Immediate Postoperative Pain Medication Use After Laparoscopic Ventral Hernia Repair

Maureen M Tedesco, MD, Dan Eisenberg, MD MS. Stanford University Medical Center and Palo Alto VA HCS

Introduction
Immediate postoperative pain control is an important, and at times, difficult aspect in laparoscopic ventral hernia repair. In this study we examined whether placement of larger mesh, with a greater number of tacks, is associated with a greater usage of pain medication after surgery.

Methods
A prospective database of laparoscopic ventral hernia repairs performed at a single institution was retrospectively reviewed. Mesh fixation was accomplished with circumferential spiral tacks (ProTack, Covidien, North Haven, CT) and 4-6 trans-fascial sutures. Mesh sizes were recorded in each case, and mesh perimeters were calculated as a surrogate measure of the number of tacks placed. Narcotic usage in the recovery room was documented and morphine equivalents calculated.

Results
Between September 2007 and September 2011, 94 patients underwent a laparoscopic ventral hernia repair with Parietex composite mesh (Covidien, North Haven, CT) (52 incisional, 39 umbilical, 2 epigastric, 1 spigellian). The average mesh perimeter was 47.6 ± 20.0 cm (range 21.98-110 cm). The average narcotic use in the recovery room corresponded to a morphine dose of 6.91 ± 7.29 mg. there was no correlation between mesh perimeter and morphine dose (correlation coefficient = -0.09). However, when the cohort was divided into small mesh (<50 cm perimeter) and large mesh (>50 cm perimeter), there was a significant difference in morphine usage. Patients with small mesh required significantly more morphine compared to those with large mesh (8.07 mg vs. 5.22 mg, p=0.03).

Conclusion
The number of tacks used to secure the mesh in a laparoscopic ventral hernia repair does not significantly influence immediate postoperative narcotic pain medication requirements. Pain medication requirements are not decreased when smaller mesh and fewer tacks are used.
 

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