title: 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.
abstract: BACKGROUND
  The potential analgesic benefit of infiltration of the wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal (TEP) repair of inguinal hernias remains unclear.
  
  
  METHODS
  Consenting adults scheduled to undergo laparoscopic TEP repair of unilateral inguinal hernias were recruited to this randomized double-blind placebo-controlled clinical trial of 0.25% bupivacaine (Group I) versus saline (Group II) infiltration of abdominal wounds and the extraperitoneal space. Pain scores were assessed at 4 and 24 hours postoperatively using the short-form McGill pain questionnaire (SF-MPQ), the Present Pain Index (PPI) score and the visual analogue scale (VAS). The intravenous and oral analgesic requirements were recorded. Each patient completed questionnaire to assess their satisfaction with the postoperative analgesia.
  
  
  RESULTS
  40 patients were randomized (Group I, n = 20; Group II, n = 20). The two groups were comparable for age, gender, body mass index, and operating time. Minor complications occurred in one patient in each group. There were no significant differences in the postoperative SF-MPQ scores, PPI and VAS at 4 hours (p = 0.413, p = 0.631, p = 0.615 respectively) and 24 hours (p = 0.116, p = 0.310, p = 0.100 respectively) post-operatively. The parenteral and oral analgesics consumed post-surgery were comparable (p = 0.605, p = 0.235). No difference was ob-served in the patient satisfaction scores.
  
  
  CONCLUSIONS
  Infiltration of abdominal wounds and extraperitoneal space with bupivacaine in patients undergoing laparoscopic TEP repair of unilateral inguinal hernias does not appear to offer analgesic benefits.Key words: Laparoscopic; extraperitoneal; inguinal hernia; repair; pain; bupivacaine; analgesia; satisfaction; day case; randomized.
authors.affiliation: Department of Surgery at Manchester Royal Infirmary, and the University of Manchester, Manchester, UK.
authors.forename: M H
authors.initials: MH
authors.lastname: Abbas
authors.forename: A
authors.initials: A
authors.lastname: Hamade
authors.forename: M N
authors.initials: MN
authors.lastname: Choudhry
authors.forename: N
authors.initials: N
authors.lastname: Hamza
authors.forename: R
authors.initials: R
authors.lastname: Nadeem
authors.forename: B J
authors.initials: BJ
authors.lastname: Ammori
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007322:Instillation, Drug; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine