Effect of spraying bupivacaine and dexamethasone on postoperative pain of total extraperitoneal hernioplasty: a retrospective analysis

Authors

  • Mehmet Ozer Department of General Surgery, Bilkent City Hospital, Ankara, Turkey
  • Serap Ulusoy Department of General Surgery, Bilkent City Hospital, Ankara, Turkey
  • İbrahim Kılınç Department of General Surgery, Bilkent City Hospital, Ankara, Turkey
  • Mustafa Oruç Department of General Surgery, Bilkent City Hospital, Ankara, Turkey

DOI:

https://doi.org/10.18203/2349-2902.isj20231379

Keywords:

TEP laparoscopic hernioplasty, Postoperative pain, Bupivacaine, Dexamethasone, Local anaesthesia

Abstract

Background: Several studies on the reduction of pain with the use of local anesthetics after laparoscopic hernia surgeries have been published. We aimed to analyze the results of local anesthesia applied to the patients by retrospectively scanning the files of patients who underwent total extraperitoneal laparoscopic hernioplasty for inguinal hernias.

Methods: The files of patients who underwent TEP laparoscopic hernioplasty for inguinal hernias between March 2019 and November 2022 in Ankara Bilkent city hospital general surgery clinic were retrospectively scanned. The pain scoring records in the observation forms of these patients and the analgesics administered were recorded.

Results: A total of 374 and 210 patients underwent unilateral and bilateral TEP laparoscopic hernioplasty, respectively. All of the patients, 232 were not administered any local anesthesia, 186 were administered bupivacaine, and 166 were administered bupivacaine+dexamethasone. When the VAS scores of the patients in both main groups were compared, significant differences were found in VAS scores between patients who received bupivacaine and bupivacaine+dexamethasone and those who did not (p<0.036 and p<0.025). No difference was found between patients who received only bupivacaine and those who were given bupivacaine+dexamethasone.

Conclusion: In patients who underwent TEP laparoscopic hernioplasty, spraying bupivacaine into the preperitoneal area after surgery was found to be significantly effective in reducing postoperative pain. The benefits of adding dexamethasone to bupivacaine have not been established.

 

References

Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362:1561-71.

van den Heuvel B, Dwars B, Klassen D. Is surgical repair of an asymptomatic groin hernia appropriate? A review. Hernia. 2011;15:251-9.

Liem MS, van der Graaf Y, Zwart RC. A randomized comparison of physical performance following laparoscopic and open inguinal hernia repair. Br J Surg. 1997;84:64-7.

Stoker DL, Spiegelhalter DJ, Singh R, Wellwood JM. Laparoscopic versus open inguinal hernia repair: A randomized prospective trial. Lancet. 1994;343: 1243-5.

D.S. O'Riordain, P. Kelly, P.G. Horgan, et al. A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair Am J Surg. 1998;176:254-7.

Sakamoto B, Harker G, Eppstein AC, Gwirtz K. Efficacy of local anesthetic with dexamethasone on the quality of recovery following total extraperitoneal bilateral inguinal hernia repair: A randomized clinical trial. JAMA Surg. 2016;151(12): 1108-14.

Saff GN, Marks RA, Kuroda M, Rozan JP, Hertz R. Analgesic effect of bupivacaine on extraperitoneal laparoscopic hernia repair. Anesth Analg. 1998; 87(2):377-81.

Edelman DS, Misiakos EP, Moses K. Extraperitoneal laparoscopic hernia repair with local anesthesia. Surg Endosc. 2001;15(9):976-80.

Kumar S, Joshi M, Chaudhary S. ‘Dissectalgia’ following TEP, a new entity: Its recognition and treatment: results of a prospective randomized controlled trial. Hernia. 2009;13(6):591-6.

Subwongcharoen S, Udompornmongkol V. A randomized control trial of levobupivacaine, bupivacaine versus placebo extraperitoneal infusion in totally extraperitoneal laparoscopic inguinal hernioplasty. J Surg Res. 2010;162(2):279-83.

Abbas MH, Hamade A, Choudhry MN, Hamza N, Nadeem R, Ammori BJ. Infiltration of wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal repair of unilateral inguinal hernias. J Surg Res. 2008;158(3):48-53.

Bar-Dayan A, Natour M, Barzakai B. Preperitoneal bupivacaine attenuates pain following laparoscopic inguinal hernia repair. Surg Endosc. 2004;18:1079-81.

Hon SF, Poon CM, Leong HT. Pre-emptive infiltration of bupivacaine in laparoscopic total extraperitoneal hernioplasty: A randomized controlled trial. Hernia. 2009;13:53-6.

Abbas MH, Hamade A, Choudhry MN. 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. Scand J Surg. 2010;99:18-23.

Kim MG, Kim SI, Ok SY. The analgesic effect of ultrasound-guided transverse abdominis plane block after laparoscopic totally extraperitoneal hernia repair. Korean J Anesthesiol. 2012;63(3):227-32.

Kim MG, Kim SI, Ok SY. Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair? Korean J Anesthesiol. 2014;67(6):398-403.

Sakamoto B, Harker G, Eppstein AC, Gwirtz K. Efficacy of local anesthetic with dexamethasone on the quality of recovery following total extraperitoneal bilateral inguinal hernia repair: A randomized clinical trial. JAMA Surg. 2016;151(12): 1108-14.

Clark WC, Yang JC, Tsui SL, et al. Unidimensional pain rating scales: A multidimensional affect and pain survey (MAPS) analysis of what they really measure. Pain. 2002;98:241-7.

Gagliese L, Weizblit N, Ellis W. The measurement of postoperative pain: A comparison of intensity scales in younger and older surgical patients. Pain. 2005;117:412-20.

Kopacz DJ, Lacouture PG, Wu D, Nandy P, Swanton R, Landau C. The dose response and effects of dexamethasone on bupivacaine microcapsules for intercostal blockade (T9 to T11) in healthy volunteers. Anesth Analg. 2003;96(2):576-82.

Shrestha BR, Maharjan SK, Tabedar S. Supraclavicular brachial plexus block with and without dexamethasone: A comparative study. Kathmandu Univ Med J. 2003;1(3):158-60. KUMJ.

Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102(1):263-7.

Vieira PA, Pulai I, Tsao GC, Manikantan P, Keller B, Connelly NR. Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Eur J Anaesthesiol. 2010;27(3):285-8.

Cummings KC III, Napierkowski DE, Parra-Sanchez I. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth. 2011;107(3):446-53.

Downloads

Published

2023-04-29

Issue

Section

Original Research Articles