Efficacy and safety of 5% lidocaine patches for postoperative pain management in patients undergoing unilateral inguinal hernia repair: study protocol for a prospective, double-blind, randomized, controlled clinical trial

Abstract

Background Acute postoperative pain is a common complication of inguinal hernia repair. Pain management using local application of anesthetic agents over the skin surrounding the surgical incision may reduce the requirement for other pain medications. Targeted topical analgesics such as 5% lidocaine patches have been known to improve acute and chronic pain. However, the clinical effect of lidocaine patches on postoperative pain after inguinal hernia repair has not been studied, especially in patients undergoing surgery at day surgery units. Methods/design This is a single-center, prospective, double-blind, randomized, controlled clinical trial. Participants with unilateral inguinal hernia will be randomized to the lidocaine patch group or the placebo patch group. Based on the randomized allocation sequence, either lidocaine patches or placebo patches will be attached near each participant’s surgical wound after open hernia repair under general anesthesia. Participants will be asked to follow up at our outpatient clinic on the first postoperative day and at 1 week after surgery. The primary outcome is pain intensity, which will be measured using the visual analog scale (VAS) at the time of discharge from the day surgery unit. The secondary outcomes are VAS score at 24 h and 1 week after surgery. We will collect and analyze the participants’ clinical data (amount of intraoperative opioid use, time to recovery, and pain intensity at 30 min after surgery) and demographic characteristics (age, sex, body weight, and height). Discussion This trial may not only provide evidence on the efficacy of a 5% lidocaine patch for acute postoperative pain management after unilateral inguinal hernia repair, but also demonstrate the efficacy and safety of the patch for post-discharge pain management. Trial registration ClinicalTrials.gov NCT04754451. Registered on February 10, 2021.

Role of Injection Lidocaine with and without Triamcinolone Acetonide in the Management of Chronic Pain in Post-Operative Inguinal Hernioplasty

“…To address this, the current study compared the effectiveness of using triamcinolone acetonide along with lidocaine versus lidocaine alone for chronic pain after Lichtenstein repair. Lidocaine, a local anesthetic, blocks nerve signals and provides analgesia, while triamcinolone acetonide, a corticosteroid, reduces inflammation at the surgical site 5,14,17,18 . The current study findings showed that patients receiving triamcinolone acetonide with lidocaine experienced significantly lower chronic pain at different time points compared to those who received lidocaine alone, suggesting that this intervention consistently reduced postoperative pain at 1st week, 1st month, and 3rd month.…”

“…Although chronic pain following inguinal hernia repair has been thoroughly researched, the treatment remains difficult 1,5,6 . Almost 8% to 16% of patients report chronic pain within six months of hernioplasty, that significantly associated with quality of life 7 .…”

“…Almost 8% to 16% of patients report chronic pain within six months of hernioplasty, that significantly associated with quality of life 7 . The use of local anesthetic blocks, such as opioids and non-steroidal anti-inflammatory medications (NSAIDs), as well as other techniques, have historically been used to enhance pain outcomes during inguinal hernioplasty 5,8 . These pain medications can give temporary relief but be associated with adverse side effects like nausea, vomiting, sedation, and opioid addiction 9 .…”

“…In recent times, local anesthetic blocks combined with corticosteroids have been used for postoperative pain management in various surgical procedures 5,6,10,11 . Among the commonly used local anesthetic agents, lidocaine stands out as a potent amide-type anesthetic that has undergone extensive study and widespread application in diverse surgical settings for effective pain relief 5,6,11 .…”

“…In recent times, local anesthetic blocks combined with corticosteroids have been used for postoperative pain management in various surgical procedures 5,6,10,11 . Among the commonly used local anesthetic agents, lidocaine stands out as a potent amide-type anesthetic that has undergone extensive study and widespread application in diverse surgical settings for effective pain relief 5,6,11 . Simultaneously, triamcinolone acetonide, a well-known synthetic corticosteroid, has been employed alongside local anesthetics due to its powerful anti-inflammatory properties, making it a valuable drug in pain management strategies 10,12 .…”