Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

Abstract

Introduction The open prosthetic repair of inguinal hernias under local anaesthesia (LA) is well established, with the concept of intraoperative 'pre-emptive analgesia' evolving so that patients are as comfortable as possible. We used a peri-incisional LA solution in patients undergoing day-case inguinal hernioplasty under general anaesthesia (GA) and recorded use of analgesia in the immediate postoperative period. Methods In this observational cohort study, 100 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 75 underwent repair under GA and 25 with peri-incisional LA solution (equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline). Analgesia prescribed at induction, for maintenance and after cessation of anaesthesia was scored in accordance with the World Health Organization (WHO) analgesic ladder. Results The median age in the GA group was 59 years (range: 25-89 years) and in the GA+LA group, it was 62 years (range: 27-88 years). Of the 100 patients, 82 underwent a mesh plug repair by seven surgeons whereas 18 underwent a flat (Lichtenstein) mesh repair by two surgeons. WHO analgesic induction and postoperative scores were significantly lower in the GA+LA group (p=0.034 and p<0.001 respectively). There was also a significant difference in use of postoperative antiemetics (23% vs 0% in the GA only and GA+LA cohorts respectively, p=0.020). Six patients (8%) in the GA group failed day-case discharge criteria. Conclusions Patients undergoing contemporary day-case GA inguinal hernioplasty with pre-emptive LA solution infiltration require lower levels of postoperative opioid analgesia and antiemetics. These cases are less likely to fail discharge criteria for planned day surgery.

Effect of Ultrasound-Guided Quadratus Lumborum Block Preemptive Analgesia on Postoperative Recovery of Patients with Open Radical Colon Cancer Surgery: A Retrospective Study

“…At present, preemptive analgesia has been defined as a clinical anesthesia technique and/or multi-drug combination analgesic treatment, which anticipates that pain can be modified by analgesic nerve blocks prior to tissue trauma with its resultant release of nociceptive stimuli and prevent central sensitization. 14,15 In recent years, with the development of ultrasound visualization technology, regional block technique has become a hot spot in the field of anesthesia. Quadratus lumborum block (QLB) provides a local block through the local anesthetic in the paravertebral space.…”

Аssessment of pain intensity: tools and their clinical using

“…Многочисленность звеньев патогенеза оказывается не единственным объединяющим критерием. Эти состояния близки друг другу вследствие широкой распространенности, известности этиологического фактора, встречаемости в любом возрасте, а также сложности индивидуализации подбора схемы обезболивания и повсеместной применяемости анальгетической лестницы ВОЗ [29,30]. Именно поэтому практические достижения в работе с одной из групп пациентов могут быть перенесены в другую группу.…”

Avoiding migration at open mesh plug inguinal hernioplasty

“…Indeed residents may need a little more supervision [ 3 ] and intra-operative tutoring with regard to the correct placement (and fixation) of the MP prosthesis, which is indeed the motivation for this piece of writing. Furthermore we believe trainees should be encouraged to perform all types of open repair under local anaesthesia albeit initially at general anaesthesia [ 4 , 5 ].…”