Journal d'anesthésiologie clinique : accès libre

A Small Prospective Randomized Double-Blind Placebo Controlled Trial Evaluating the Efficacy of Postoperative Use of Elastomeric Pain Pumps Following Laparoscopic Ventral Hernia Repair

Abstract

Francis J Deasis, Brittany Lapin, Matthew E Gitelis, John G Linn, Woody Denham, Stephen P Haggerty, Joann M Carbray and Michael B Ujiki

Objective: Laparoscopic Ventral Hernia Repair (LVHR) can result in significant postoperative pain. Elastomeric pain pump devices may reduce pain and narcotic medication use postoperatively. We present a prospective randomized double-blind placebo-controlled trial evaluating device efficacy in LVHR patients. Methods: Pumps were preperitoneally placed in LVHR patients, and a 4-day continuous bupivacaine or saline infusion (4 ml/hour) was given. Demographics, intra/postoperative information, and quality-of-life were compared between groups using chisquare test, t-test, and Mann-Whitney-U test. Quality-of-life consisted of pre/postoperative Short Form-36 surveys and 7-day self-reported pain and medication logs. Results: Twenty-nine LVHR patients received pumps: 17 (59%) with bupivacaine and 12 (41%) with saline. There was no difference in demographic and intraoperative variables. Mesh size was larger for saline patients compared to bupivacaine patients (median 429 vs 225 cm2, p=0.05). There was no difference in length-of-stay or complications. Discharge pain scores were worse for saline patients versus those receiving bupivacaine (median (q1,q3): 4 (2,5) vs 2 (0,3), p=0.064). Ketorolac use was higher in saline patients (p=0.01), and saline patients used pain medication longer (median (q1, q3) 9 (7,10) vs 6 (4,8), p=0.05). Other narcotic and non-narcotic use did not differ. Pain and medication logs showed significantly worse self-reported pain and pain management for the saline group versus the bupivacaine group on days 1-4 (p<0.05), with no differences reported after day 4. There were no differences in quality-of-life scores preoperatively or at 3 weeks postoperative. Conclusion: In this prospective randomized double-blind placebo-controlled trial, we found less pain at discharge, fewer days on pain medications, and less self-reported pain in patients receiving bupivacaine versus saline. However there was no significant reduction in most narcotic and non-narcotic medication use and no postoperative improvements in quality-of-life for LVHR patients using pumps. Larger studies investigating bupivacaine and other alternatives for reducing postoperative pain after LVHR are needed.