Randomized Clinical Trial of Postoperative Subfascial Infusion with Bupivacaine following Ambulatory Open Mesh Repair of Inguinal Hernia

Abstract

Background: Wound pain remains the commonest problem after ambulatory open repair of inguinal hernia. Postoperative subfascial infusion of the wound with bupivacaine extends local analgesia at home and may achieve superior analgesia compared with oral analgesics alone. The objective of the present trial was to evaluate the efficacy of postoperative subfascial infusion of the wound with 0.5% bupicavaine at 2 ml per hour for 48 h after operation. Methods: Forty-four patients who underwent ambulatory open tension-free mesh hernioplasties were randomized to two arms of treatment. The pump group had an infusion pump containing 100 ml 0.5% bupivacaine being placed between the external oblique aponeurosis and the Prolene mesh, whereas the nonpump group was treated with oral analgesics alone. Assuming that an observed difference of 2.0 existed between the mean pain scores of the two groups, the estimated sample size would be at least 20 patients in each group. Results: Postoperative pain scores at rest and on coughing were significantly lower in the pump group than in the nonpump group on days 0 and 1 after surgery (p < 0.01). Before being discharged, none of the pump group patients requested analgesics, but 6 patients of the nonpump group required analgesic supplement (p = 0.025). Ten patients (50%) of the pump group experienced no pain during the period of bupivacaine infusion. Recovery variables, including time taken to resume ambulation and micturition, were comparable between the two groups. The pump and nonpump group patients returned to their normal activities after a median of 3 and 4 days, respectively (p = 0.217). The postoperative morbidity rates of the two groups were similar. Conclusion: Postoperative subfascial infusion of the wound with 0.5% bupivacaine achieved superior analgesia compared with oral analgesics alone. Portable infusion pump is a safe technique to continue local analgesia at home after ambulatory open repair of inguinal hernia. The drawbacks of the ON-Q Pain Management System included its high cost and frequent seepage of blood-stained anesthetic fluid into the wound dressing.

A Randomized Trial of Bupivicaine Pain Pumps to Eliminate the Need for Patient Controlled Analgesia Pumps in Primary Laparoscopic Roux-en-Y Gastric Bypass

“…This has previously been shown in orthopedic, urologic, gynecologic and thoracic applications. [1][2][3][4][5][6][7][8][9][10] However, to the present, there has been only one prior study which evaluated its efficacy in a laparoscopic model. 11 At our institution, a multimodal opioid-sparing approach, using the ON-Q ® pain pump, oral pain medications the night of the surgery, and meperidine boluses by patient request, is as effective as PCA in controlling postoperative pain in a LRYGBP model.…”

Safety of opioid patch initiation in Australian residential aged care

“…A 'pain meter' (PAULA) which used five coloured emoticon faces on the front of a ruler and corresponding VAS scores on the back, and allowed patients to move a slider to mark the pain they were experiencing, resulted in less variance than pain scores obtained from a standard VAS (Machata et al A reduction in pain intensity by 30% to 35% has been rated as clinically meaningful by patients with postoperative pain (Cepeda et al, 2003 Level IV; Jensen et al, 2003 Level IV), acute pain in the emergency department (Lee et al, 2003 Level IV), breakthrough cancer pain (Farrar et al, 2000 Level IV) and chronic pain (Farrar et al, 2001 Level IV).…”

Kontinuierliche Wundinfusion von Lokalanästhetika

“…Einschrän-kend sollte jedoch hinzugefügt werden, dass sich die gesamte Wundheilung über Monate hinzieht [28], während der Beobachtungszeitraum in den oben genannten Studien auf einige Tage limitiert ist. In den Studien, die mögliche Effekte auf die Wundheilung beobachteten, wurden keine Hinweise auf eine Wundheilungsstö-rung erkannt [4,8,9,19,25,39]. Ähnliches gilt für das Auftreten von Wundinfektionen im Zusammenhang mit der kontinuierlichen Wundinfusion von Lokalanästhetika.…”