The impact of preemptive ropivacaine in inguinal hernioplasty – A randomized controlled trial

Saeed, Muhammad; Andrabi, W.I.; Rabbani, Said; ZAHUR, None SAQUIB; Mahmood, Khalid; Andrabi, Syed Imran Hussain; Butt, Hira; Chaudhry, Amit

doi:10.1016/j.ijsu.2014.11.037

Cited by 11 publications

(5 citation statements)

References 18 publications

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“…Several research trials have tested the preemptive analgesic efficacy of various medications and techniques, such as nonsteroidal anti-inflammatory drugs (NSAID), also known as non opioid analgesics [5][6][7]. NSAIDs restrict cyclooxygenase enzymes, leading to inhibition in prostaglandin synthesis.…”

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confidence: 99%

Comparison of the Analgesic Effects of Preemptive Lornoxicam and Paracetamol after Laparoscopic Cholecystectomy

Karaman¹

2016

Int J Anesthetic Anesthesiol

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Objectives: Despite increasing knowledge about pain, postoperative pain management is still a challenge. Opioids are widely used drugs in the treatment, but the side effects of the opioids lead to investigations about the novel pain management strategies. We aimed to compare the effects of preemptive intravenous lornoxicam and paracetamol on postoperative pain scores, opioid consumption, and patient satisfaction during laparoscopic cholecystectomy recovery. Materials and methods:Sixty patients scheduled for laparoscopic cholecystectomy surgery were randomized into three treatment groups that received lornoxicam (8 mg), paracetamol (1000 mg), or normal saline (control) 30 minutes before surgery. Time to the first analgesic requirement, visual analog scale scores, tramadol consumption, side effects, and patient satisfaction were recorded.Results: Time to the first analgesic requirement and tramadol consumption were higher in the control group than in the paracetamol and lornoxicam groups (p < 0.001). Tramadol consumption of the lornoxicam group was higher than that of the paracetamol group at the 1-, 2-, and 8-hour measurements (p = 0.048, p = 0.047, p = 0.040, respectively). However, total tramadol consumption in lornoxicam and paracetamol groups was not statistically different at 24 hours. Conclusion:Preemptive intravenous lornoxicam and paracetamol equally reduce opioid consumption, compared to placebo, after laparoscopic cholecystectomy. Both drugs may be viable alternatives for postoperative pain treatment to avoid opioid-related side effects.

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confidence: 99%

Comparison of the Analgesic Effects of Preemptive Lornoxicam and Paracetamol after Laparoscopic Cholecystectomy

Karaman¹

2016

Int J Anesthetic Anesthesiol

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“…Regional anesthetic techniques, such as wound infiltration received by all our study patients, have been shown to be very beneficial [23,24].…”

Section: Discussionmentioning

confidence: 91%

Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair

Péré

Harju

Kairaluoma

et al. 2016

Journal of Clinical Anesthesia

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Study objective: Comparison of local anesthetic infiltration (LAI), spinal anesthesia (SPIN) and total intravenous anesthesia (TIVA) for open inguinal herniorrhaphy. We hypothesized that patients receiving LAI could be discharged faster than SPIN and TIVA patients. Design: Randomized, prospective trial. Setting: University hospital day-surgery center. Patients: 156 adult male patients (ASA 1-3) undergoing day-case open inguinal herniorrhaphy. Interventions: Patients were randomized to either LAI (lidocaine + ropivacaine), SPIN (bupivacaine + fentanyl) or TIVA (propofol + remifentanil). Perioperative Ringer infusion was 1.5 mL/h. Urinary bladder was scanned before and after surgery. Interviews were performed on postoperative days 1, 7 and 90. Measurements: Duration of surgery, duration of the patients' stay in the operating room and time until their readiness for discharge home. Patient satisfaction and adverse effects were registered. Main results: Surgery lasted longer in LAI group (median 40 min) than in SPIN group (35 min) (P = .003) and TIVA group (33 min) (P b .001). Although surgery was shortest in TIVA group, TIVA patients stayed longer in the operating room than LAI patients (P = .001). Time until readiness for discharge was shorter in LAI group (93 min) than in TIVA (147 min) and SPIN (190 min) groups (P b .001). Supplementary lidocaine infiltration was given to 32 LAI patients, and IV fentanyl to 29 LAI and 4 SPIN patients. Ephedrine was required in 34 TIVA, 5 LAI and 5 SPIN patients. One SPIN and three LAI patients had to be given TIVA and another SPIN patient LAI to complete the operations. Urinary retention was absent. Discomfort in the scar (26%) three months postoperatively was not anesthesia-related. Conclusions: Logistically, LAI was superior because of the fastest recovery postoperatively. The anesthetic techniques were adequate for surgery in all but a few LAI and SPIN patients. Lack of urinary retention was probably related to the small IV infusion volumes.

