Periprosthetic Anesthetic for Postoperative Pain After Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial | Surgery | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Forbes  SS, Eskicioglu  C, McLeod  RS, Okrainec  A.  Meta-analysis of randomized controlled trials comparing open and laparoscopic ventral and incisional hernia repair with mesh.  Br J Surg. 2009;96(8):851-858.PubMedGoogle ScholarCrossref
Goodney  PP, Birkmeyer  CM, Birkmeyer  JD.  Short-term outcomes of laparoscopic and open ventral hernia repair: a meta-analysis.  Arch Surg. 2002;137(10):1161-1165.PubMedGoogle ScholarCrossref
Colavita  PD, Tsirline  VB, Belyansky  I,  et al.  Prospective, long-term comparison of quality of life in laparoscopic versus open ventral hernia repair.  Ann Surg. 2012;256(5):714-722.PubMedGoogle ScholarCrossref
Saber  AA, Elgamal  MH, Rao  AJ, Itawi  EA, Martinez  RL.  Early experience with lidocaine patch for postoperative pain control after laparoscopic ventral hernia repair.  Int J Surg. 2009;7(1):36-38.PubMedGoogle ScholarCrossref
Bellows  CF, Berger  DH.  Infiltration of suture sites with local anesthesia for management of pain following laparoscopic ventral hernia repairs: a prospective randomized trial.  JSLS. 2006;10(3):345-350.PubMedGoogle Scholar
Rosen  MJ, Duperier  T, Marks  J,  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.PubMedGoogle ScholarCrossref
Carbonell  AM, Harold  KL, Mahmutovic  AJ,  et al.  Local injection for the treatment of suture site pain after laparoscopic ventral hernia repair.  Am Surg. 2003;69(8):688-691.PubMedGoogle Scholar
Dallal  GE. Last modified March 29, 2013. Accessed December 2011.
Heniford  BT, Park  A, Ramshaw  BJ, Voeller  G.  Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias.  Ann Surg. 2003;238(3):391-399.PubMedGoogle Scholar
Gammaitoni  AR, Fine  P, Alvarez  N, McPherson  ML, Bergmark  S.  Clinical application of opioid equianalgesic data.  Clin J Pain. 2003;19(5):286-297.PubMedGoogle ScholarCrossref
RxList Inc. Sensorcaine: clinical pharmacology. Last reviewed on RxList May 19, 2009. Accessed January 15, 2015.
Bansal  VK, Misra  MC, Babu  D,  et al.  Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study.  Surg Endosc. 2012;26(12):3476-3485.PubMedGoogle ScholarCrossref
Muysoms  F, Vander Mijnsbrugge  G, Pletinckx  P,  et al.  Randomized clinical trial of mesh fixation with “double crown” versus “sutures and tackers” in laparoscopic ventral hernia repair.  Hernia. 2013;17(5):603-612.PubMedGoogle ScholarCrossref
Nguyen  SQ, Divino  CM, Buch  KE,  et al.  Postoperative pain after laparoscopic ventral hernia repair: a prospective comparison of sutures versus tacks.  JSLS. 2008;12(2):113-116.PubMedGoogle Scholar
Wassenaar  E, Schoenmaeckers  E, Raymakers  J, van der Palen  J, Rakic  S.  Mesh-fixation 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(6):1296-1302.PubMedGoogle ScholarCrossref
Eriksen  JR, Poornoroozy  P, Jørgensen  LN, Jacobsen  B, Friis-Andersen  HU, Rosenberg  J.  Pain, quality of life and recovery after laparoscopic ventral hernia repair.  Hernia. 2009;13(1):13-21.PubMedGoogle ScholarCrossref
Reynvoet  E, Deschepper  E, Rogiers  X, Troisi  R, Berrevoet  F.  Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? a systematic review.  Langenbecks Arch Surg. 2014;399(1):55-63.PubMedGoogle ScholarCrossref
Sanchez  B, Waxman  K, Tatevossian  R, Gamberdella  M, Read  B.  Local anesthetic infusion pumps improve postoperative pain after inguinal hernia repair: a randomized trial.  Am Surg. 2004;70(11):1002-1006.PubMedGoogle Scholar
Bertoglio  S, Fabiani  F, Negri  PD,  et al.  The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: a randomized controlled multicenter study.  Anesth Analg. 2012;115(6):1442-1450.PubMedGoogle ScholarCrossref
Forastiere  E, Sofra  M, Giannarelli  D, Fabrizi  L, Simone  G.  Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy.  Br J Anaesth. 2008;101(6):841-847.PubMedGoogle ScholarCrossref
Bedi  AP, Bhatti  T, Amin  A, Zuberi  J.  Laparoscopic incisional and ventral hernia repair.  J Minim Access Surg. 2007;3(3):83-90.PubMedGoogle ScholarCrossref
Gonzalez  R, Mason  E, Duncan  T, Wilson  R, Ramshaw  BJ.  Laparoscopic versus open umbilical hernia repair.  JSLS. 2003;7(4):323-328.PubMedGoogle Scholar
Reynvoet  E, Berrevoet  F.  Pros and cons of tacking in laparoscopic hernia repair.  Surg Technol Int. 2014;25:136-140.PubMedGoogle Scholar
Candiotti  K.  Liposomal bupivacaine: an innovative nonopioid local analgesic for the management of postsurgical pain.  Pharmacotherapy. 2012;32(9)(suppl):19S-26S.PubMedGoogle ScholarCrossref
Eriksen  JR.  Pain and convalescence following laparoscopic ventral hernia repair.  Dan Med Bull. 2011;58(12):B4369.PubMedGoogle Scholar
Original Investigation
Pacific Coast Surgical Association
September 2015

