title: Effects of bupivacaine infiltration on postoperative tramadol consumption in elective day care unilateral inguinal hernia repair.
abstract: OBJECTIVE
  To determine the difference in analgesic requirement in terms of mean postoperative narcotic consumption and mean postoperative pain score in patients undergoing unilateral inguinal hernia repair with or without bupivacaine infiltration as day-care patients.
  
  
  METHODS
  The randomised controlled trial was conducted at Aga Khan University Hospital, Karachi, from June to December 2011, and comprised patients who were randomly divided into groups A and B. Tramadol 1.5 mgkg-1 was used as intraoperative analgesia. At the time of closure of surgical incision, 20ml of bupivacaine 0.25% plain was infiltrated in the subcutaneous tissue sub-facially and in the deeper layers along the incision line in patients of group A. In group B, which was the control group, the surgical wound was closed without infiltrating bupivacaine. On arrival in post-anaesthesia care unit, the patient's pain scores was assessed using Visual Analogue Scale every 15 minutes for the first hour, every 30 minutes for next one hour, and hourly for the next two hours by a blinded observer. Postoperative narcotic consumption was also noted.
  
  
  RESULTS
  There were 80 patients in the study; 40(50%) in each of the two groups. Mean postoperative narcotic consumption and mean pain scores were high in group B in all follow-ups (up to 4 hours) compared to group A patients (p<0.05).
  
  
  CONCLUSIONS
  Wound infiltration with 0.25% bupivacaine diminished post-operative pain and decreased narcotic analgesic consumption for the first four hours after unilateral inguinal hernia repair.
authors.affiliation: Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Rehan Muhammad
authors.initials: RM
authors.lastname: Qureshi
authors.affiliation: Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan.
authors.forename: Fauzia Anis
authors.initials: FA
authors.lastname: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D014147:Tramadol / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D002045:Bupivacaine
keywords: Inguinal hernia, Narcotic consumption, Local anaesthetic infiltration.