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Canadian Journal of Anesthesia

, Volume 49, Issue 5, pp 481–486 | Cite as

Incisional self-administration of bupivacaine or ropivacaine provides effective analgesia after inguinal hernia repair

  • Neli VintarEmail author
  • Gorazd Pozlep
  • Narinder Rawal
  • Marija Godec
  • Slavko Rakovec
Regional Anesthesia and Pain

Abstract

Purpose

To evaluate the safety and applicability of two local anesthetic (LA) solutions self-administered for pain treatment after inguinal hernia repair (IHR) by balloon-pumps via catheters placed in the surgical wound. Effectiveness of analgesia was also compared.

Methods

Two groups of patients for IHR were included in the randomized, double-blind study. An epidural catheter was placed in the surgical wound, tunneled subcutaneously and connected to a balloon-pump containing either 0.25% bupivacaine (B) or 0.25% ropivacaine (R). Postoperatively, the patient self-administered the LA into the wound. Administration could be repeated after 20 min. If moderate to severe pain still persisted, rescue medication (piritramid) was given intravenously. The variables recorded in both groups were: visual analogue scale (VAS), pain scores at rest and with movement, number of applications, wound healing, patients’ satisfaction.

Results

During the first 24 hr, median number of LA applications in 26 B patients was 4 (range 1–6) and in 25 R patients 3 (range 1–5). Both groups showed low VAS pain scores: less than 2 at rest, less than 4 with movement. Eighty percent of patients of each group would choose this type of analgesia again. Two patients from B Group and three from R Group needed rescue medication. No wound infection was observed. There were no statistically significant differences between the groups.

Conclusion

Self-administration of the LA solution via a catheter in the surgical wound is an effective method of pain relief after IHR with little side-effects.

Keywords

Bupivacaine Local Anesthetic Ropivacaine Ketorolac Inguinal Hernia Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’auto-administration de bupivacaïne ou de ropivacaïne au site d’incision procure une analgésie efficace a la suite d’une herniorraphie inguinale

Résumé

Objectif

Évaluer l’innocuité et l’applicabilité de l’auto-administration de deux solutions d’anesthésiques locaux (AL), pour l’analgésie faisant suite à une herniorraphie inguinale (HI), au moyen d’une pompe et utilisant des cathéters placés dans la plaie chirurgicale. Comparer aussi l’efficacité de l’analgésie.

Méthode

Deux groupes de patients qui devaient subir une HI ont participé à l’étude randomisée et à double insu. Un cathéter péridural a été inséré dans la plaie chirurgicale, avec tunnellisation sous-cutanée, et relié à une pompe perfusant soit de la bupivacaine à 0,25 % (B), soit de la ropivacaïne à 0,25 % (R). Après l’opération, le patient pouvait procéder à l’auto-administration d’AL et répéter après 20 min. Si une douleur modérée ou sévère persistait, une médication de secours intraveineuse (piritramide) était donnée. Les variables enregistrées ont été: les scores de douleur au repos et pendant le mouvement à l’aide de l’échelle visuelle analogique (EVA), le nombre de recours à l’analgésie, l’état de la plaie et la satisfaction des patients.

Résultats

Pendant les 24 premières heures, le nombre moyen de recours à l’AL a été de 4 (intervalle de 1–6) chez 26 patients du groupe B et de 3 (intervalle de 1–5) chez 25 patients du groupe R. Les patients des deux groupes ont présenté des scores de douleur faibles à l’EVA: moins de 2 au repos et moins de 4 pendant le mouvement. Quatrevingt pour cent des patients de chaque groupe choisiraient encore ce type d’analgésie. Deux patients du groupe B et trois du groupe R ont eu besoin d’analgésie de secours. Aucun infection de la plaie chirurgicale n’a été observée. Aucune différence statistique intergroupe significative n’a été enregistrée.

Conclusion

Lauto-administration d’une solution d’AL au moyen d’une cathéter implanté au site d’incision constitue une méthode d’analgésie efficace à la suite d’une HI et comporte peu d’effets secondaires.