Periprosthetic Anesthetic for Postoperative Pain After Laparoscopic Ventral Hernia Repair: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California
  • 2Department of Surgery, Community Hospital of the Monterey Peninsula, Monterey, California
  • 3Department of Surgery, Cleveland Clinic, Cleveland, Ohio
JAMA Surg. 2015;150(9):835-840. doi:10.1001/jamasurg.2015.1530

Importance  Laparoscopic ventral hernia repair (LVHR) using mesh is a well-established intervention for ventral hernia, but pain control can be challenging.

Objective  To determine whether instillation of a long-acting local anesthetic between the mesh and the peritoneum after LVHR reduces pain or narcotic requirements.

Design, Setting, and Participants  A prospective, double-blind, randomized clinical trial with data collection during a brief hospital stay in a tertiary care, community teaching hospital over 3 years between December 15, 2011, and March 28, 2014. Of 120 screened patients undergoing LVHR in this intention-to-treat analysis, 99 eligible patients were randomized. Forty-two patients received the study drug, and 38 patients received placebo. Patients with a history of chronic narcotic use were excluded.

Intervention  After mesh placement, a long-acting local anesthetic (bupivacaine hydrochloride, 0.50%) or placebo (0.9% normal saline) was injected between the mesh and the peritoneum.

Main Outcomes and Measures  Postoperative pain (on a standard scale ranging from 0 to 10), and narcotic medication use (intravenous morphine equivalents). There were no adverse events.

Results  Baseline and operative characteristics were similar except that the treatment group was older (61.8 vs 52.3 years, P = .001). After surgery, pain scores in the recovery room (3.2 vs 4.7, P = .003), interval total narcotic use (6.7 vs 12.5 mg, P = .003 at <4 hours and 0 vs 2.7 mg, P = .01 at 8-12 hours), and total intravenous narcotic use (9.2 vs 17.2 mg of morphine sulfate equivalents, P = .03) were significantly less in the treatment group.

Conclusions and Relevance  Administration of a long-acting local anesthetic between the mesh and the peritoneum significantly reduces postoperative pain and narcotic use after LVHR.

Trial Registration Identifier: NCT01530815