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Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

100%

Cybułka B.

Polish Journal of Surgery

2017

vol. 89(2)

11-25

With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may eventually result in loss of trust in the operator. Every surgical intervention is associated with the risk of immediate or delayed complications. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surrounding tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair. The possibility of minimizing chronic inguinal pain by proper management during herniorraphy should be considered in all cases of an inguinal canal reconstruction. The aim of the study was to investigate whether an intraoperative injection of 0.5% bupivacaine into the operated site (preemptive analgesia) has an influence on the postoperative pain assessed on the day of operation as well as the 1st and 2nd postoperative day after Lichtenstein hernioplasty of an inguinal, scrotal or recurrent hernia. In the studied population, we attempted to identify risk factors affecting pain level after surgical repair of an inguinal, scrotal or recurrent hernia. Materials and methods. During the period between December 2015 and May 2016, 133 patients with preoperative diagnosis of an inguinal (81.95%, n=109), scrotal (13.53%, n=18) or recurrent hernia (4.51%, n=6) underwent an elective intervention and were randomly allocated to the group, which intraoperatively received 20 mL of 0.5% bupivacaine locally in selected anatomical points of the inguinal canal. In the group with preoperative diagnosis of an inguinal hernia, this intervention was applied in 56.88% of cases (n=62). In the case of scrotal or recurrent hernia, a similar intervention was applied in 41.67% (n=10) of patients. During the hospital stay, pain was assessed four times a day using the NRS numeric scale. All patients received preoperative antibiotic prophylaxis, and, during observation, analgesics and low-molecular-weight heparin were used. In the studied group, risk factor were identified, which affect the pain level associated with surgical treatment of an inguinal hernia. Results: Mean pain level score according to the NRS scale (0-10) for an inguinal hernia was 4.17 on day 0 (standard deviation 2.22; minimum 0; maximum 10). On day 1 – 2.86 (standard deviation 1.86; minimum 0; maximum 8). On day 2 – 0.84 (standard deviation 1.21; minimum 0; maximum 5). The values of those parameters for a scrotal and recurrent hernia were as follows: on day 0 – 3.67 (standard deviation 1.76; minimum 0; maximum 7). On day 1 – 3.79 (standard deviation 1.67; minimum 0; maximum 7). On day 2 – 2.25 (standard deviation 1.54; minimum 0; maximum 4). Intraoperative application of 20 mL 0.5% bupivacaine did not reduce the postoperative pain on the postoperative day 0, 1, 2. Among independent risk factors exacerbating pain, the following variables were identified: local complications of the operated site including edema, ecchymosis and hematoma of the inguinal region. More frequent dressing changes were directly correlated with an increased pain sensation. Postoperative urethral catheterization due to urinary retention was associated with an increased pain immediately after surgery. In the case of intraoperative diagnosis of concurrent direct and indirect hernia (so-called pantaloon hernia), less intense pain was observed on postoperative day 0. Other parameters such as age, sex, duration of operation, duration of hospitalization and wound drainage did not influence the pain sensation. Conclusions: Local injection of an analgesic into the operated site was not associated with the reduction of pain assessed on postoperative day 0, 1 and 2 after an isolated inguinal, scrotal or recurrent hernia repair. Pathologies of the operated site such as edema, ecchymosis or hematoma were associated with an increased pain sensations on observation. Also, postoperative urinary retention and urethral catheterization increased the pain sensation after an inguinal hernia repair. A lack of wound complications significantly decreased the pain sensation during the immediate postoperative period after hernia repair.

Comparison of spinal anaesthesia with 0.75% ropivacaine and 0.5% bupivacaine for elective caesarean section

72%

Kasza T., Knapik P., Misiołek H., Knapik D.

BACKGROUND The aim of this study was to compare clinical effi cacy and safety of hyperbaric ropivacaine and hyperbaric bupivacaine for spinal anaesthesia for elective cesarean section. METHODS A prospective, randomized study was performed in 75 patients with low preoperative risk, scheduled for elective caesarean section, randomly allocated in two groups (ropivacaine – 36 patients, bupivacaine – 39 patients). Spinal anaesthesia was performed in sedentary position, at the L3/L4 level and 2 mls of 0.75% hyperbaric ropivacaine or 0.5% hyperbaric bupivacaine was administered. The infl uence of the blockade on the function of the cardiovascular and respiratory system, the need for additional medications, side-eff ects, the quality of the blockade as well as spread and regression were assessed. The evaluation of anaesthesia was performed by both the patients and the surgeons. All data underwent statistical analysis. Statistical signifi cance was noted if p value was below 0,05. RESULTS Haemodynamic parameters and respiratory function were similiar in both groups. There were no diff erences between groups regarding side-eff ects, the need for additional medication and the quality of the blockade. Spread and regression of motor and sensory blockade and their duration was similar. The evaluation of the anaesthesia by the patients and the surgeons was similar. Both local anaesthetic agents provided suffi cient, safe and satisfactory spinal anaesthesia for elective caesarean section. CONCLUSIONS Spinal administration of 2 ml of plain hyperbaric 0,75% ropivacaine and hyperbaric 0,5% bupivacaine provides safe anaesthesia for caesarean section, satisfactory analgesia and good surgical conditions. Ropivacaine off ers no signifi cant advantage over bupivacaine during spinal anaesthesia for elective caesarean section.

WSTĘP Celem badania było porównanie użyteczności klinicznej i bezpieczeństwa hiperbarycznej ropiwakainy i hiperbarycznej bupiwakainy podczas znieczulenia podpajęczynówkowego do planowego cięcia cesarskiego. MATERIAŁ I METODY Prospektywne, randomizowane badanie zostało przeprowadzone u 75 pacjentek niskiego ryzyka operacyjnego, zakwalifi kowanych do planowego cięcia cesarskiego, które zostały przydzielone losowo do dwóch grup (ropiwakaina, n=36, bupiwakaina, n=39). Znieczulenie podpajęczynówkowe zostało wykonane w pozycji siedzącej. Pacjentkom podano 2 ml hiperbarycznej ropiwakainy w stężeniu 0,75% lub 2 ml hiperbarycznej bupiwakainy w stężeniu 0,5% do przestrzeni podpajęczynówkowej na poziomie L3/L4. Oceniono wpływ blokady na funkcję układu krążenia i układu oddechowego, konieczność zastosowania dodatkowych leków, częstość objawów ubocznych związanych z blokadą, oraz jakość uzyskanej blokady. Znieczulenie zostało ocenione zarówno przez operatorów, jak i przez pacjentki. Dane poddano analizie statystycznej, a znamienność statystyczną przyjęto dla wartości współczynnika p<0,05. WYNIKI Parametry hemodynamiczne i funkcja układu oddechowego były zbliżone w obu badanych grupach. Nie stwierdzono żadnych istotnych różnic w zakresie częstości występowania objawów ubocznych, konieczności zastosowania dodatkowych leków, a także jakości i charakterystyki (rozprzestrzeniania się i regresji) uzyskanej blokady. Ocena znieczulenia z użyciem obu środków była zbliżona. Oba analgetyki miejscowe zapewniły wystarczającą i bezpieczną analgezję podpajęczynówkową do planowego cięcia cesarskiego. WNIOSKI Znieczulenie podpajęczynówkowe z użyciem 2 ml hiperbarycznej 0,75% ropiwakainy i hiperbarycznej 0,5% bupiwakainy zapewnia bezpieczne znieczulenie do cięcia cesarskiego, zadowalającą analgezję i dobre warunki operacyjne. Ropiwakaina nie wykazuje znaczącej przewagi nad bupiwakainą podczas planowego cięcia cesarskiego.

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1 Annales Academiae Medicae Silesiensis

1 Polish Journal of Surgery

1 2017

1 2009

1 Cybułka B.

1 Kasza T.

1 Knapik D.

1 Knapik P.

1 Misiołek H.

Search results

Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

Comparison of spinal anaesthesia with 0.75% ropivacaine and 0.5% bupivacaine for elective caesarean section