Skip to main content

Advertisement

SpringerLink
Log in

Pre-peritoneal local anaesthetic does not reduce post-operative pain in laparoscopic total extra-peritoneal inguinal hernia repair: double-blinded randomized controlled trial

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

A Comment to this article was published on 22 January 2018

Abstract

Purpose

Laparoscopic total extra-peritoneal hernia repair (TEP) is associated with less post-operative pain and earlier return to normal activity compared to open hernia repair (OHP). Despite this, post-operative pain remains a major issue. The aim of this double-blinded randomized controlled trial was to identify whether the instillation of local anaesthetic in the pre-peritoneal space improves pain scores following TEP.

Methods

One hundred patients undergoing laparoscopic total pre-peritoneal hernia repair (TEP) between the years of 2009–2014 were included. Patients were randomly assigned to receive either 20 mL of normal saline or 0.25% bupivacaine with adrenaline. Visual analogue scores (VAS 0–10) were recorded post-operatively at the 4 h, 1 day, 2 weeks, and 6 week mark. Secondary endpoints included complications, time to discharge, and return to normal activity.

Results

51 patients were allocated to the local group. 49 patients were allocated to the placebo group. The baseline characteristics and demographics of patients in both groups were comparable. Patients in the local group had similar VAS scores compared to the placebo group at both 4 h (1.1 vs. 1.4, respectively; p = 0.19) and 24 h (2.1 vs. 2.3; p = 0.63). No statistically significant difference noted in other primary and secondary outcomes.

Conclusion

Although the concept of pre-peritoneal local anaesthetic instillation following laparoscopic TEP is attractive, this appropriately powered study has failed to show any advantage in pain scores at 4 and 24 h. The pain scores recorded, however, were remarkably low in both groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. McCormack K, Scott NW, Go PM, Ross S, Grant AM, Collaboration EUHT (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD001785. doi:10.1002/14651858.CD001785

  2. Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess (Winchester, England) 9(14):1–203 (iii–iv)

    Google Scholar 

  3. Bracale U, Melillo P, Pignata G, Di Salvo E, Rovani M, Merola G, Pecchia L (2012) Which is the best laparoscopic approach for inguinal hernia repair: TEP or TAPP? A systematic review of the literature with a network meta-analysis. Surg Endosc 26(12):3355–3366. doi:10.1007/s00464-012-2382-5

    Article  PubMed  Google Scholar 

  4. Wake BL, McCormack K, Fraser C, Vale L, Perez J, Grant AM (2005) Transabdominal pre-peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair. Cochrane Database Syst Rev (1):CD004703. doi:10.1002/14651858.CD004703.pub2

  5. Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26(3):639–649. doi:10.1007/s00464-011-1931-7

    Article  PubMed  Google Scholar 

  6. O’Riordain DS, Kelly P, Horgan PG, Keane FB, Tanner WA (1998) A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair. Am J Surg 176(3):254–257

    Article  PubMed  Google Scholar 

  7. O’Riordain DS, Kelly P, Horgan PG, Keane FB, Tanner WA (1999) Laparoscopic extraperitoneal inguinal hernia repair in the day-care setting. Surg Endosc 13(9):914–917

    Article  PubMed  Google Scholar 

  8. Ramshaw BJ, Tucker JG, Duncan TD, Heithold D, Garcha I, Mason EM, Wilson JP, Lucas GW (1996) Technical considerations of the different approaches to laparoscopic herniorrhaphy: an analysis of 500 cases. Am Surg 62(1):69–72

    CAS  PubMed  Google Scholar 

  9. Felix EL, Michas CA, Gonzalez MH Jr (1995) Laparoscopic hernioplasty. TAPP vs TEP. Surg Endosc 9(9):984–989

    Article  CAS  PubMed  Google Scholar 

  10. Tong YS, Wu CC, Bai CH, Lee HC, Liang HH, Kuo LJ, Wei PL, Tam KW (2014) Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials. Hernia 18(2):177–183. doi:10.1007/s10029-013-1100-0

    Article  PubMed  Google Scholar 

  11. Abbas MH, Hamade A, Choudhry MN, Hamza N, Nadeem R, Ammori BJ (2010) Infiltration of wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal repair of unilateral inguinal hernias: a randomized double-blind placebo-controlled trial. Scand J Surg 99(1):18–23

