A randomized, double-blinded, placebo-controlled trial of the effects of infusing local analgesia on post-operative pain during laparoscopic inguinal hernia repair.
Matthew Rade1, Anusha Jayaram2, Richard Birkett1, Heather Ford1, Desmond Birkett1, Dmitry Nepomnayshy1
1Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States, 2Tufts University School of Medicine, Boston, Massachusetts, United States
1. Objective: To assess the effect of local anesthetic instilled into the preperitoneal space during laparoscopic inguinal hernia repair on postoperative pain.
2. Design: Prospective, randomized, double-blind, placebo-controlled study with immediate and 2-week postoperative follow-up.
3. Setting: Single-center tertiary referral teaching hospital.
4. Patients: Recruited 77 patients with unilateral, non-recurrent inguinal herniae who underwent laparoscopic TEP inguinal herniorrhaphy, (7 patients withdrew). Exclusion criteria included patients less than 18 years old, an ASA of 3 or more, conversion to open operation, history of chronic pain or allergy to anesthetics.
5. Interventions: All received unilateral laparoscopic TEP inguinal hernia repair with standardized subcutaneous port-site local anesthetic. Control patients had 10cc of 0.9% saline instilled into preperitoneal space while treatment group received 10cc 0.5% bupivacaine without epinephrine.
6. Main Outcome Measures: The primary outcome was reduction in patient-reported postoperative pain (obtained via 1-10 visual analog scale). Secondary outcomes include time spent in the PACU, and narcotic usage postoperatively.
7. Results: A total of 70 patients enrolled (mean age [SD] 57 years [13.8]), 35 randomized into each group. Demographics between the groups were similar. No differences were found in postoperative pain between the control and treatment groups at 1 hour (mean [SD] of 3.15 [2.5] vs 3.21 [2.9]; p=0.92), 2 hours (3.39 [1.55] vs 2.74 [1.85] p=0.18), or 1 day (4.79 [2.19] vs 4.39 [2.37]; p=0.13) postoperatively. Likewise, no significant differences were observed in usage of narcotic pain medication, as 17 control patients (50%) and 16 (46%) treatment patients required narcotics within 2 hours after surgery (p=0.72).
8. Conclusions: Instilling local anesthetic into the pre-peritoneal space during laparoscopic TEP inguinal hernia repair did not result in statistically significant difference in postoperative pain.
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