Comparative Evaluation of Different Parenteral Agents as Postoperative Analgesics among Patients of Lichtenstein Repair: A Prospective Observational Study

Abstract

Introduction: Hernia surgery is one of the most frequently done surgeries worldwide. It is of special concern since, the postoperative pain can be because of injury to the nerves apart from the skin incision. Different drugs are used as analgesics for the management of postoperative pain, but there are hardly any guidelines for their judicious use. Besides, these analgesics are not free from clinically significant adverse effects. Therefore, there is a need of developing some guideline/protocols for using analgesics postoperatively. Aim: To compare the efficacy and safety of intravenous (i.v.) diclofenac bolus, i.v. paracetamol infusion, and i.v. tramadol as postoperative analgesics in cases of inguinal hernia undergoing Lichenstein repair (open hernioplasty). Materials and Methods: A prospective observational study was conducted in the Department of General Surgery at a Tertiary Care Teaching and Training Institute, North India. The duration of the study was two months, from February 2021 to March 2021. A total of 57 patients were included in the study and grouped as per the primary analgesic used in them, out of which 18 belonged to group A (i.v. diclofenac bolus), 22 to group B (i.v. paracetamol infusion), and 17 to group C (i.v. tramadol). Visual Analogue Scale (VAS) scores were assessed at 6 hours, 24 hours, and 48 hours, postoperatively. The type and frequency of additional analgesics used were noted. Any clinically significant adverse effects were also recorded. Analysis of Variance (ANOVA) and Chi-square tests were applied to analyse the continuous and categorical data respectively. Results: The mean age of the study participants was 48±16 years. The mean VAS scores at 6 hours were 3.6, 3.4, and 4.1 in the three groups, respectively. Whereas, at 24 hours and 48 hours, the scores were 3.5, 3.4, 3.4, and 2, 1.6, and 1.9, respectively. There was no statistically significant difference in the VAS scores. A total of 12 (66.67%) patients in group A, 18 (81.81%) in group B, and 16 (94.12%) in group C required additional analgesics but the difference was not statistically significant. Similarly, 5 (27.78%) patients in group A, 6 (27.27%) in group B, and 4 (23.53%) in group C suffered from adverse effects, but there was no statistically significant difference amongst them. Conclusion: Intravenous diclofenac bolus, i.v. paracetamol infusion, and i.v. tramadol are equally efficacious and safe, when used as postoperative analgesics in cases of inguinal hernia undergoing Lichtenstein repair. But studies with larger sample size are required to draw any definite conclusion.