Early experience with lidocaine patch for postoperative pain control after laparoscopic ventral hernia repair

Reduced postoperative pain is one of the many factors that have driven the growing emphasis on the role of laparoscopic surgery for surgical management. Several studies have documented the advantages of the laparoscopic repair of ventral hernias compared to the open ventral herniorraphy. However, the laparoscopic approach may be associated with more postoperative pain initially. In this preliminary study, we present data from our early experience with the use of a lidocaine patch for pain control in the immediate postoperative period following laparoscopic ventral hernia repair (LVH).

Thirty consecutive patients underwent laparoscopic ventral herniorraphy (LVH) and were selected randomly and placed into one of two groups. In one group, we placed a lidocaine patch (LP) (Lidoderm, Endo Pharmaceuticals, Inc., Chadds Ford, PA) on the anterior abdominal wall corresponding to the placement site of the underlying mesh in fifteen patients (Group A). In the second group, we did not place a LP on the abdominal wall of fifteen consecutive patients (Group B). We assessed all patients according to their demographic data, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) score, the size of the abdominal wall defect (AWD), area of mesh (size) used, operative time, length of hospital stay (LOA), morbidity, and the individual patient's pain score at discharge, two weeks and two months postoperatively.

The two groups were similar with respect to demographics, BMI, ASA, AWD, size of mesh, LOS and morbidity. Group A had a statistically significant reduction in their postoperative pain score at discharge when compared to Group B (3.13+/-1.68 and 4.8+/-1.42, respectively, p value=0.0067).

In this preliminary study, the use of a lidocaine patch in the management of postoperative pain following laparoscopic ventral herniorraphy is a safe and promising modality to consider in the management of postoperative pain control.