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“…6 In contrast (and not surprisingly), when ilioinguinal and iliohypogastric blocks (with 0.75% ropivacaine) were combined with wound infiltration and compared with placebo, there were a number of clinical benefits. 7 Although these reports may oversimplify the concept of pre-emptive analgesia (and the difficulties of any meaningful clinical data), any study that demonstrates a positive effect is worth exploring further. To our knowledge, the present study is the first to look at the use of this common LA solution mixture to provide pre-emptive analgesia in a day-case setting.…”

Section: Discussionmentioning

confidence: 99%

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

Radwan

Gardner

Jayamanne

et al. 2018

annals

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Introduction The open prosthetic repair of inguinal hernias under local anaesthesia (LA) is well established, with the concept of intraoperative 'pre-emptive analgesia' evolving so that patients are as comfortable as possible. We used a peri-incisional LA solution in patients undergoing day-case inguinal hernioplasty under general anaesthesia (GA) and recorded use of analgesia in the immediate postoperative period. Methods In this observational cohort study, 100 consecutive unselected men underwent open inguinal hernia repair as a day case. Of these, 75 underwent repair under GA and 25 with peri-incisional LA solution (equal mixture of 0.5% bupivacaine and 1% lignocaine with 1:200,000 adrenaline). Analgesia prescribed at induction, for maintenance and after cessation of anaesthesia was scored in accordance with the World Health Organization (WHO) analgesic ladder. Results The median age in the GA group was 59 years (range: 25-89 years) and in the GA+LA group, it was 62 years (range: 27-88 years). Of the 100 patients, 82 underwent a mesh plug repair by seven surgeons whereas 18 underwent a flat (Lichtenstein) mesh repair by two surgeons. WHO analgesic induction and postoperative scores were significantly lower in the GA+LA group (p=0.034 and p<0.001 respectively). There was also a significant difference in use of postoperative antiemetics (23% vs 0% in the GA only and GA+LA cohorts respectively, p=0.020). Six patients (8%) in the GA group failed day-case discharge criteria. Conclusions Patients undergoing contemporary day-case GA inguinal hernioplasty with pre-emptive LA solution infiltration require lower levels of postoperative opioid analgesia and antiemetics. These cases are less likely to fail discharge criteria for planned day surgery.

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The impact of preemptive ropivacaine in inguinal hernioplasty – A randomized controlled trial

Abstract: Preemptive analgesia with 0.75% ropivacaine causes significant reduction in pain perception, request for an analgesic and hospital stay. Therefore it is advisable before inguinal hernioplasty.

Cited by 11 publications

References 18 publications

Comparison of the Analgesic Effects of Preemptive Lornoxicam and Paracetamol after Laparoscopic Cholecystectomy

Comparison of the Analgesic Effects of Preemptive Lornoxicam and Paracetamol after Laparoscopic Cholecystectomy

Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair

Benefits of pre-emptive analgesia by local infiltration at day-case general anaesthetic open inguinal hernioplasty

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