Effects of bupivacaine infiltration on postoperative tramadol consumption in elective day care unilateral inguinal hernia repair
Objective: To determine the difference in analgesic requirement in terms of mean postoperative narcotic consumption and mean postoperative pain score in patients undergoing unilateral inguinal hernia repair with or without bupivacaine infiltration as day-care patients.Methods: The randomised controlled trial was conducted at Aga Khan University Hospital, Karachi, from June to December 2011, and comprised patients who were randomly divided into groups A and B. Tramadol 1.5 mgkg-1 was used as intraoperative analgesia. At the time of closure of surgical incision, 20ml of bupivacaine 0.25% plain was infiltrated in the subcutaneous tissue sub-facially and in the deeper layers along the incision line in patients of group A. In group B, which was the control group, the surgical wound was closed without infiltrating bupivacaine. On arrival in post-anaesthesia care unit, the patient's pain scores was assessed using Visual Analogue Scale every 15 minutes for the first hour, every 30 minutes for next one hour, and hourly for the next two hours by a blinded observer. Postoperative narcotic consumption was also noted.Results: There were 80 patients in the study; 40(50%) in each of the two groups. Mean postoperative narcotic consumption and mean pain scores were high in group B in all follow-ups (up to 4 hours) compared to group A patients (p<0.05).CONCLUSIONS: Wound infiltration with 0.25% bupivacaine diminished post-operative pain and decreased narcotic analgesic consumption for the first four hours after unilateral inguinal hernia repair.