Single-Shot Subcutaneous Lidocaine Infiltration at Closure Is Associated with Reduced Early Pain and Opioid Requirement After Single-Incision Laparoscopic Totally Extraperitoneal Hernia Repair

Abstract

Background: Subcutaneous wound infiltration with local anesthetics has been proposed as a simple adjunct for postoperative pain control; however, its value in single-incision laparoscopic total extraperitoneal (SILTEP) inguinal hernia repair remains unclear. Methods: We retrospectively analyzed 199 consecutive SILTEP inguinal hernia repairs performed between November 2022 and July 2025 (117 no-lidocaine, 82 lidocaine). A double adjustment, combining 1:1 propensity score matching with multivariable regression across 20 multiply imputed datasets was performed. The primary outcome was maximal numeric pain intensity scale (NPIS) on postoperative day (POD) 0. Results: Eighty-two matched pairs were generated. In the final pooled, adjusted models, lidocaine infiltration was associated with a significant reduction in the primary outcome, maximal NPIS on POD 0 (beta = -1.25; 95% CI: -2.01 to -0.50; p = 0.001). Lidocaine was also associated with significantly lower odds of requiring rescue analgesia on POD 0 (OR = 0.12; 95% CI: 0.03-0.46; p = 0.002), fewer rescue doses during hospitalization (beta = -1.11; 95% CI: -1.62 to -0.49; p < 0.001), and a lower morphine-equivalent dose (beta = -5.14; 95% CI: -7.79 to -2.49; p < 0.001). No increase in postoperative complications was observed. Conclusions: Single-shot subcutaneous lidocaine infiltration in SILTEP hernia repair is a simple, low-risk intervention that was associated with reduced immediate postoperative pain and opioid use without increasing complications. However, the effect was short-lived with no sustained benefit beyond the first postoperative day.