Page 44 - Journal of World Association of Laparoscopic Surgeons

Pain Relief After LVHR
Table 2: Study characteristics of included trials comparing LA interventions for postoperative pain up to 24 hours following LVHR
Mean morphine
consumption in
Design, 24 hours (mg) Pain score Mean pain scores at

N [intervention/ [intervention/ measure rest [intervention/ Main findings
Study control] Intervention LA agent, control control] (0–10) † control] of intervention
29
Bellows RCT, 9/9 Trans-abdominal LA 10 mL 0.25% 24.1 ± 7.2/ VAS 1 hours: 2.2 ± 0.8/ Significant
injected at suture bupivacaine with 26.3 ± 9.2 6.4 ± 0.9* reduction in
sites prior to suture epinephrine, no 2 hours: 3.1 ± 0.9/ pain scores at
placement control 3.9 ± 1.1 one hour after
4 hours: 1.1 ± 0.4/ surgery
2.6 ± 0.9
24 hours: 2.3 ±
0.8/2.3 ± 1.0
30
Fields RCT, 52/48 Laparoscopic assisted 50–60 mL 0.25% 25.64/42.56* VAS 1 hours: 5.19 ± 0.39/ Significant
TAP block bupivacaine, 0.9% 6.46 ± 0.38* reduction in
normal saline 24 hours: 4.60 ± pain scores and
0.39/4.52 ± 0.31* total morphine
consumption in
24 hours
31
Gough RCT, 42/38 Peri-prosthetic LA 0.5% bupivacaine, 4.8 ± 17.3/ NRS <1.5 hours: 4.4 ± 2.4/ Reduced pain
injection, with all 0.9% normal 6.7 ± 15.4 4.8 ± 2.2 scores and total
patients receiving LA saline 22.5–24.5 hours: morphine con-
port site injections 3.6 ± 2.5/2.7 ± 1.4 sumption (not
significant)
32
Rosen RCT, 37/36 Continuous 0.5% bupivacaine, 52.2/44.5 VAS 0:1.7/2.3 No advantage
elastomeric pain 0.9% normal 8 hours: 5.7/5.5 in reduction
pump infusion of LA saline 16 hours: 5.4/5.6 pain scores and
for 48 hours above total morphine
the mesh in the 24 hours: 5.0/6.0 consumption in
hernia sac 24 hours
VAS, visual analog scale; LA, local anesthetic; LVHR, laparoscopic ventral hernia repair; TAP, transverse abdominis plane; NRS, numerical rating scale; VRS,
verbal rating score; PPI, present pain intensity; RCT, randomized controlled trial.
† All pain scores use a 0–10 point scale with a score of 10 signifying the worst possible pain.
*p <0.05.

Fig. 1: Cochrane risk of bias figure

36 World Journal of Laparoscopic Surgery, Volume 12 Issue 1 (January–April 2019)