L. S. Sparber1, T. Vialet1, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Department Of Surgery,Livingston, NJ, USA 2St. George’s School Of Medicine,St. George’s, , Grenada 3New Jersey Medical School,Rutgers University – Department Of Surgery,Newark, NJ, USA
Introduction: Inguinal and umbilical hernia repair are among the most common surgical procedures performed in the US. Optimal perioperative pain control regimens remain challenging and opioid analgesics are commonly used. NSAIDs have been shown to reduce narcotic requirements in several procedures if given prior to anesthesia induction purportedly by blocking the inflammatory cascade. This study sought to evaluate the efficacy of perioperative IV ibuprofen on postoperative pain level and narcotic use in patients undergoing open or laparoscopic inguinal and/or umbilical hernia repair.
Methods: A single center, randomized, double-blind placebo-controlled trial involving a total of 48 adult male patients aged 20-75 years undergoing inguinal and/or combined umbilical hernia repair was performed. Patients were randomized to receive 800 mg of IV ibuprofen or placebo (NS) preoperatively. Postoperative pain was managed with IV hydromorphone, or oral oxycodone/acetaminophen, acetaminophen only or ibuprofen. The primary endpoint was the number of patients that experienced a >20% decrease in postoperative narcotic and a decreased Visual Analog Scale (VAS) Pain Score within the first 2 hours.
Results: 48 male patients aged 20-75 years underwent inguinal and/or umbilical hernia repair (Table 1). Laparoscopic inguinal hernia repair was the most common procedure in both groups (72.0% ibuprofen, 78.3% placebo, p=.437). Patients receiving IV ibuprofen used more oxycodone/acetaminophen (32% vs 13%, p=.556) and IV hydromorphone (12% vs 8.7%, p=.556) than the placebo group in the first 2 hour period following surgery. Conversely, patients receiving placebo used more combinations of pain medications (65.2% vs 44%, p=.556) in the same period. The IV ibuprofen group had more patients (28%, p=.358) pain free at two hours postoperatively compared to the placebo group (8.7%, p=.358) and the mean/median VAS score was also significantly lower in the IV ibuprofen group. Pain levels recorded on patient completed questionnaires showed similar levels of pain at 1, 3, and 7 days post-surgery and similar use of rescue medications.
Conclusion: Pre-operative administration of IV ibuprofen in patients undergoing elective hernia repair resulted in less pain 2 hours following the procedure, and a higher percentage of patients who were pain free compared to placebo. Considerable variability in the postoperative narcotic analgesic requirement was noted, and a larger study is needed to better understand the narcotic analgesic requirements associated with IV ibuprofen in hernia repair patients. IV ibuprofen should be considered as a safe option for the reduction of pain as an adjunct to standard pain therapy in this patient population.
