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Hernia

, Volume 18, Issue 2, pp 177–183 | Cite as

Effect of extraperitoneal bupivacaine analgesia in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials

  • Y.-S. Tong
  • C.-C. Wu
  • C.-H. Bai
  • H.-C. Lee
  • H.-H. Liang
  • L.-J. Kuo
  • P.-L. Wei
  • K.-W. TamEmail author
Original Article

Abstract

Background

Laparoscopic total extraperitoneal (TEP) inguinal hernioplasty is significantly less painful than open repair, but it is not completely painless. Local anesthetics are thought to decrease postoperative pain when placed at the surgical site. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of extraperitoneal bupivacaine treatment during laparoscopic inguinal hernia repair for the reduction of postoperative pain.

Methods

We conducted a systematic review and meta-analysis of RCTs that investigated the outcomes of extraperitoneal bupivacaine analgesia versus control in laparoscopic TEP hernia repair. Pain was assessed using a visual analog scale at 4–6 h and at 24 h following the surgery. The secondary outcomes included complications and analgesia consumption.

Results

We reviewed eight trials that included a total of 373 patients. We found no difference between the groups in postoperative pain reduction following laparoscopic TEP inguinal hernia repair. The intensity of pain was not significantly different between the bupivacaine treatment group and the control group. The pooled mean differences in pain scores were −0.26 (95 % CI −0.72 to 0.21) at 4–6 h and −0.47 (95 % CI −1.24 to 0.29) at 24 h. No bupivacaine-related complications were reported.

Conclusion

Extraperitoneal bupivacaine treatment during laparoscopic TEP inguinal hernioplasty is not more efficacious for the reduction of postoperative pain than placebo.

Keywords

Bupivacaine Local anesthesia Laparoscopic hernioplasty Inguinal hernia Extraperitoneal Postoperative pain Meta-analysis 

Notes

Conflict of interest

The authors have no conflict of interest or financial ties to disclose.

