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


CONCLUSIONS
Extraperitoneal bupivacaine minimizes pain following day-care TEP repair, facilitates recovery, and increases patient satisfaction. Benefits persist beyond the pharmacological action of bupivacaine.
O'Riordain
D S
DS
Department of Surgery, Trinity College Dublin, Meath Hospital, Ireland.
Kelly
P
P
Horgan
P G
PG
Keane
F B
FB
Tanner
W A
WA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods* / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003631:Day Care, Medical / Q000379:methods; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018709:Statistics, Nonparametric
D000779:Anesthetics, Local; D002045:Bupivacaine