A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair

O’Riordain, Diarmuid S; Kelly, Paul; Horgan, Paul G; Keane, Frank B.V; Tanner, W.Arthur

« Previous Next »The American Journal of Surgery
Volume 176, Issue 3 , Pages 254-257, September 1998

A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair

Presented to the Surgical Research Society, Nottingham, United Kingdom, July 1997.

Diarmuid S O’Riordain, MD (FRCSI)
- Department of Surgery, Trinity College Dublin, Meath and Adelaide Hospitals, Dublin, Ireland
- Requests for reprints should be addressed to Diarmuid O’Riordain, MD, FRCSI, Department of Surgery, Clinical Sciences Building, St James’s University Hospital, Leeds LS9 7TF United Kingdom
Paul Kelly, MB (FRCSI)
- Department of Surgery, Trinity College Dublin, Meath and Adelaide Hospitals, Dublin, Ireland
Paul G Horgan, PhD (FRCSI)
- Department of Surgery, Trinity College Dublin, Meath and Adelaide Hospitals, Dublin, Ireland
Frank B.V Keane, MD (FRCSI)
- Department of Surgery, Trinity College Dublin, Meath and Adelaide Hospitals, Dublin, Ireland
W.Arthur Tanner, MD (FRCSI)
- Department of Surgery, Trinity College Dublin, Meath and Adelaide Hospitals, Dublin, Ireland

Received 20 January 1998; received in revised form 15 May 1998; accepted 15 May 1998.

Abstract

Background: The limited space developed in totally extraperitoneal laparoscopic inguinal hernia repair (TEP) provides the ideal setting for direct instillation of local anesthetic. This study evaluates the efficacy of extraperitoneal bupivacaine analgesia in patients undergoing day-care TEP.

Methods: Fifty-six consecutive patients were randomized to intraoperative extraperitoneal instillation of bupivacaine (n = 29) or normal saline control (n = 27). Patients were blindly assessed on discharge from hospital, at 24 hours, 1 week, and 1 month postoperatively.

Results: Compared with controls, patients treated with bupivacaine had lower median (range) visual analogue pain scores on discharge (1.5 [0 to 5.9] versus 3.7 [0.2 to 6.9], P = 0.03), and were more frequently pain free (54% versus 31%, P = 0.078). Although this difference had gone by 24 hours, the bupivacaine group continued to recover faster; stopping analgesia earlier (2 [0 to 7] days versus 3 [0 to 21] days, P = 0.01) and returning to full activity earlier (2.5 [1 to 14] days versus 5 [1 to 21] days, P = 0.013). Of bupivacaine patients 100% were completely satisfied with the procedure compared with 81% of controls (P = 0.02).

Conclusion: Extraperitoneal bupivacaine minimizes pain following day-care TEP repair, facilitates recovery, and increases patient satisfaction. Benefits persist beyond the pharmacological action of bupivacaine.