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

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

Neli Vintar, MD^*, Gorazd Pozlep, MD^*, Narinder Rawal, MD PhD, Marija Godec, MD^* and Slavko Rakovec, MD PhD

^* From the Departments of Anesthesiology and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia;
the Department of Anesthesiology and Intensive Care, Örebro Medical Center Hospital, Örebro, Sweden, and
the Clinical Department for general surgery and surgical infections, University Medical Centre Ljubljana, Ljubljana, Slovenia.

Address correspondence to: Dr. Neli Vintar, Clinical Department of Anesthesiology and Intensive Therapy, University Medical Centre, 1000 Ljubljana, Slovenia, Phone and Fax: ++386-01-52-22-234; E-mail: neli.vintar{at}mf.uni-lj.si

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.

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