDs \/ COX-2 Selective Inhibitors<br \/>(use Weak Opioids when these drugs are contraindicated)<br \/>Combine with Paracetamol<\/li>\n<li>Add <strong>Weak Opioid<\/strong>\u00a0when VAS > 30 and < 50* <\/li>\n<li>Add <strong>Strong Opioid<\/strong>\u00a0when VAS > or = 50*<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-338155533\" class=\"col medium-3 small-12 large-3\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>Postoperative Beyond 6 h<\/strong><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-421059560\" class=\"col medium-9 small-12 large-9\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<ul>\n<li><strong>Continue Base Medication<\/strong><br \/>Conventional NSAIDs or COX-2 Selective Inhibitors<br \/>(use Weak Opioids when these drugs are contraindicated)<br \/>Combine with Paracetamol<\/li>\n<li>Add <strong>Weak Opioid<\/strong>\u00a0when VAS > 30 and < 50*<\/li>\n<li>Add <strong>Strong Opioid<\/strong>\u00a0when VAS > or = 50*<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1999012583\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p>*<br \/>VAS > or = 50, on a scale of 1 \u2013 100 mm = high &#8211; intensity pain<br \/>VAS > 30 or < 50, on a scale of 1 \u2013 100 mm = moderate - intensity pain<br \/>VAS < or = 30, on a scale of 1 \u2013 100 mm = low - intensity pain\u00a0<\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-872319180\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<p><strong>NOT RECOMMENDED<\/strong><\/p>\n<ul class=\"multi-column-gs\">\n<li>Preoperative IV Opioids<\/li>\n<li>IV Magnesium<\/li>\n<li>Spinal Anaesthesia<\/li>\n<li>Epidural Anaesthesia<\/li>\n<li>Systemic Clonidine, Corticosteroid, Gabapentin\/Pregabalin, Ketamine<\/li>\n<li>Addition of Clonidine, Ketorolac, Ketamine to Anaesthetic Solution<\/li>\n<li>Epinephrine as part of Local Anaesthetic Solution<\/li>\n<li>Intraoperative Wound Instillation with LAs<\/li>\n<li>Paravertebral Nerve Block<\/li>\n<li>Postoperative Single \/ Repeat Wound Injection of LAs<\/li>\n<li>Postoperative Continuous Wound Infusion with LAs<\/li>\n<li>Wound Infiltration with Conventional NSAIDs, Clonidine, Weak \/ Strong Opioids<\/li>\n<li>Topical Conventional NSAIDs<\/li>\n<li>Nerve Section, Cryoanalgesia<\/li>\n<li>Warming Techniques \/ TENS<\/li>\n<li>Bowel Preparation<\/li>\n<\/ul>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n\t<div id=\"gap-1164679281\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1164679281 {\n  padding-top: 30px;\n}\n<\/style>\n\t<\/div>\n\t\n<div class=\"social-icons share-icons share-row relative full-width text-center\" ><a 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