Acetazolamide reduces postoperative pain following laparoscopic inguinal herniorrhaphy
Abstract
Background
Carbonic acid accumulation, which results from CO2 insufflation, can produce visceral and referred pain in the postoperative setting. Acetazolamide inhibits carbonic anhydrase, an enzyme that accelerates carbonic acid formation. We hypothesized that preoperative administration of acetazolamide would decrease postoperative pain in patients undergoing laparoscopic inguinal herniorrhaphy.
Methods
A retrospective review was conducted of patients who underwent laparoscopic preperitoneal inguinal herniorrhaphy at the Medical College of Wisconsin between October 2012 and September 2014. Beginning in January 2014, patients began receiving 250 mg of acetazolamide preoperatively; patients prior to that time did not. The visual analog scale (range 0–10) was used to assess both preoperative pain and postoperative pain.
Results
A total of 66 patients underwent laparoscopic inguinal herniorrhaphy during the study interval. Of these, 22 (33 %) patients received acetazolamide preoperatively, and 44 (67 %) were included as controls. Overall mean pain scores were lower in the acetazolamide group (1.9 ± 1.45 vs 2.9 ± 1.5, p = 0.04). Specifically, patients who received acetazolamide reported lower pain scores immediately after surgery (0.6 ± 1.2 vs 1.9 ± 2.3, p = 0.01) and on post-op day one (2.3 ± 0.9 vs 4.0 ± 2.1, p = 0.04). Total morphine equivalents administered to manage postoperative pain were significantly less for the acetazolamide group (4.3 ± 4.8 mg) when compared to the control group (8.9 ± 8.4 mg), p = 0.04. Perioperative complications did not differ between the groups (p = 0.16).
Conclusions
Acetazolamide appears to reduce pain in the immediate postoperative setting. Patients who received acetazolamide had lower pain scores postoperatively and required fewer narcotics for pain management prior to discharge.
Keywords
Acetazolamide Inguinal hernia Postoperative painNotes
Compliance with ethical standards
Disclosures
Matthew J. Frelich, Irene Pourladian, Alex W. Lois, Andrew S. Kastenmeier and Harvey J. Woehlck declare no conflicts of interest. Dr. Matthew I. Goldblatt is a consultant for Gore, Covidien/Medtronic and Bard/Davol. He is a speaker for Gore and Covidien/Medtronic and has a research grant from Bard/Davol. Michelle Weber and Jon C. Gould have no conflicts of interest or financial ties to disclose.
References
- 1.Manworren R (2015) Multimodal pain management and the future of a personalized medicine approach to pain. AORN J 101(3):307–318CrossRefGoogle Scholar
- 2.Woehlck HJ, Otterson M, Yun H, Connolly LA, Eastwood D, Colpaert K (2003) Acetazolamide reduces referred postoperative pain after laparoscopic surgery with carbon dioxide insufflation. Anesthesiology 99(4):924–928CrossRefPubMedGoogle Scholar
- 3.Figueroa-Balderas L, Franco-López F, Flores-Álvarez E, López-Rodríguez JL, Vázquez-García JA, Barba-Valadez CT (2013) Reduction of omalgia in laparoscopic cholecystectomy: clinical randomized trial ketorolac vs ketorolac and acetazolamide. cir cir 81(5):368–372Google Scholar
- 4.Nyerges A (1994) Pain mechanisms in laparoscopic surgery. Semin Laparosc Surg 1:215–218PubMedGoogle Scholar
- 5.Asiedu M, Ossipov MH, Kaila K, Price TJ (2010) Acetazolamide and midazolam act synergistically to inhibit neuropathic pain. Pain 148(2):302–308. doi: 10.1016/j.pain.2009.11.015 CrossRefPubMedGoogle Scholar
- 6.Asiedu MN, Mejia GL, Hübner CA, Kaila K, Price TJ (2014) Inhibition of carbonic anhydrase augments GABAA receptor-mediated analgesia via a spinal mechanism of action. J Pain 15(4):395–406. doi: 10.1016/j.jpain.2014.01.001 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Sun Y, Chen Y, Pang C, Wu N, Li J (2014) Acetazolamide attenuates chemical-stimulated but not thermal-stimulated acute pain in mice. Acta Pharmacol Sin 35(1):41–47. doi: 10.1038/aps.2013.149 CrossRefPubMedGoogle Scholar
- 8.Singh R, Sen I, Wig J, Minz M, Sharma A, Bala I (2009) An acetazolamide based multimodal analgesic approach versus conventional pain management in patients undergoing laparoscopic living donor nephrectomy. Indian J Anaesth 53(4):434–441PubMedPubMedCentralGoogle Scholar
- 9.Cavalcanti IL et al (2014) Safety and tolerability of controlled-release oxycodone on postoperative pain in patients submitted to the oncologic head and neck surgery. Rev Col Bras Cir 41(6):393–399CrossRefPubMedGoogle Scholar
- 10.Koh W, Nguyen KP, Jahr JS (2015) Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesth 68(1):3–12. doi: 10.4097/kjae.2015.68.1.3 CrossRefGoogle Scholar
- 11.Song K, Melroy MJ, Whipple OC (2014) Optimizing multimodal analgesia with intravenous acetaminophen and opioids in postoperative bariatric patients. Pharmacotherapy 34(S1):1875–9114CrossRefGoogle Scholar
- 12.Arngrim N, Schytz HW, Asghar MS, Amin FM, Hougaard A, Larsen VA, de Koning PJ, Larsson HB, Olesen J, Ashina M (2014) Association of acetazolamide infusion with headache and cranial artery dilation in healthy volunteers. Pain 155(8):1649–1658CrossRefPubMedGoogle Scholar
- 13.Zimmermann S, Achenbach S, Wolf M, Janka R, Marwan M, Mahler V (2014) Recurrent shock and pulmonary edema due to acetazolamide medication after cataract surgery. Heart Lung 43(2):124–126. doi: 10.1016/j.hrtlng.2013.11.008 CrossRefPubMedGoogle Scholar
- 14.Ogasawara K, Tomitsuka N, Kobayashi M, Komoribayashi N, Fukuda T, Saitoh H, Inoue T, Ogawa A (2006) Stevens–Johnson syndrome associated with intravenous acetazolamide administration for evaluation of cerebrovascular reactivity. Case report. Neurol Med Chir (Tokyo) 46(3):161–163CrossRefGoogle Scholar