The Effect of Wound Instillation of a Novel Purified Capsaicin Formulation on Postherniotomy Pain: A Double-Blind, Randomized, Placebo-Controlled Study

Eske K. Aasvang, Jeanette B. Hansen, Jørgen Malmstrøm, Torsten Asmussen, Daniel Gennevois, Michel M. R. F. Struys, Henrik Kehlet
2008 Anesthesia and Analgesia  
BACKGROUND: Acute postoperative pain is common after most surgical procedures. Despite the availability of many analgesic options, postoperative pain management is often unsatisfactory. Purified capsaicin (ALGRX 4975 98% pure) has demonstrated prolong inhibition of C-fiber function in in vitro, preclinical, and clinical studies, and may be an effective adjunct to postoperative pain management. METHODS: We performed a single-center, randomized, double-blind, placebocontrolled study of the
more » ... ic efficacy of a single intraoperative wound instillation of 1000 g ultrapurified capsaicin (ALGRX 4975) after open mesh groin hernia repair in 41 adult male patients. The primary end-point was average daily visual analog scale (VAS) pain scores during the first week after surgery assessed as area under the curve (AUC). Pain was recorded twice daily in a pain diary for 4 wk. Physical examination and laboratory tests were done before and 1 wk after surgery, together with recordings of adverse events up to 28 days. Adverse events were recorded. Data were also analyzed using a mixed-effects analysis with NONMEM. RESULTS: VAS AUC was significantly lower during the first 3 days postoperatively (P Ͻ 0.05), but not for the whole 1 or 4 wk postoperatively. Mixed-effects analysis with NONMEM revealed that pain scores were significantly lower (P Ͻ 0.05) in the capsaicin group during the first 4 days. No clinically significant serious adverse events were observed, although a mild transient increase in liver enzymes was seen more often in the capsaicin-treated group. CONCLUSION: In the setting of a well-defined analgesic protocol standard, VAS AUC analysis and a mixed-effect analysis showed superior analgesia of capsaicin relative to placebo during the first 3-4 days after inguinal hernia repair. One Week Postoperatively The patient was seen at the hospital and a physical examination, ECG, urine, and blood test similar to that
doi:10.1213/ane.0b013e31816b94c9 pmid:18635499 fatcat:5hdq3vexbbbvdora3xxfrhc5na