Background Inguinal hernia repairs are a common procedure, occurring in 800,000 patients across the United States and 20 million patients worldwide annually (Simmons et al. in Hernia 22:1–165, 2018;Knight et al. in Surgery 166:752–757, 2019;Schirle et al. in Syst Rev 9:139, 2020;). Currently, the most common form of pain management used by providers has been opioids despite unwanted side effects and dependence risk. Studies show up to 71% of patients undergoing TEP are prescribed opioids for pain management (Brummett et al. in JAMA Surg 152, 2017). The growing national misuse of opioids stresses the importance of alternative pain management options. Zynrelef has proven effective for managing post-op pain up to 72 h following several other surgeries but has not been effectively tested in TEP(s) (Hill et al. in Ann Surg 265:709–714, 2017; Provisional Drug Overdose Death Counts. National Vital Statistics System. Centers for Disease Control and Prevention. <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.;Hamilton">https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.;Hamilton</a> et al. in Anaesthesia 78:170, 2023;). This study observed opioid usage in patients following the use of Zynrelef during TEP procedures to determine if Zynrelef proves to be an effective alternative to opioid usage. Methods 43 subjects (42 male and 1 female) between ages 32 and 79 years, scheduled to undergo TEP, were enrolled in the study and received between 7 and 14 mL’s of Zynrelef prior to wound closure in the pre-peritoneal space via the most inferior 5 mm trocar. Subjects were instructed to take multimodal agents (Acetominophen1000 mg Q6 and Ibuprofen 800 mg q6) and given a prescription for opioids if their NRS pain score was greater than 6/10 in recovery. Subjects were then followed for 10 days after surgery to observe and record all medication usage and pain levels. Results 39 subjects completed the study period (2 subjects excluded due to multiple hernias found during surgery and 2 lost to follow-up). 6 (15.4%) subjects received an opioid prescription, 33 (84.6%) did not. Mean pain immediately following surgery was 3.51 (SD ± 1.94), 2.63(SD ± 1.73) on POD1, 2.51(SD ± 1.57) on POD3, 2.00(SD ± 1.34) on POD5, and 1.11(SD ± 0.98) on POD 10. Mean discontinuation of acetaminophen and ibuprofen was 6.23 and 5.63 days post-op, respectively. Of the six subjects who received opioids post-op the mean time to opioid discontinuation was 5 days. Conclusion Results of this study display adequate pain management following TEP procedures with the use of Zynrelef and a reduction in the use of opioids compared to patients undergoing TEP without Zynrelef. The findings from this study are in alignment with findings from other studies such as the HOPE trial in which Zynrelef was used in patients with open inguinal hernias and displayed an opioid-free rate of 91%.

Use of Zynrelef (bupivacaine and meloxicam) to eliminate the need for opioids in laparoscopic pre-peritoneal inguinal hernia repairs

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发表日期：

2026年1月22日

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Cameron A. Beard,
Timothy Beard,
Madison Linde Devenny,
Michael Masterangelo

摘要

Background

Inguinal hernia repairs are a common procedure, occurring in 800,000 patients across the United States and 20 million patients worldwide annually (Simmons et al. in Hernia 22:1–165, 2018;Knight et al. in Surgery 166:752–757, 2019;Schirle et al. in Syst Rev 9:139, 2020;). Currently, the most common form of pain management used by providers has been opioids despite unwanted side effects and dependence risk. Studies show up to 71% of patients undergoing TEP are prescribed opioids for pain management (Brummett et al. in JAMA Surg 152, 2017). The growing national misuse of opioids stresses the importance of alternative pain management options. Zynrelef has proven effective for managing post-op pain up to 72 h following several other surgeries but has not been effectively tested in TEP(s) (Hill et al. in Ann Surg 265:709–714, 2017; Provisional Drug Overdose Death Counts. National Vital Statistics System. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.;Hamilton et al. in Anaesthesia 78:170, 2023;). This study observed opioid usage in patients following the use of Zynrelef during TEP procedures to determine if Zynrelef proves to be an effective alternative to opioid usage.

Methods

43 subjects (42 male and 1 female) between ages 32 and 79 years, scheduled to undergo TEP, were enrolled in the study and received between 7 and 14 mL’s of Zynrelef prior to wound closure in the pre-peritoneal space via the most inferior 5 mm trocar. Subjects were instructed to take multimodal agents (Acetominophen1000 mg Q6 and Ibuprofen 800 mg q6) and given a prescription for opioids if their NRS pain score was greater than 6/10 in recovery. Subjects were then followed for 10 days after surgery to observe and record all medication usage and pain levels.

Results

39 subjects completed the study period (2 subjects excluded due to multiple hernias found during surgery and 2 lost to follow-up). 6 (15.4%) subjects received an opioid prescription, 33 (84.6%) did not. Mean pain immediately following surgery was 3.51 (SD ± 1.94), 2.63(SD ± 1.73) on POD1, 2.51(SD ± 1.57) on POD3, 2.00(SD ± 1.34) on POD5, and 1.11(SD ± 0.98) on POD 10. Mean discontinuation of acetaminophen and ibuprofen was 6.23 and 5.63 days post-op, respectively. Of the six subjects who received opioids post-op the mean time to opioid discontinuation was 5 days.

Conclusion

Results of this study display adequate pain management following TEP procedures with the use of Zynrelef and a reduction in the use of opioids compared to patients undergoing TEP without Zynrelef. The findings from this study are in alignment with findings from other studies such as the HOPE trial in which Zynrelef was used in patients with open inguinal hernias and displayed an opioid-free rate of 91%.