Introduction: The laparoscopic repair of ventral hernias can result in significant postoperative pain resulting in prolonged length of hospital stay, increased narcotic utilization, and patient dissatisfaction. Elastomeric pain pump devices with local analgesics may result in a significant reduction in postoperative discomfort after laparoscopic ventral hernia repair. We evaluated the effect of continuous infusion of local anesthetic with an elastomeric pain pump device to reduce postoperative pain in a prospective randomized double blind placebo controlled study.
Methods: After IRB approval, all patients undergoing laparoscopic ventral hernia repair were consented to participate in the study. Standardized technique included routine transfascial fixation sutures and titanium spiral tacks. Elastomeric pain pumps were placed percutaneously just above the mesh, in the hernia sac. 100cc’s of continuous 0.5% marcaine or normal saline at 2 ml/hr were utilized for 48 hours postoperatively. Postoperatively, patients were evaluated every 8 hours for the first 72 hours, then 2 weeks, 6 weeks, and 3 months for pain scores, narcotic usage (both PO and IV), return of flatus, length of hospital stay, and postoperative complications.
Results: 73 patients were enrolled in the study, 37 received 0.5% marcaine and 36 received placebo. Despite randomization, the control group had significantly more obese patients (mean BMI 39 v 33 kg/m2;p=0.005), more recurrent hernias (40% v 19%; p= 0.05), and tended to have more prior hernia repairs (0.8 v 0.3; p=0.06). There were no significant differences between the two groups based on operative times (p=0.7), hernia size (p=0.9), mesh size (p=0.6), number of transfascial fixation sutures (p=0.4), or spiral tacks (p=0.13). Postoperative visual analog pain scores, usage of oral or intravenous narcotics, and morphine equivalents were similar between the two groups at all study points (p>0.05). There were no significant differences between the two groups based on return of bowel function, tolerating a regular diet, or length of stay. No postoperative complications occurred directly related to the catheter.
Conclusions: This prospective randomized double blind placebo controlled trial shows no advantage of an elastomeric pain pump device to provide a measurable reduction in postoperative pain scores, narcotic utilization, return of bowel function, or hospital stay after laparoscopic ventral hernia repair. Further studies are warranted to determine other alternatives for reducing postoperative pain after laparoscopic ventral hernia repair.
Session: Podium Presentation
Program Number: S092