Effect of Bupivacaine on Preperitoneal in Laparoscopic Total Extraperitoneal Hernioplasty: Prospective Randomized Double Blind Controlled Trial
Keywords:
Bupivacaine, preperitoneal, laparoscopic total extraperitonealhernioplasty inguinal herniaAbstract
Objectives: The aim of the study was to evaluate the analgesic effect after instillation of bupivacaine in preperitoneal space in patients undergoing unilateral laparoscopic totally extraperitoneal (TEP) hernioplasty. Methods: A total of 44 patients with unilateral reducible inguinal hernia were randomly assigned into two groups. The bupivacaine group received 40 mL of 0.25% bupivacaine, and the control group received 40 mL of normal saline, instilled into the preperitoneal space during the TEP procedure. Surgeons, anesthesiologists, and patients were blinded to the assigned treatments. A nurse assessor also blindly assessed the pain score, using the visual analogue scale (VAS) and the numeric rating scale (NRS). Postoperative pain scores were recorded at 2, 4, 8, 12, 24 hours after operation. Complications, time of first analgesia and fentanyl consumption were recorded. All operations were performed by one surgeon. Results: The age, sex, BMI, operative time did not significantly differ between the two groups. Similarly, there were no significant differences between groups with regard to postoperative pain, time to first analgesia, fentanyl consumption and complications. Conclusions: The instillation of bupivacaine in the preperitoneal space during laparoscopic totally extraperitoneal hernioplasty did not reduce postoperative pain compared with placebo. The study was registered on www.clinicaltrial.in.th with number TCTR2016712004
References
2. Kumar S, Joshi M, Chaudhary S. ùDissectalgiaû following TEP, a new entity: its recognition and treatment; results of a prospective randomized controlled trial. Hernia 2009;13:591-6.
3. Bar-Dayan A, Natour M, Bar-Zakai B, Zmora O, Shabtai M, Ayalon A, Kuriansky J. Preperitoneal bupivacaine attenuates pain following laparoscopic inguinal hernia repair. SurgEndosc 2004;18:1079-81.
4. O’Riordain DS, Kelly P, Horgan PG, Keane FB, Tanner WA. A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair. Am J Surg 1998; 176:254-7.
5. Saff GN, Marks RA, Kuroda M, Rozan JP, Hertz R. Analgesic effect of bupivacaine on extraperitoneal laparoscopic hernia repair. AnesthAnalg 1998;87:377-81.
6. Abbas MH, Hamade A, Choudhry MN, Hamza N, Nadeem R, Ammori BJ. Infiltration of wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal repair of unilateral inguinal hernias:a randomized double-blind placebocontrolled trial. Scand J Surg 2010; 99: 18-23.
7. Hon SF, Poon CM, Leong HT, Tang YC. Pre-emptive infiltration of bupivacaine in laparoscopic total extraperitoneal hernioplasty: a randomized controlled trial. Hernia 2009;13: 53-6.
8. Subwongcharoen S, Udompornmongkol V. A randomized control trial of levobupivacaine, bupivacaine versus placebo extraperitoneal infusion in totally extraperitoneal laparoscopic inguinal hernioplasty. J Surg Res 2010;162:279-83.
9. Tolver MA, Strandfelt P, Rosenberg J, Bisgaard T. Pain characteristics after laparoscopic inguinal hernia repair. SurgEndosc 2011;25:3859-64.
10. Tam KW, Liang HH, Chai CY. Outcomes of staple fixation of mesh versus non fixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Sur 2010;34:3065-74.
11. Nixon SJ, Kumar S. The totally extraperitoneal approach (TEP) to inguinal hernia repair. Surgeon 2005;3:281-7.
12. Fischer S, Troidl H, MacLean AA, Koehler L, Paul A. Prospective double-blind randomized study of a new regimen of preemptive analgesia for inguinal hernia repair: evaluation of postoperative pain course. Eur J Surg 2000;166:545-51.
13. Mixter CG 3rd, Meeker LD, Gavin TJ. Preemptive pain control in patients having laparoscopic hernia repair: a comparison of ketorolac and ibuprofen. Arch Surg 1998; 133: 432-7.
14. Barczynski M, Konturek A, Herman RM. Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 2006;20:1088-93.
15. Tong YS, Wu CC, Bai CH, Lee HC, Liang HH,Kuo LJ, et al. Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials. Hernia 2014;18:177-83.
16. Lau H, Patil NG. Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors. Surg Endosc 2004;18:92-6.
17. Paajanen H, Montgomery A, Simon T, Sheen A. Systematic review: laparoscopic treatment of long-standing groin pain in athletes. Br J Sports Med 2015; 49: 814-18.
18. Fisher S, Troidl H, MacLean AA, Koehler L, Paul A. Prospective double-blind randomized study of a new regimen of preemptive analgesia for inguinal hernia repair:evaluation of prospective pain course. Eur J Surg 2000;166:545-51.
19. Crawford Clark W, Yang JC, Tsui SU, Fu ng K, Benette Clark S. Unidimensional pain rating scales: a multidimensional affect and pain surgery(MAPS) analysis of what they really measure. Pain 2002;98:241-7.
20. Kingnorth AN, Cummings CG, Bennett DH.Local anesthesia in elective inguinal hernia repair:a randomized, doubleblind study comparing the efficacy of levobupivacaine with Racemic bupivacaine. Eur J Surg 2002;168:391-6.
21. Joris J, Thiry E, Paris P, Weerts J, Lamy M. pain after laparoscopic cholecystectomy:characteristics and effect of intraperitoneal bupivacaine. AnesthAnalg 1995;81:379-84.
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