Use of Local Anesthetic in Open Surgery of the Abdominal Wall Defects

Hernias of the abdominal wall, either primary or incisional, are one of the most common in surgical practice and postoperative morbidity is mainly due to pain, thus limiting recovery after surgery and prolongs both the length of hospitalization and the period until the return to previous activities. There are recommendations of local anesthetic use for control of postoperative pain in inguinal hernias, but not in incisional hernias. Ropivacaine may be the local anesthetic of choice for parietal defect surgery, having little cardiac toxicity and providing a satisfactory sensory block. We conducted an analytical prospective study of 56 cases of uncomplicated abdominal parietal hernia, either primary or incisional, in adults over 18 years old, operated under general anesthesia in the Ist Surgery Clinic of the University Emergency Hospital Bucharest over 1 year. Exclusion criteria were spinal anesthesia (due to the limitation of the amount of anesthetic that could be used) and wound complications. Patients were randomly assigned for administration of the local anesthetic or not, so that 28 patients were included in group I (positive administration) and 28 in group II (negative administration). The results of the study proved that in the local anesthesia positive group the postoperative pain measured by the Numeric Rating Scale (NRS) at different times after completion of surgery and the need for supplementary I. V. analgesia were lower for this group, as the mobilization time and the hospital stay were lower; return to previous normal activities was in average the same in time interval in both groups. In conclusion, the use of local analgesia in open abdominal wall surgery is suitable for the reduction of postoperative pain and use of classical postoperative analgesics, leading to early mobilization with the possibility of reducing the complication rate and reduced hospital stay in comparison to classical intravenous analgesia alone.