Journal of Clinical Anesthesiology: Open Access

Objective: Laparoscopic Ventral Hernia Repair (LVHR) can result in significant postoperative pain. Elastomeric pain pump devices may reduce pain and narcotic medication use postoperatively. We present a prospective randomized double-blind placebo-controlled trial evaluating device efficacy in LVHR patients. Methods: Pumps were preperitoneally placed in LVHR patients, and a 4-day continuous bupivacaine or saline infusion (4 ml/hour) was given. Demographics, intra/postoperative information, and quality-of-life were compared between groups using chisquare test, t-test, and Mann-Whitney-U test. Quality-of-life consisted of pre/postoperative Short Form-36 surveys and 7-day self-reported pain and medication logs. Results: Twenty-nine LVHR patients received pumps: 17 (59%) with bupivacaine and 12 (41%) with saline. There was no difference in demographic and intraoperative variables. Mesh size was larger for saline patients compared to bupivacaine patients (median 429 vs 225 cm2, p=0.05). There was no difference in length-of-stay or complications. Discharge pain scores were worse for saline patients versus those receiving bupivacaine (median (q1,q3): 4 (2,5) vs 2 (0,3), p=0.064). Ketorolac use was higher in saline patients (p=0.01), and saline patients used pain medication longer (median (q1, q3) 9 (7,10) vs 6 (4,8), p=0.05). Other narcotic and non-narcotic use did not differ. Pain and medication logs showed significantly worse self-reported pain and pain management for the saline group versus the bupivacaine group on days 1-4 (p<0.05), with no differences reported after day 4. There were no differences in quality-of-life scores preoperatively or at 3 weeks postoperative. Conclusion: In this prospective randomized double-blind placebo-controlled trial, we found less pain at discharge, fewer days on pain medications, and less self-reported pain in patients receiving bupivacaine versus saline. However there was no significant reduction in most narcotic and non-narcotic medication use and no postoperative improvements in quality-of-life for LVHR patients using pumps. Larger studies investigating bupivacaine and other alternatives for reducing postoperative pain after LVHR are needed.

Situs Inversus is a congenital anomaly where most of the internal organs are located in a reverse position. The mirrored position of the visceral organs along with dextrocardia is known as situs inversus totalis. These patients may not present for the co-existing anomalies but can present with common abdominal pathology where diagnosis plays a vital role. In a patient with situs inversus totalis, not only the diagnosis of any abdominal pathology can be difficult due to the reversed position of the thoraco-abdominal organs but also the anesthetic management becomes challenging. Herein we present the challenging aspects of anesthesia in a young female with situs inversus totalis with symptomatic cholelithiasis for cholecystectomy.

Objective: Personalised post-operative pain treatment holds the potential to minimize side effects while maximizing effectiveness. Several phonotypical factors including gender and the presence of tattoos might influence post-operative pain experience. Tattoos have grown in popularity in recent years and the number of patients with tattoos has increased rapidly. A preconception arose in our department about the pain experience of patients with tattoos. We decided to investigate whether patients with tattoos experienced more post-operative pain than patients without tattoos.

Methods: We studied the relationship between tattoos and post-operative pain in a prospective cohort study. All adults willing to provide informed consent and scheduled for surgery (elective or emergency) or placement of a venous cannula in the pre-surgery ward were enrolled in this study. Main outcome measures were post-operative pain scores (Numeric Rating Scale). Secondary outcomes included pain scores after administration of a locoregional technique (neuraxial, plexus, peripheral nerve block) or insertion of a venous cannula.

Results: After multivariable analyses, tattoos were not associated with increased post-procedural pain. Younger people and women experienced more pain.

Conclusion: Our findings suggest that there is no relationship between the presence of tattoos and postprocedural pain.