World Journal of Laparoscopic Surgery

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VOLUME 12 , ISSUE 1 ( January-April, 2019 ) > List of Articles


Local Anesthetic Use for Pain Relief Following Laparoscopic Ventral Hernia Repair: A Systematic Review

Vaaiga Autagavaia, Jamie-Lee Rahiri, Melanie Lauti, Lydia Poole, Garth Poole, Andrew G Hill

Keywords : Analgesia, Laparoscopy, Outcomes, Ventral hernia

Citation Information : Autagavaia V, Rahiri J, Lauti M, Poole L, Poole G, Hill AG. Local Anesthetic Use for Pain Relief Following Laparoscopic Ventral Hernia Repair: A Systematic Review. World J Lap Surg 2019; 12 (1):33-38.

DOI: 10.5005/jp-journals-10033-1349

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To assess the effectiveness of the addition of local anesthetic (LA) techniques in reducing pain and morphine consumption in the first 24 hours following laparoscopic ventral hernia repair (LVHR) in adults. Background: Ventral hernias (VH) are a common condition; with risk factors (including obesity), the incidence of VH is projected to increase. Surgical VH repair is required for symptom relief and to prevent related complications. LVHR has significant advantages over open repair, with reduced infectious complications, shorter hospital stays, and more favorable outcomes in obese patients. However, in comparisonto open repair LVHR patients often experience severe pain post-LVHR. LA is an important part of multimodal analgesia regimes and their use in the context of post-operative LVHR pain management is growing in importance. Review results: A systematic review was performed according to PRISMA using search terms related to LA, LVHR post-operative pain, and morphine consumption; studies were limited to adults (>18 years) and randomized control trials (RCT). Four RCT met the inclusion criteria. All studies compared bupivacaine with normal saline, one also used bupivacaine with epinephrine; varying LA interventions were used. One study showed a statistically significant, but small (0.08 mg) reduction in pain scores at 24 hours, which is likely to be clinically insignificant. Three studies showed an overall reduction in morphine consumption at 24 hours, with only one reaching statistical and clinical significance. Conclusion: Bupivicaine LA interventions post-LVHR did not reduce pain scores at 24 hours, but morphine consumption appeared to have been reduced. Clinical significance: Despite some evidence of reduction in morphine consumption in the first 24 hours post-LVHR, further investigation is required regarding post-operative LVHR pain management using LA, including agent and mode of delivery.