References

  1. 1.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD001785PubMedGoogle Scholar
  2. 2.
    McCormack K, Wake BL, Fraser C, Vale L, Perez J, Grant A (2005) Transabdominal pre-peritoneal (TAPP) versus totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair: a systematic review. Hernia 9:109–114PubMedCrossRefGoogle Scholar
  3. 3.
    Krishna A, Misra MC, Bansal VK, Kumar S, Rajeshwari S, Chabra A (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26:639–649PubMedCrossRefGoogle Scholar
  4. 4.
    Tolver MA, Strandfelt P, Rosenberg J, Bisgaard T (2011) Pain characteristics after laparoscopic inguinal hernia repair. Surg Endosc 25:3859–3864PubMedCrossRefGoogle Scholar
  5. 5.
    Tam KW, Liang HH, Chai CY (2010) Outcomes of staple fixation of mesh versus nonfixation in laparoscopic total extraperitoneal inguinal repair: a meta-analysis of randomized controlled trials. World J Sur 34:3065–3074CrossRefGoogle Scholar
  6. 6.
    Vidović D, Kirac I, Glavan E, Filipović-Cugura J, Ledinsky M, Bekavac-Beslin M (2007) Laparoscopic totally extraperitoneal hernia repair versus open Lichtenstein hernia repair: results and complications. J Laparoendosc Adv Surg Tech A 17:585–590PubMedCrossRefGoogle Scholar
  7. 7.
    Garg P, Rajagopal M, Varghese V, Ismail M (2009) Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias. Surg Endosc 23:1241–1245PubMedCrossRefGoogle Scholar
  8. 8.
    O’Riordain DS, Kelly P, Horgan PG, Keane FB, Tanner WA (1999) Laparoscopic extraperitoneal inguinal hernia repair in the day-care setting. Surg Endosc 13:914–917PubMedCrossRefGoogle Scholar
  9. 9.
    Alkhamesi NA, Peck DH, Lomax D, Darzi AW (2007) Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial. Surg Endosc 21:602–606PubMedCrossRefGoogle Scholar
  10. 10.
    Sripada S, Roy S, Mathur M, Hamilton M, Cranfield K, Bhattacharya S (2006) A prospective double-blind randomised controlled trial of intraoperative pelvic instillation with bupivacaine for management of pain following laparoscopy and dye. BJOG 113:835–838PubMedCrossRefGoogle Scholar
  11. 11.
    Abbas MH, Hamade A, Choudhry MN, Hamza N, Nadeem R, Ammori BJ (2010) Infiltration of wounds and extraperitoneal space with local anesthetic in patients undergoing laparoscopic totally extraperitoneal repair of unilateral inguinal hernias: a randomized double-blind placebo-controlled trial. Scand J Surg 99:18–23PubMedGoogle Scholar
  12. 12.
    Subwongcharoen S, Udompornmongkol V (2010) A randomized control trial of levobupivacaine, bupivacaine versus placebo extraperitoneal infusion in totally extraperitoneal laparoscopic inguinal hernioplasty. J Surg Res 162:279–283PubMedCrossRefGoogle Scholar
  13. 13.
    Suvikapakornkul R, Valaivarangkul P, Noiwan P, Phansukphon T (2009) A randomized controlled trial of preperitoneal bupivacaine instillation for reducing pain following laparoscopic inguinal herniorrhaphy. Surg Innov 16:117–123PubMedCrossRefGoogle Scholar
  14. 14.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34PubMedCrossRefGoogle Scholar
  15. 15.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  16. 16.
    Bar-Dayan A, Natour M, Bar-Zakai B, Zmora O, Shabtai M, Ayalon A, Kuriansky J (2004) Preperitoneal bupivacaine attenuates pain following laparoscopic inguinal hernia repair. Surg Endosc 18:1079–1081PubMedCrossRefGoogle Scholar
  17. 17.
    Hon SF, Poon CM, Leong HT, Tang YC (2009) Pre-emptive infiltration of bupivacaine in laparoscopic total extraperitoneal hernioplasty: a randomized controlled trial. Hernia 13:53–56PubMedCrossRefGoogle Scholar
  18. 18.
    Kumar S, Joshi M, Chaudhary S (2009) ‘Dissectalgia’ following TEP, a new entity: its recognition and treatment. Results of a prospective randomized controlled trial. Hernia 13:591–596PubMedCrossRefGoogle Scholar
  19. 19.
    O’Riordain DS, Kelly P, Horgan PG, Keane FB, Tanner WA (1998) A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair. Am J Surg 176:254–257PubMedCrossRefGoogle Scholar
  20. 20.
    Saff GN, Marks RA, Kuroda M, Rozan JP, Hertz R (1998) Analgesic effect of bupivacaine on extraperitoneal laparoscopic hernia repair. Anesth Analg 87:377–381PubMedGoogle Scholar
  21. 21.
    McKernan JB, Laws HL (1993) Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc 7:26–28PubMedCrossRefGoogle Scholar
  22. 22.
    Hernández-Palazón J, Tortosa JA, Nuño de la Rosa V, Giménez-Viudes J, Ramírez G, Robles R (2003) Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Eur J Anaesthesiol 20:891–896PubMedCrossRefGoogle Scholar
  23. 23.
    Deans GT, Wilson MS, Brough WA (1998) Controlled trial of preperitoneal local anaesthetic for reducing pain following laparoscopic hernia repair. Br J Surg 85:1013–1014PubMedCrossRefGoogle Scholar
  24. 24.
    Lau H, Patil NG, Lee F, Yuen WK (2002) A prospective trial of analgesia following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc 16:159–162PubMedCrossRefGoogle Scholar
  25. 25.
    Fischer S, Troidl H, MacLean AA, Koehler L, Paul A (2000) Prospective double-blind randomised study of a new regimen of pre-emptive analgesia for inguinal hernia repair: evaluation of postoperative pain course. Eur J Surg 166:545–551PubMedCrossRefGoogle Scholar
  26. 26.
    Mixter CG 3rd, Meeker LD, Gavin TJ (1998) Preemptive pain control in patients having laparoscopic hernia repair: a comparison of ketorolac and ibuprofen. Arch Surg 133:432–437PubMedGoogle Scholar
  27. 27.
    Shpitz B, Kuriansky J, Werener M, Osadchi A, Tiomkin V, Bugayev N, Klein E (2004) Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias. J Laparoendosc Adv Surg Tech A 14:353–357PubMedCrossRefGoogle Scholar
  28. 28.
    Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 17:1773–1777PubMedCrossRefGoogle Scholar
  29. 29.
    Honigmann P, Fischer H, Kurmann A, Audigé L, Schüpfer G, Metzger J (2007) Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair. A randomized placebo controlled triple blinded and group sequential study design [NCT00484731]. BMC Surg 7:22PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Y.-S. Tong
    • 1
  • C.-C. Wu
    • 2
    • 3
  • C.-H. Bai
    • 4
  • H.-C. Lee
    • 1
  • H.-H. Liang
    • 1
    • 3
    • 5
  • L.-J. Kuo
    • 1
    • 5
  • P.-L. Wei
    • 1
    • 3
  • K.-W. Tam
    • 1
    • 3
    • 5
    • 6
    Email author
  1. 1.Division of General Surgery, Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan
  2. 2.Department of UrologyTaipei Medical University HospitalTaipeiTaiwan
  3. 3.Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  4. 4.School of Public HealthTaipei Medical UniversityTaipeiTaiwan
  5. 5.Graduate Institute of Clinical Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  6. 6.Center for Evidence-based MedicineTaipei Medical UniversityTaipeiTaiwan

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