Laparoscopic inguinal hernia repair: quality of recovery following the use of intraperitoneal bupivacaine

Abstract

In a prospective, randomized, double-blind study in 40 adult patients undergoing laparoscopic inguinal hernia repair, we have compared the quality of recovery following intraperitoneal administration of either 0.15% bupivacaine with adrenaline 1: 666 000 100 ml ( n = 20) or 0.9% NaCl 100 ml ( n = 20). Quality of recovery was assessed in terms of postoperative pain, opioid requirements, nausea and vomiting, change in bowel habit and time to discharge. Patients in the bupivacaine group compared with the saline group had significantly lower visual analogue pain scores on arrival in recovery (2.0 (1–3) vs. 5.5 (4–7.5), P < 0.05). Reporting of severe pain and absent-mild pain (verbal rating scale) over the 48 h period studied significantly favoured the bupivacaine group ( P < 0.05). Postoperative morphine requirement was significantly less in the bupivacaine group (2:20 vs. 10:20, P < 0.05). There were no significant differences between the two groups in terms of nausea and vomiting, change in bowel habit, or duration of hospital stay. Serum bupivacaine assayed in 10 further patients did not approach accepted toxic levels. These data suggest that intraperitoneal bupivacaine, in the dosage used, is effective in reducing postoperative pain following laparoscopic inguinal hernia repair.