References

  1. 1.
    Rawal N, Hylander J, Nydahl P-A, Olofsson I, Gupta A. Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiol Scand 1997; 41: 1017–22.PubMedGoogle Scholar
  2. 2.
    Pettersson N, Berggren P, Larsson M, Westman B, Hahn RG. Pain relief by wound infiltration with bupivacaine or high-dose ropivacaine after inguinal hernia repair. Reg Anesth Pain Med 1999; 24: 569–75.PubMedCrossRefGoogle Scholar
  3. 3.
    Rawal N, Axelsson K, Hylander J, et al. Postoperative patient-controlled local anesthetic administration at home. Anesth Analg 1998; 86: 86–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Schindler M, Swann M, Crawford M. A comparison of postoperative analgesia provided by wound infiltration or caudal analgesia. Anaesth Intensive Care 1991; 19: 46–9.PubMedGoogle Scholar
  5. 5.
    Bültmann M, Streich R, Risse A, Falke KJ, Pappert D. Postoperative analgesia in children after hernioplasty. Wound infiltration with different concentrations of bupivacaine: a pilot study (German). Anaesthesist 1999; 48: 439–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Mulroy MF, Burgess FW, Emanuelsson B-M. Ropivacaine 0.25% and 0.5%, but not 0.125%, provide effective wound infiltration analgesia after outpatient hernia repair, but with sustained plasma drug levels. Reg Anesth Pain Med 1999; 24: 136–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Dierking GW, Østergaard E, Østergård HT, Dahl JB. The effects of wound infiltration with bupivacaine versus saline on postoperative pain and opioid requirements after herniorrhaphy. Acta Anaesthesiol Scand 1994; 38: 289–92.PubMedGoogle Scholar
  8. 8.
    Horn E-P, Schroeder F, Wilhelm S, et al. Wound infiltration and drain lavage with ropivacaine after major shoulder surgery. Anesth Analg 1999; 89: 1461–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Pettersson N, Emanuelsson B-M, Reventlid H, Hahn RG. High-dose ropivacaine wound infiltration for pain relief after inguinal hernia repair. A clinical and pharmacokinetic evaluation. Reg Anesth Pain Med 1998; 23: 189–96.PubMedGoogle Scholar
  10. 10.
    Elliott S, Eckersall S, Fligelstone L, Jothilingam S. Does the addition of clonidine affect duration of analgesia of bupivacaine wound infiltration in inguinal hernia surgery? Br J Anaesth 1997; 79: 446–9.PubMedGoogle Scholar
  11. 11.
    Erichsen CJ, Vibits H, Dahl JB, Kehlet H. Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy. Acta Anaesthesiol Scand 1995; 39: 67–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Cherian MN, Mathews MP, Chandy MJ. Local wound infiltration with bupivacaine in lumbar laminectomy. Surg Neurol 1997; 47: 120–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Reuben SS, Duprat KM. Comparison of wound infiltration with ketorolac versus intravenous regional anesthesia with ketorolac for postoperative analgesia following ambulatory hand surgery. Reg Anesth 1996; 21: 565–8.PubMedGoogle Scholar
  14. 14.
    Kastrissios H, Triggs EJ, Sinclair F, Moran P, Smithers M. Plasma concentrations of bupivacaine after wound infiltration of an 0.5% solution after inguinal herniorrhaphy: a preliminary study. Eur J Clin Pharmacol 1993; 44: 555–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Rosenberg PH, Renkonen OV. Antimicrobial activity of bupivacaine and morphine. Anesthesiology 1985; 62: 178–9.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • Neli Vintar
    • 1
    Email author
  • Gorazd Pozlep
    • 1
  • Narinder Rawal
    • 2
  • Marija Godec
    • 1
  • Slavko Rakovec
    • 3
  1. 1.Departments of Anesthesiology and Intensive CareUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Department of Anesthesiology and Intensive CareÖrebro Medical Center HospitalÖrebroSweden
  3. 3.Clinical Department for generalsurgery and surgical infectionsUniversity Medical Centre LjubljanaLjubljanaSlovenia

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