Inguinal Hernia Unilateral, Pain Management
Conditions
Keywords
Lichtenstein repair, ketorolac, tramadol, opioid, visual analogue score, non-steroidal anti-inflammatory drugs
Brief summary
To control post-operative pain, multiple drugs are available, and in the western countries opioids are preferred. However, they have their own side effects, and so to reduce their dependence, multiple adjuncts are used. We compared the use of opioids vs just non steroidal anti-inflammatory drugs on post-operative pain control following inguinal hernia surgery
Detailed description
Inguinal hernia repair is one of the most common surgeries performed by general surgeons worldwide. The preferred procedure for primary open inguinal hernias is open mesh repair (tension-free)-also called Lichtenstein repair. Opioids remain the mainstay for post-operative analgesia, however, they have a tendency for dependence along with other side effects. Non-steroidal anti-inflammatory drugs (NSIADs) have been used as adjuncts to decrease the use of opioids, however, usually NSAIDs are not used in isolation following surgery. We compared post-operative analgesia following primary open inguinal hernia repair, with patients receiving only opioids vs patients only receiving NSAIDs. 60 patients were randomized in to 2 groups. Group A patients received tramadol injection (opioid) every 8 hours, while patients in Group B received injection ketorolac (NSAID) every 8 hourly. Pain was measured using visual analogue score at 2-, 6-, 12- and 24-hours following surgery.
Interventions
Patients in Group A received injection tramadol 50mg intravenously every 8 hours following surgery. Patients in Group B received injection ketorolac 30mg intravenously every 8 hours following surgery.
Sponsors
Pakistan Air Force (PAF) Hospital Islamabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Undergoing elective primary unilateral open inguinal hernia repair under spinal anesthesia - Lichtenstein repair with prolene mesh * ASA I or II * Ages 18 - 65
Exclusion criteria
* Patient on chronic pain meds * Patient receiving analgesics 24hrs prior to surgery * Incarcerated or strangulated hernia or recurrent hernia * BMI >40 * Allergic to medications being tested in this study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analogue scale - pain score | 2-, 6-, 12-, 24-hours following surgery | Visual analogue score to quantify pain following laparoscopic cholecystectomy. Maximum value is 10 (which means worst pain), and minimum value is 0 (which means no pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| nausea/vomiting | within 24 hours following surgery | time when nausea/vomiting was not present in the patient |
| Time to ambulation | within 24 hours following surgery | time after surgery when the patient started ambulating |
| rescue analgesia | within 24 hours following surgery | number of times rescue analgesia was used |
| Flatus | within 24 hours following surgery | Time to passing flatus |
| Heart rate | 2-, 6-, 12-, 24 hours | Heart rate was measured at intervals in beats per minute |
| oxygen saturation | 2-, 6-, 12-, 24 hours | oxygen saturation was noted at intervals |
| Mean arterial pressure | 2-, 6-, 12-, 24-hours following surgery | systolic and diastolic blood pressures were measured for the patients at intervals, and then mean arterial pressures were calculated |
Countries
Pakistan
Outcome results
None listed