Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: a prospective randomized trial

Charles F Bellows, David H Berger, Charles F Bellows, David H Berger

Abstract

Background: Postoperative pain control after laparoscopic ventral hernia repairs remains a significant clinical problem. We sought to determine the pain-sparing efficacy of local anesthetic infiltrated into the abdominal wall wounds created by the placement of transabdominal sutures used to ensure adequate fixation of the mesh during laparoscopic ventral hernia repair.

Methods: Patients undergoing laparoscopic ventral/incisional hernia repair were randomized to receive local anesthesia (0.25% bupivacaine with epinephrine) into all layers of the abdominal wall to the level of the parietal peritoneum at suture fixation sites immediately before suture placement (Group I; n=9) or no local anesthesia (Group II, control; n=9). The anesthetic technique was otherwise standard for both groups. Postoperatively, pain was assessed with a 10-point visual analogue scale (VAS) at 1, 2, 4, and 24 hours. Analgesic use and hospital stay were also recorded.

Results: The groups were similar in age, sex, ASA, and size of hernia defect. The operative times were not statistically different between the 2 groups (Group I, 118+/-12 minutes; Group II, 144+/-21 minutes; P>0.05). Group I had a statistically significant decrease in the pain scores compared with Group II (2.2+/-0.8 vs. 6.4+/-0.9; P<0.05) at 1 hour postoperatively. At 2 and 4 hours, the mean pain scores were decreased but not statistically different. Similarly, the cumulative consumption of pain medication at 1, 2, and 4 hours postoperatively as well as the average hospital stay (Group I, 2.0+/-0.4; Group II, 2.4+/-0.4 days) were lower but not statistically significant in patients in Group I compared with those in Group II.

Conclusion: This small, randomized study demonstrates that infiltration of suture fixation sites is effective in reducing early postoperative pain but not analgesic consumption following laparoscopic incisional and ventral hernia repairs. A larger study is required to investigate this strategy on later postoperative pain and hospital stay.

Figures

Figure 1.
Figure 1.
Cumulative narcotic use after laparoscopic ventral hernia repairs in Group I (bupivacaine; closed diamonds) and Group II (control; open triangles). The cumulative dose is expressed in milligrams. The difference between the groups at all time points was not statistically significant (P>0.05; n=9 in each group).

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