Inguinal Hernia
Conditions
Keywords
Dexamethasone, Ilioinguinal and Iliohypogastric nerve block, Bupivacaine, Rebound Pain
Brief summary
Rebound pain is a newly defined phenomenon, observed within the first 24 hours after the operation. Open inguinal hernia repair is a common surgical procedure that can be associated with pain of the either acute or chronic character. A peripheral nerve block of the ilioinguinal (IIN) and iliohypogastric (IHN) nerves is a relatively well-known method for postoperative pain management. However, rebound pain after IIN/IHN block resolution may reduce its overall benefit. The primary aim is to assess whether intravenous dexamethasone reduces postoperative opioid consumption and the incidence of rebound pain in patients undergoing unilateral hernia repair in adults.
Detailed description
Male patients older than 18 years, of American Society of Anesthesiologists physical status I or II, and scheduled for unilateral primary hernia repair with a Lichtenstein style (open surgery with insertion of mesh) under general anesthesia will be included in the study. The patients will be randomized using a computer-generated randomization technique. After induction of general anesthesia, the patients in the dexamethasone group (Group Dex) will receive 5 mg dexamethasone in a 50 ml syringe containing normal saline. The patients in the saline group (Group S) will receive normal saline in a 50 ml syringe. Ultrasound-guided block of the ilioinguinal (IIN) and iliohypogastric (IHN) nerves will be performed on all patients included in both groups. The primary aim is to assess whether intravenous dexamethasone reduces postoperative opioid consumption and the incidence of rebound pain in patients undergoing unilateral hernia repair in adults.
Interventions
DRUGDexamethasone
5 mg dexamethasone in a 50 ml syringe containing normal saline will be infused within 15 minutes. The syringe will be prepared by a nurse outside the research team and the Study participants, care providers, and data collectors will be blinded to the allocation throughout the study. Global Quality of Recovery- 15 score and standard pain follow-up scores will be noted.
DRUGSaline
A 50 ml syringe containing normal saline will be infused within 15 minutes. The syringe will be prepared by a nurse outside the research team and the study participants, care providers, and data collectors will be blinded to the allocation throughout the study. Global Quality of Recovery- 15 score and standard pain follow-up scores will be noted.
Sponsors
Karaman Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* ASA I-II * Having signed a written informed consent form * Scheduled for unilateral primary hernia repair Lichtenstein style (open surgery with insertion of mesh) under general anesthesia
Exclusion criteria
* Chronic opioid use (more than one month of 60 mg of oral morphine equivalents daily) * Contraindications to peripheral nerve blocks including localized infection, coagulopathy, or allergy to local anesthetics * Stomach ulcer * Severe obesity (body mass index \> 35 kg/m2) * Uncontrolled Diabetes * Psychiatric disorders * Systemic steroid use * Neuropathic disorder * Can not communicate in Turkish
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified Rebound Pain Score | Postoperative 24 hours | Modified Rebound Pain score is described as the difference between the last recorded postanesthesia care pain score while it will be working and the highest pain score reported within the first 24 h after IIN/IHN blocks will be performed. Pain score will be calculated with Numeric Rating Scale (NRS)(0 = no pain; 10 = worst pain imaginable) |
| Analgesic consumption | Postoperative 24 hours | Postoperative total opioid consumption |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of Sleep | One week after surgery | Patient's perceived sleep quality will be assessed with Likert scale.Likert scale is scored from 1(very dissatisfied) to 5 (very satisfied). |
| Analgesic consumption | Postoperative 48 hours | Postoperative total opioid consumption |
| Numerical Rating Scale scores at rest and mobilization | Postoperative 48 hours | Pain scores (0 = no pain; 10 = worst pain imaginable) using a Numerical Rating Scale (NRS) ranging from 0 to 10. |
| Glucose measurement | Postoperative 24th hour | Glucose measurement |
| Surgical infection | Postoperative 14 days | Surgical infection |
| Adverse events | Postoperative 24 hour | Incidence of nausea and vomiting during postoperative 24 hour time period will be noted. |
| Quality of Recovery 15 Score | Postoperative Day 1 | Quality of Recovery (QoR)-15 survey.Minimum value: 0, Maximum value: 150, higher scores mean better. |
Countries
Turkey (Türkiye)
Outcome results
None listed