Efficacy of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following anterior abdominal wall hernia repair-A prospective case-control study

Abstract

Introduction: With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event [1, 2]. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh [3]. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may even­tually result in loss of trust in the operator [3]. Every surgical intervention is associated with the risk of immediate or delayed complications [4, 5]. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surround­ing tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair [5]. The possibility of minimizing chronic inguinal pain by proper management during herniorrhaphy should be considered in all cas­es of an inguinal canal reconstruction [6]. Objectives: To assess the efficacy of intraoperative injection of 0.5% bupivacaine (analgesic) into the operated site on the postoperative pain over operated site, assessed on the day of operation as well as the 1st and 2nd postoper­ative day after anterior abdominal wall hernia repair. Materials and methods: A prospective analysis of patient data compiled by assessment of Post-Operative pain at operated site documented and patient follow up recorded over the period from March 2018 and December 2018 at RL Jalappa hospital and research centre, Tamaka, Kolar. Results: All complications of the surgical wound significantly increased pain level on postoperative day 2. The NRS score for complicated surgical wound was 2.1 on av­erage. In the case of uncomplicated wounds, it was 0.72 (2.1 vs. 0.72 on day 2). Presence of blood in the surgical wound manifesting itself by ecchymosis and hematoma increased pain level assessed on postoperative day 2 (NRS score 2.0 vs. 0.79 in day 2). Duration of procedure did not influence pain sensation on post­operative day 0, 1, 2. In the group with inguinal hernias, postoperative complications of the wound occurred in 8.3% (n=3). Skin and subcutaneous tissue oedema of the wound was found in 10% (n=5) of patients.