title: Periprosthetic Anesthetic for Postoperative Pain After Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Laparoscopic ventral hernia repair (LVHR) using mesh is a well-established intervention for ventral hernia, but pain control can be challenging.
  
  
  OBJECTIVE
  To determine whether instillation of a long-acting local anesthetic between the mesh and the peritoneum after LVHR reduces pain or narcotic requirements.
  
  
  METHODS
  A prospective, double-blind, randomized clinical trial with data collection during a brief hospital stay in a tertiary care, community teaching hospital over 3 years between December 15, 2011, and March 28, 2014. Of 120 screened patients undergoing LVHR in this intention-to-treat analysis, 99 eligible patients were randomized. Forty-two patients received the study drug, and 38 patients received placebo. Patients with a history of chronic narcotic use were excluded.
  
  
  METHODS
  After mesh placement, a long-acting local anesthetic (bupivacaine hydrochloride, 0.50%) or placebo (0.9% normal saline) was injected between the mesh and the peritoneum.
  
  
  METHODS
  Postoperative pain (on a standard scale ranging from 0 to 10), and narcotic medication use (intravenous morphine equivalents). There were no adverse events.
  
  
  RESULTS
  Baseline and operative characteristics were similar except that the treatment group was older (61.8 vs 52.3 years, P = .001). After surgery, pain scores in the recovery room (3.2 vs 4.7, P = .003), interval total narcotic use (6.7 vs 12.5 mg, P = .003 at <4 hours and 0 vs 2.7 mg, P = .01 at 8-12 hours), and total intravenous narcotic use (9.2 vs 17.2 mg of morphine sulfate equivalents, P = .03) were significantly less in the treatment group.
  
  
  CONCLUSIONS
  Administration of a long-acting local anesthetic between the mesh and the peritoneum significantly reduces postoperative pain and narcotic use after LVHR.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01530815.
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
authors.forename: Aimee E
authors.initials: AE
authors.lastname: Gough
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California2Department of Surgery, Community Hospital of the Monterey Peninsula, Monterey, California.
authors.forename: Steven
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California3Department of Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Subhash
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ferrigno
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
authors.forename: Marc
authors.initials: M
authors.lastname: Zerey
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grotts
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
authors.forename: Samantha
authors.initials: S
authors.lastname: Yim
authors.affiliation: Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Thoman
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D013526:Surgical Mesh
chemical_list: D000779:Anesthetics, Local