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Continuous local analgesia is effective in postoperative pain treatment after medium and large incisional hernia repair

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Abstract

Introduction

Incisional hernias are a frequent complication of laparotomy. Open surgery is still an option for the treatment of incisional hernias with medium and large wall defects. Major opioids are routinely used in the treatment of postoperative pain, with several side effects. Continuous local analgesia can be effective in postoperative pain management after various surgical interventions. However, very few reports exist on its application in incisional hernias.

Purpose

We assessed the effectiveness of ropivacaine in reducing the need for systemic analgesics in postoperative pain management related to these interventions.

Methods

We conducted an open-label, prospective, randomized design study. One hundred patients with medium and large incisional hernias were treated by open surgery. Thirty patients with abdominal defects > 8 cm received continuous postoperative local analgesia with ropivacaine 5 mg/ml. Thirty four and 36 patients (abdominal defects of more, and respectively less than 8 cm) received conventional analgesia.

Results

Continuous local anesthesia during the first 72 h after surgery reduced the number of patients needing analgesia with pethidine (17 vs 47% and 53%, p = 0.006), as well as the cumulative doses of pethidine (p < 0.05), tramadol (p < 0.001), and metamizole (p < 0.001) needed to control postoperative pain. Catheter installation for local anesthesia did not increase surgery time (p = 0.16) or the rate of local complications.

Conclusion

Continuous local analgesia reduces the need for systemic opioids and can be successfully used in the postoperative pain management after medium and large incisional hernias treated by open surgery.

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Authors and Affiliations

  1. Department M5, Surgery 1, Emergency Clinical County Hospital of Tirgu Mures, Clinic Surgery 1, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania

    M. C. Gherghinescu, C. Copotoiu, D. Popa & C. Molnar

  2. Clinic of Anaesthesiology and Intensive Care, Department M4, Anaesthesiology and Intensive Care II, Emergency Clinical County Hospital of Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, 50, Gheorghe Marinescu St., 540136, Tirgu Mures, Romania

    A. E. Lazar

  3. Department of Surgery, Faculty of Dentistry, University of Medicine and Pharmacy Craiova, 2, Petru Rareş St., 200349, Craiova, Romania

    S. S. Mogoanta

Authors
  1. M. C. Gherghinescu
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  2. C. Copotoiu
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  3. A. E. Lazar
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  4. D. Popa
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  5. S. S. Mogoanta
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  6. C. Molnar
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Corresponding author

Correspondence to C. Copotoiu.

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Conflict of interest

Authors Mircea C. Gherghinescu, Constantin Copotoiu, Alexandra E. Lazar, Daniel Popa, Stelian S. Mogoanta, Calin Molnar declare that they have no conflict of interest.

Funding

No external source of funding was used.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any study with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Gherghinescu, M.C., Copotoiu, C., Lazar, A.E. et al. Continuous local analgesia is effective in postoperative pain treatment after medium and large incisional hernia repair. Hernia 21, 677–685 (2017). https://doi.org/10.1007/s10029-017-1625-8

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  • DOI: https://doi.org/10.1007/s10029-017-1625-8

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