    Article  CAS  PubMed  Google Scholar 

  12. Suvikapakornkul R, Valaivarangkul P, Noiwan P, Phansukphon T (2009) A randomized controlled trial of preperitoneal bupivacaine instillation for reducing pain following laparoscopic inguinal herniorrhaphy. Surg Innov 16(2):117–123. doi:10.1177/1553350609334128

    Article  PubMed  Google Scholar 

  13. Lau H, Patil NG, Yuen WK, Lee F (2002) Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 16(11):1547–1550. doi:10.1007/s00464-001-8292-6

    Article  CAS  PubMed  Google Scholar 

  14. Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 17(11):1773–1777. doi:10.1007/s00464-002-8771-4

    Article  CAS  PubMed  Google Scholar 

  15. Bar-Dayan A, Natour M, Bar-Zakai B, Zmora O, Shabtai M, Ayalon A, Kuriansky J (2004) Preperitoneal bupivacaine attenuates pain following laparoscopic inguinal hernia repair. Surg Endosc 18(7):1079–1081. doi:10.1007/s00464-003-8214-x

    Article  CAS  PubMed  Google Scholar 

  16. Hon SF, Poon CM, Leong HT, Tang YC (2009) Pre-emptive infiltration of Bupivacaine in laparoscopic total extraperitoneal hernioplasty: a randomized controlled trial. Hernia 13(1):53–56. doi:10.1007/s10029-008-0422-9

    Article  CAS  PubMed  Google Scholar 

  17. Palmes D, Rottgermann S, Classen C, Haier J, Horstmann R (2007) Randomized clinical trial of the influence of intraperitoneal local anaesthesia on pain after laparoscopic surgery. Br J Surg 94(7):824–832. doi:10.1002/bjs.5810

    Article  CAS  PubMed  Google Scholar 

  18. Pasqualucci A, de Angelis V, Contardo R, Colo F, Terrosu G, Donini A, Pasetto A, Bresadola F (1996) Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology 85(1):11–20

    Article  CAS  PubMed  Google Scholar 

  19. Fischer S, Troidl H, MacLean AA, Koehler L, Paul A (2000) Prospective double-blind randomised study of a new regimen of pre-emptive analgesia for inguinal hernia repair: evaluation of postoperative pain course. Eur J Surg 166(7):545–551. doi:10.1080/110241500750008619

    Article  CAS  PubMed  Google Scholar 

  20. Barczynski M, Konturek A, Herman RM (2006) 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 20(7):1088–1093. doi:10.1007/s00464-005-0458-1

    Article  CAS  PubMed  Google Scholar 

  21. Lau H, Patil NG, Lee F, Yuen WK (2002) A prospective trial of analgesia following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 16(1):159–162. doi:10.1007/s00464-001-8106-x

    Article  CAS  PubMed  Google Scholar 

  22. Saff GN, Marks RA, Kuroda M, Rozan JP, Hertz R (1998) Analgesic effect of bupivacaine on extraperitoneal laparoscopic hernia repair. Anesth Analg 87(2):377–381

    CAS  PubMed  Google Scholar 

  23. Clark WC, Yang JC, Tsui SL, Ng KF, Bennett Clark S (2002) Unidimensional pain rating scales: a multidimensional affect and pain survey (MAPS) analysis of what they really measure. Pain 98(3):241–247

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand

    S. Kulasegaran, L. Pearless & M. Hulme-Moir

  2. Southern Cross Surgery-North Harbour, Auckland, New Zealand

    L. Pearless & M. Hulme-Moir

  3. Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand

    M. Rohan

  4. Department of General Surgery, North Shore Hospital, PO Box 93503, Auckland, New Zealand

    M. Hulme-Moir

Authors
  1. S. Kulasegaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Rohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Pearless
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Hulme-Moir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Hulme-Moir.

Ethics declarations

Conflict of interest

SK declares no conflicts of interest, MR declares no conflicts of interest, LP declares no conflicts of interest, and MHM declares no conflicts of interest.

Funding

No financial disclosures to make.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

I hereby undersign and certificate that this article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent obtained from every patient prior to inclusion

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kulasegaran, S., Rohan, M., Pearless, L. et al. Pre-peritoneal local anaesthetic does not reduce post-operative pain in laparoscopic total extra-peritoneal inguinal hernia repair: double-blinded randomized controlled trial. Hernia 21, 879–885 (2017). https://doi.org/10.1007/s10029-017-1672-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-017-1672-1

Keywords

Search

Navigation