Mesh prosthetic soaked in local anesthetic for laparoscopic ventral hernia repair – A retrospective review on post-operative pain control

Simran K Randhawa, MD, Lawrence N Cetrulo, MD, Walter Capote, BA, Tuong C Nguyen, Pak S Leung, MD, Amit R Joshi, MD, FACS. Einstein Healthcare Network

Background: Laparoscopic ventral hernia repair (LVHR) has multiple advantages when compared to open repair.  However, patients continue to report early post-operative pain.  In an effort to minimize post-operative pain, we used polyester composite mesh pre-soaked in bupivacaine, and observed its mitigating effect on pain by measuring postoperative narcotic requirements.

Methods: We conducted a retrospective review of all patients undergoing outpatient LVHR using composite intra-abdominal polyester mesh by a single surgeon over three years.  Patients were divided into two groups:  those who underwent conventional LVHR with mesh and those who underwent LVHR with bupivacaine-soaked mesh. The amount of anesthetic solution absorbed by the mesh was estimated using weight-based calculations. Immediate post-operative narcotic requirement (total opioid dose) was calculated and compared using a t-test.

Results: A total of 40 patients underwent elective outpatient LVHR with polyester mesh from 2013-2015, of which plain mesh was used in 29 patients and soaked mesh in 11 patients.  Baseline and operative characteristics were similar in the two groups. The volume of anesthetic taken up by the mesh averaged 0.034 cc/cm2 mesh.  This was equivalent to 70% of the solution applied to the mesh topically.  In the recovery room, mean oral and intravenous narcotic use were not significantly reduced in the target group (15.2mg from 17.9 mg of oral oxycodone equivalent/patient, p=0.223)

Conclusion: Introduction of mesh soaked in local anesthetic did not significantly reduce the immediate post-operative narcotic requirement after LVHR.  Development of novel agents should be studied in the future using prospective randomized trials to reduce post-operative pain after LVHR.

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