'Dissectalgia' following TEP, a new entity: its recognition and treatment. Results of a prospective randomized controlled trial.
OBJECTIVE
To find the effect of pre-peritoneal instillation of bupivacaine on 'dissectalgia' (pain over a wide area corresponding to the area of pre-peritoneal dissection) and return to work following totally extraperitoneal (TEP) repair for groin hernia in labor-active males.


METHODS
Fifty-three consecutive ASA grade I adult males undergoing TEP for groin hernia were randomized to control group A (n = 28) and test group B (n = 25), receiving 30 ml saline or 0.25% bupivacaine pre-peritoneally after placing mesh, respectively. Assessment parameters included time (h) to rescue analgesia, number of patients needing additional injectable analgesia at night during their hospital stay, visual analog scale (VAS) score for pain at 24 h, 48 h, and then weekly for 4 weeks, and time of resuming their job.


RESULTS
The time to rescue analgesia was significantly shorter in group A (4.50 ± 2.3) than in group B (7.00 ± 4.1), P = 0.0077. A significantly greater number of group A patients needed additional injectable analgesia at bed time than group B patients (24 vs. 6, respectively, P < 0.0001 on the first night; 11 vs. 2, respectively, P = 0.008 on the second night). The VAS scores were significantly higher in group A patients than group B patients (3.47 ± 1.04 vs. 1.69 ± 1.04, respectively, at 24 h postoperatively, P < 0.0001; 2.29 ± 1.44 vs. 1.36 ± 0.81, respectively, at 48 h postoperatively, P = 0.0063). However, subsequent VAS scores up to 4 weeks postoperatively were comparable, as was the time of resuming their job. No patient had seroma/fluid collection, chronic pain, or recurrence, with the minimum follow-up being 3 years.


CONCLUSIONS
Dissectalgia following TEP deserves its due recognition. Pre-peritoneal bupivacaine instillation significantly reduces its occurrence, although the time of patients' resuming their jobs remains unaffected.
Kumar
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S
Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, 110095, India. drskg_15@rediffmail.com
Joshi
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M
Chaudhary
S
S
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D002045:Bupivacaine; D003289:Convalescence; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D013997:Time Factors; D014147:Tramadol / Q000627:therapeutic use; D055815:Young Adult
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D002045:Bupivacaine