Pre-emptive infiltration of Bupivacaine in laparoscopic total extraperitoneal hernioplasty: a randomized controlled trial.

Aim: To investigate the effectiveness of pre-emptive preperitoneal infiltration of 0.5% Bupivacaine in postoperative pain control in laparoscopic total extraperitoneal (TEP) hernioplasty.
Method: We conducted a prospective randomized controlled three-arm study. Consecutive patients aged 18-75 years with reducible groin hernia undergoing laparoscopic TEP hernioplasty in our day surgery unit were recruited. They were randomized into three groups. The pre-emptive Bupivacaine group (PBU) received infiltration of 10 ml 0.5% Bupivacaine to port sites before skin incision and another 10 ml to the preperitoneal space immediately after the creation of a first working port before further dissection. The standard Bupivacaine group (SBU) received infiltration of Bupivacaine after mesh placement, while in the control group (CO), the same amount of saline was injected instead. All operations were performed with the same surgical technique by a single surgeon. Postoperative pain was recorded at 2, 6, and 24 h by an independent assessor using a 0-10 verbal rating scale. The operative time, complications, and analgesia consumption, as well as patient satisfaction were also measured.
Results: Ninety patients were randomized into three groups of 30. There were no differences in age, American Society of Anesthesiologists (ASA) risk classification, number of bilateral diseases, and operation time. The pain score was significantly reduced by Bupivacaine compared with control patients, while pre-emptive Bupivacaine was better than standard Bupivacaine. Fourteen out of ninety patients (15.6%) had seroma formation. All patients were discharged on the same day of operation.
Conclusion: Pre-emptive preperitoneal infiltration of 0.5% Bupivacaine significantly reduces postoperative pain in laparoscopic TEP hernioplasty.