CONTROLLED TRIAL OF PREPERITONEAL LOCAL-ANESTHETIC FOR REDUCING PAIN FOLLOWING LAPAROSCOPIC HERNIA REPAIR

Background A prospective randomized trial was performed to determine w hether local anaesthetic solutions injected into the preperitoneal spa ce may provide additional pain relief following transabdominal preperi toneal laparoscopic hernia repair. Methods One hundred patients underg oing transabdominal preperitoneal laparoscopic hernia repair were allo cated randomly to receive (1) bupivacaine 1 5 mg/kg, (2) bupivacaine 1 .5 mg/kg with 1 in 200 000 adrenaline, (3) bupivacaine 3 mg/kg or (4) saline instilled into the preperitoneal space at the end of the operat ion. An independent clinical assessor determined the level of pain usi ng a visual analogue pain score and noted the parenteral and oral anal gesia requirements at 4, 8, 12 and 24 h after operation. Results At ea ch of the time intervals, there was no significant difference between the groups for pain scores (at 24 h, P = 0.71) or the number of doses of either morphine (at 24 h, P = 0.73) or oral analgesia (at 24 h, P = 0.89). There was also no significant difference in the time to return to normal activity or work between the groups. Conclusion This study suggests that instilling local anaesthetic into the preperitoneal spac e has no significant effect on postoperative pain relief requirement f ollowing laparoscopic hernia repair. Other methods of reducing postope rative pain should be sought that may facilitate day-case laparoscopic hernia surgery.