Port Site Infiltration and Extraperitoneal Instillation of Ropivacaine in Totally Extraperitoneal Hernia Repair: A Randomized Controlled Trial.

Aim: To evaluate the role of intraoperative local anesthetic use in the reduction of postoperative pain after totally extraperitoneal (TEP) hernia repair. Settings and design: Teaching hospital in Delhi, RCT. Materials and methods: 18-60-year-old men with unilateral inguinal hernia were randomized to either ropivacaine group (30) or placebo group (30) using a randomization sequence generated online. Port sites and preperitoneal space received either 0.75% ropivacaine or 0.9% saline (placebo). The primary outcome was numerical response scale (NRS) pain score at 6 hours after surgery. The secondary outcomes include NRS at 2 hours, 24 hours, and total analgesic requirement during the first postoperative week. The same surgeon using the same type of mesh performed all procedures using three midline ports and without mesh fixation. The patient, surgery team, and observer were blinded. Statistical analysis used: Shapiro--Wilk test of normality, median test for independent samples. Results: All patients underwent allocated procedure. There were no conversions. The baseline parameters were comparable in the two groups. The Shapiro--Wilk test of normality revealed that the data were not distributed normally. The median NRS at 6 hours was 3 (IQR 1, 3) in the ropivacaine group compared with 3 (IQR 1, 4) in the placebo group (p = 0.981, Independent samples median test). Similar comparable pain scores were obtained at 2 and 24 hours. No significant difference was noted in analgesic requirement in the first 24 hours, till postoperative day 7, time to ambulation or micturition between groups. Conclusions: Infiltration of port sites and preperitoneal space with ropivacaine does not reduce postoperative pain or analgesic requirement in TEP. Clinical significance: The use of local anesthetic agents intraoperatively has no added benefit in reducing postoperative pain in TEP hernia repair. [ABSTRACT FROM AUTHOR]