  1. Muysoms FE, Miserez M, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13(4):407–414. DOI: 10.1007/s10029-009-0518-x.
  2. Moreno-Egea A, Carrillo-Alcaraz A. Management of non-midline incisional hernia by the laparoscopic approach: results of a long-term follow-up prospective study. Surg Endosc 2012;26:1069–1073. DOI: 10.1007/s00464-011-2001-x.
  3. Weerasekera D, Cox S, et al. Annual update of key results: New Zealand health survey. Wellington: Ministry of Health; 2015.
  4. Poulose BK, Shelton J, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 2012;16(2):179–183. DOI: 10.1007/s10029-011-0879-9.
  5. Melvin WS, Renton D. Laparoscopic ventral hernia repair. World J Surg 2011;35:1496–1499.
  6. Evans KK, Chim H, et al. Survey on ventral hernias: surgeon indications, contraindications, and management of large ventral hernias. Am J Surg 2012;78(4):388–397.
  7. Burger JW, Luijendijk RW, et al. Long-term follow-up of a randomized controlled trial of suture vs mesh repair of incisional hernia. Ann Surg 2004;240:578–583. DOI: 10.1007/s10029-015-1345-x.
  8. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc 1993;3:39–41.
  9. Forbes SS, Eskicioglu C, et al. Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh. Br J Surg 2009;96:851–858. DOI: 10.1002/bjs.6668.
  10. Sajid MS, Bokhari SA, et al. Laparoscopic vs open repair of incisional/ventral hernia: a meta-analysis. Am J Surg 2009;197:64–72. DOI: 10.1016/j.amjsurg.2007.12.051.
  11. Kapischke M, Schulz T, et al. Open vs laparoscopic incisional hernia repair: something different from a meta-analysis. Surg Endosc 2008;22:2251–2260. DOI: 10.1007/s00464-008-9773-7.
  12. Sauerland S, Walgenbach M, et al. Laparoscopic vs open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011 Mar 16(3):CD007781. DOI: 10.1002/14651858.CD007781.pub2.
  13. Mavros MN, Athanasiou S, et al. Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies. World J Surg 2011;35(11):2389–2398. DOI: 10.1007/s00268-011-1266-5.
  14. Shabanzadeh DM, Sorensen LT. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg 2012;256(6):934–945. DOI: 10.1097/SLA.0b013e318269a46b.
  15. Colon MJ, Kitamura R, et al. Laparoscopic umbilical hernia repair is the preferred approach in obese patients. Am J Surg 2013;205:231–236. DOI: 10.1016/j.amjsurg.2012.02.022.
  16. Colavita PD, Tsirline VB, et al. Laparoscopic vs open hernia repair: outcomes and sociodemographic utilization results from the nationwide inpatient sample. Surg Endosc 2013;27(1):109–117. DOI: 10.1007/s00464-012-2432-z.
  17. Misra MC, Bansal VK, et al. Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study. Surg Endosc 2006;20:1839–1845. DOI: 10.1007/s00464-006-0118-0.
  18. Barbaros U, Asoglu O, et al. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia 2007;11:51–56. DOI: 10.1007/s10029-006-0160-9.
  19. Asencio F, Aguiló J, et al. Open randomized clinical trial of laparoscopic vs open incisional hernia repair. Surg Endosc 2009;23:1441–1448. DOI: 10.1007/s00464-008-0230-4.
  20. Winslow ER, Diaz S, et al. Laparoscopic incisional hernia repair in a porcine model. What do transfixion sutures add? Surg Endosc 2004;18:529–535. DOI: 10.1007/s00464-003-8519-9.
  21. Nguyen SQ, Divino CM, et al. Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures vs tacks. JSLS 2008;12:113–116.
  22. Wassenaar E, Schoenmaeckers E, et al. Meshfixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 2010;24:1296–1302. DOI: 10.1007/s00464-009-0763-1.
  23. Eriksen JR. Pain and convalescence following laparoscopic ventral hernia repair. Dan Med Bull 2011;58(12):B4369.
  24. Holte K, Kehlet H. Epidural anaesthesia and analgesia: effects on surgical stress responses and implications for postoperative nutrition. Clin Nutr 2002;21:199–206.
  25. Moher D, Shamseer L, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1. DOI: 10.1186/2046-4053-4-1.
  26. Higgins J, Green S. Cochrane Handbook for Systematic Review of Interventions. The Cochrane Collaboration. Version 5.1.0, 2011.
  27. Higgins JP, Altman DG, et al. Cochrane Statistical Methods Group: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:5928. DOI: 10.1136/bmj.d5928.
  28. Review Manager Version 5.3, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
  29. Bellows C, Berger D. Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: a prospective randomised trial. JSLS 2006;10:345–350.
  30. Fields AC, Gonzalez DO, et al. Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial. J Am Coll Surg 2015;21(2):462–469. DOI: 10.1016/j.jamcollsurg.2015.04.007.
  31. Gough AE, Chang S, et al. Periprosthetic Anesthetic for Postoperative Pain After Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial. JAMA Surg 2015;150(9):835–840. DOI: 10.1001/jamasurg.2015.1530.
  32. Rosen MJ, Duperier T, et al. Prospective randomized double-blind placebo-controlled trial of postoperative elastomeric pain pump devices used after laparoscopic ventral hernia repair. Surg Endosc 2009;23(12):2637–2643. DOI: 10.1007/s00464-009-0470-y.
  33. Uskova A, O'Connor JE. Liposomal bupivacaine for regional anesthesia. Curr Opin Anaesthesiol 2015;28(5):593–597. DOI: 10.1097/ACO.0000000000000240.
  34. Morrison SG, Dominguez JJ, et al. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000;90:1308–1314. DOI: 10.1097/00000539-200006000-00009.
  35. Knudsen K, Beckman SM, et al. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997;78(5):507–514. DOI: 10.1093/bja/78.5.507.
  36. McEvoy GK, Bethesda MD. American Hospital Formulary Service Drug Information Drug Information. American Society of Health System Pharmacists Inc; 2015.
  37. Kahokehr A, Sammour T, et al. Intraperitoneal local anesthetic improves recovery after colon resection: a double-blinded randomized controlled trial. Ann Surg 2011;254(1):28–38. DOI: 10.1097/SLA.0b013e318221f0cf.
  38. Alexander DJ, Ngoi SS, et al. Randomized trial of periportal peritoneal bupivacaine for pain relief after laparoscopic cholecystectomy. Br J Surg 1996;83:1223–1225.
  39. Coughlin SM, Karanicolas PJ, et al. Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis. Surg Endosc 2010;24(12): 3167–3176. DOI: 10.1007/s00464-010-1111-1. Epub.
  40. Larson GM. Ventral hernia repair by the laparoscopic approach. Surg Clin North Am 2009;80:1329–1340. DOI: 10.1016/s0039-6109(05)70228-0.
  41. Ramshaw BJ, Esartia P, et al. Comparison of laparoscopic and open ventral herniorrhaphy. Am Surg 2009;65:827–831.
  42. White P. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg 2005;101:5–22. DOI: 10.1213/01.ane.0000177099.28914.a7.
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