Abstract

BackgroundInguinal hernia repair is one of the most frequently performed procedures in Switzerland (15'000/year). The most common complication postoperatively is development of chronic pain in up to 30% of all patients irrespective of the operative technique.Methods/Design264 patients scheduled for an inguinal hernia repair using one of three procedures (Lichtenstein, Barwell and TEP = total extraperitoneal hernioplasty) are being randomly allocated intra-operatively into two groups. Group I patients receive a local injection of 20 ml Carbostesin® 0.25% at the end of the operation according to a standardised procedure. Group II patients get a 20 ml placebo (0.9% Saline) injection. We use pre-filled identically looking syringes for blinded injection, i.e. the patient, the surgeon and the examinator who performs the postoperative clinical follow-ups remain unaware of group allocation. The primary outcome of the study is the occurrence of developing chronic pain (defined as persistent pain at 3 months FU) measured by VAS and Pain Matcher® device (Cefar Medical AB, Lund, Sweden).The study started on July 2006. In addition to a sample size re-evaluation three interim analyses are planned after 120, 180 and 240 patients had finished their 3-months follow-up to allow for early study termination.DiscussionUsing a group sequential study design the minimum number of patients are enrolled to reach a valid conclusion before the end of the study.To limit subjectivity, both a VAS and the Pain Matcher® device are used for the evaluation of pain. This allows us also to compare these two methods and further assess the use of Pain Matcher® in clinical routine.The occurrence of chronic pain after inguinal hernia repair has been in focus of several clinical studies but the reduction of it has been rarely investigated. We hope to significantly reduce the occurrence of this complication with our investigated intervention.Trial RegistrationOur trial has been registered at ClinicalTrials.gov. The trial registration number is: [NCT00484731].

Highlights

  • Using a group sequential study design the minimum number of patients are enrolled to reach a valid conclusion before the end of the study

  • Both a Visual Analogue Scale (VAS) and the Pain Matcher® device are used for the evaluation of pain

  • The occurrence of chronic pain after inguinal hernia repair has been in focus of several clinical studies but the reduction of it has been rarely investigated

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Summary

Discussion

Chronic pain after inguinal hernia repair is a common complication that needs to be addressed This randomized placebo controlled triple blinded designed trial should provide conclusive results regarding the effectiveness of intra-operative use of local anaesthesia in mitigating this problem. Using a group sequential study design, a minimum number of patients will be recruited until interim results suggest continuing the study became unethical. This approach has been described first by Pocock [33,34] who provided methodological guidelines already in the late bFoiguunrdear5ies and estimated example of the interim analysis boundaries and estimated example of the interim analysis. Publishing this study protocol we contribute to good, VAS visual analog scale honest and ethically correct clinical research already

Background
Methods/Design
25. Corbitt JD Jr
Introduction
Findings
34. Pocock SJ
Full Text
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