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AMBULATORY ANESTHESIA

Preincisional Treatment to Prevent Pain After Ambulatory Hernia Surgery

From the Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington

Address correspondence to D. J. Pavlin, Department of Anesthesiology, University of Washington, 1959 NE Pacific, Seattle, WA 98195. Address email to jpavlin{at}u.washington.edu

We designed this study as a randomized comparison of postoperative pain after inguinal hernia repair in patients treated with triple preincisional analgesic therapy versus standard care. Triple therapy consisted of a nonsteroidal antiinflammatory, a local anesthetic field block, and an N-methyl-D-aspartate inhibitor before incision. The treatment group (n = 17) received rofecoxib, 50 mg PO, a field block with 0.25% bupivacaine/0.5% lidocaine, and ketamine 0.2 mg/kg IV before incision; controls (n = 17) received a placebo PO before surgery. The anesthetic protocol was standardized. Postoperative pain was treated by fentanyl IV and oxycodone 5 mg/acetaminophen 325 mg PO as required for pain. Pain scores (0–10) and analgesic were recorded for the first 7 days after surgery. Pain scores were 47% lower in the treatment group before discharge (3.1 ± 0.6 versus 5.9 ± 0.6, P = 0.0026) (mean ± SE) and 18% less in the first 24 h after discharge (5.6 ± 0.4 versus 6.8 ± 0.5, P = 0.05); oral analgesic use was 34% less in the treatment group (4.6 ± 0.8 doses versus 7.1 ± 0.7 doses, P = 0.02) in the first 24 h after surgery. We conclude that triple preincisional therapy diminishes pain and analgesic use after outpatient hernia repair, and encourage further evaluation of this technique.

IMPLICATIONS: Outpatients undergoing inguinal hernia repair under general anesthesia report moderate-to-severe pain after surgery. Triple preincisional therapy that included rofecoxib, 50 mg PO, ketamine, 0.2 mg/kg IV, and local anesthetic field block reduced pain scores and analgesic use in the first 24 h after discharge.

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