Combined subfascial and subcutaneous bupivacaine instillation for inguinal hernia wounds

To determine if combined subfascial (SF) and subcutaneous (SC) bupivacaine is more effective than SC bupivacaine only in decreasing postoperative pain and opioid requirement for hernia wounds.

Sixty consecutive male patients undergoing inguinal hernia repair were randomly allocated to one of two groups. Patients in the SC group (S; n = 30) received SC instillation of 10 mL of 0.25% bupivacaine and SF instillation of 10 mL of 0.9% saline, while patients in the combination group (C; n = 30) received SF and SC instillation of 10 mL of 0.25% bupivacaine each. All injections were given in a standardized manner by the surgeon during wound closure. Postoperative pain was scored by means of a 100 mm visual analogue scale.

Pain scores at 1, 12 and 24 hours postoperatively were significantly more in group S patients (53 vs. 30, 41 vs. 32 and 22 vs. 15, respectively, p < 0.0001). First time to analgesia was longer in group C (260 +/- 17 vs. 137 +/- 12 minutes, p < 0.0001). The consumption of pethidine was significantly lower in group C than in group S (23 +/- 34 mg vs. 55 +/- 42 mg, p = 0.003).

SF combined with SC instillation of bupivacaine during wound closure prolongs the first time to analgesia, reduces early postoperative opioid requirements and lowers pain in males undergoing open hernia repair.