'Dissectalgia' following TEP, a new entity: its recognition and treatment. Results of a prospective randomized controlled trial

Hernia (2009) 13:591596DOI 10.1007/s10029-009-0538-6

ORIGINAL ARTICLE

Dissectalgia following TEP, a new entity: its recognition and treatment. Results of a prospective randomized controlled trial

S. Kumar M. Joshi S. Chaudhary

Received: 28 April 2009 / Accepted: 8 July 2009 / Published online: 31 July 2009 Springer-Verlag 2009

Abstract

Purpose To Wnd the eVect of pre-peritoneal instillation of bupivacaine on dissectalgia (pain over a wide area corresponding to the area of pre-peritoneal dissection) and return to work following totally extraperitoneal (TEP) repair for groin hernia in labor-active males.

Methods Fifty-three consecutive ASA grade I adult males undergoing TEP for groin hernia were randomized to control group A (n = 28) and test group B (n = 25), receiving 30 ml saline or 0.25% bupivacaine pre-peritoneally after placing mesh, respectively. Assessment parameters included time (h) to rescue analgesia, number of patients needing additional injectable analgesia at night during their hospital stay, visual analog scale (VAS) score for pain at 24 h, 48 h, and then weekly for 4 weeks, and time of resuming their job.

Results The time to rescue analgesia was signiWcantly shorter in group A (4.50 2.3) than in group B

(7.00 4.1), P = 0.0077. A signi

Wcantly greater number of group A patients needed additional injectable analgesia at bed time than group B patients (24 vs. 6, respectively,

P < 0.0001 on the Wrst night; 11 vs. 2, respectively, P = 0.008 on the second night). The VAS scores were signiWcantly higher in group A patients than group B patients(3.47 1.04 vs. 1.69 1.04, respectively, at 24 h postop

eratively, P < 0.0001; 2.29 1.44 vs. 1.36 0.81, respec

tively, at 48 h postoperatively, P = 0.0063). However, subsequent VAS scores up to 4 weeks postoperatively were comparable, as was the time of resuming their job. No patient had seroma/Xuid collection, chronic pain, or recurrence, with the minimum follow-up being 3 years. Conclusions Dissectalgia following TEP deserves its due recognition. Pre-peritoneal bupivacaine instillation signiW-cantly reduces its occurrence, although the time of patients resuming their jobs remains unaVected.

Keywords TEP repair Pre-peritoneal bupivacaine instillation Dissectalgia Laparoscopic hernia repair Inguinal hernia

Introduction

Endoscopic totally extraperitoneal (TEP) repair of groin hernia holds certain advantages (over open repair), such as less postoperative pain and early return to work...