Analgesic Efficacy of TAP Block Versus Wound Subfascial Infiltration After Inguinal Hernia Surgery: Randomized Prospective Study (original) (raw)
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Çukurova anestezi ve cerrahi bilimler dergisi, 2023
Pain of open inguinal hernia repair can be moderate-to-severe in intensity, with the most severe pain commonly experienced on the day of surgery 2. Postoperative acute pain can cause immobilization, risk of respiratory failure, atelectasis, hypoxia and pneumonia. Daily life activities can be limited if inadequate analgesia is provided, and chronic pain can also impair quality of life 3. Patients should be trained to be able to evaluate with Visual Analog Scale (VAS) or numerical rating system (NRS) to facilitate postoperative pain management 4. Multimodal analgesia involves the simultaneous use of different pain control mechanisms to reduce the dose of a single agent, particularly opioids, while providing postoperative pain relief, augmenting analgesic efficacy and minimizing the risk of side effects 5. This strategy attempts to avoid the use of opioids, or at least the enable the use of opioids at the lowest dose required, thus minimizing the risk of developing side effects that may even delay recovery 6. TAP block is used in lower abdominal operations (cesarean section, inguinal hernia repair, appendectomy, abdominal hysterectomy, prostatectomy) 7. TAP block decreases the perioperative opioid anal-Aim: The objective of this study was to investigate the effect of preincisional (preemptive) Transversus Abdominis Plane (TAP) block on perioperative opioid consumption, hemodynamic parameters and postoperative rescue analgesic consumption in patients undergoing inguinal hernia repair. Methods: 60 adult patients were included in this prospective randomized controlled study. The patients were divided into two groups: those who received conventional systemic analgesia (Group C) and those who received US-guided TAP block (Group TAP). By ultrasonography, normal saline (1 mL) was injected between the internal oblique and transverse abdominal muscles, and after separation was observed, 20 mL of 0.25% bupivacaine was administered. Postoperatively, 1mg/kg Tramadol HCl was given to all patients as a rescue analgesic. Perioperative hemodynamic data, perioperative total amount of remifentanil consumption amount, postoperative Visual Analogue Scale (VAS) scores, starting time and number of rescue analgesics were recorded. Results: There was no difference in demographic data. Intraoperative remifentanil dose, VAS values at all times, need for rescue analgesics and the number of applications were significantly lower in Group TAP than in Group C (p=0.012, p<0.05, p=0.047). The number of patients who received rescue analgesics was significantly higher in Group C than in Group TAP (p<0.05). It was found that the first rescue analgesic administration time was needed later in Group TAP than in Group C (p=0.032). No difference was found in postoperative nausea and vomiting (p>0.05). Conclusions: We concluded that preincisional TAP block is a safe and effective analgesia technique for postoperative pain control in patients undergoing unilateral inguinal hernia repair and our findings should be supported by advanced controlled randomized studies.
Local and Regional Anesthesia, 2013
In this prospective, randomized, double-blind study, our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane (TAP) block with a placebo block in patients undergoing unilateral inguinal hernia repair. Methods: After receiving hospital ethical committee approval and informed patient consents, American Society of Anesthesiologists (ASA) I-III patients aged 18-80 were enrolled in the study. Standard anesthesia monitoring was applied to all patients. After premedication, spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L 3-L 4 subarachnoid space. Patients were randomly allocated into 2 groups. Group I (n = 32) received a placebo block with 20 mL saline, Group II (n = 32) received semi-blind TAP block with 0.25% bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure. At the end of the operation, intravenous (IV) dexketoprofen was given to all patients. The verbal analog scale (VAS) was recorded at 2, 4, 6, 12, and 24 hours postoperatively. Paracetamol IV was given to patients if their VAS score. 3. A rescue analgesic of 0.05 mg/kg morphine IV was applied if VAS. 3. Total analgesic consumption and morphine requirement in 24 hours were recorded. Results: TAP block reduced VAS scores at all postoperative time points (P , 0.001). Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II (P , 0.01). Conclusion: Semi-blind TAP block provided effective analgesia, reducing total 24-hour postoperative analgesic consumption and morphine requirement in patients undergoing elective unilateral inguinal hernia repair.
2020
Background Although regional techniques have been suggested more in order to provide postoperative analgesia in inguinal hernia repairs, the ideal method is still controversial. The aim of this study was to evaluate the effect of preemptive transversus abdominis plane (TAP) block, local anesthetic infiltration (LAI) and intravenous dexketoprofen (IVD) on postoperative pain in inguinal hernia repairs. Methods This prospective study included 120 patients with American Society of Anesthesiologists status 1-3 between 18-75 years of age who undergoing elective inguinal hernia surgery under spinal anesthesia. The patients were allocated into three groups: USG-guided TAP block (Group 1, n = 40), USG-guided LAI (Group 2, n = 40) and IVD (Group 3, n = 40) before surgical incision. The mean of tramadol consumption, number of patients in requiring rescue analgesics, duration of postoperative analgesia and complications were recorded for 24 hours postoperatively. VAS scores were evaluated at th...
Journal of Pain Research
Objective: To compare the efficacy of ilioinguinal/iliohypogastric (IINB) nerve block to transversus abdominis plane (TAP) block in controlling incisional pain after open inguinal hernia repair. Patients and methods: This was a prospective randomized clinical trial of 90 patients who received either IINB (N=45) or TAP block (N=45) using 0.2% bupivacaine 15 mL under ultrasound (US) guidance based on a random assignment in the postanesthesia care unit after having an open repair of inguinal hernia. Numeric Rating Scale (NRS) scores were recorded immediately following, 4, 8, 12, and 24 hours after completion of the block. NRS scores at rest and during movement were recorded 24, 36, and 48 hours after surgery. Analgesic satisfaction level was also evaluated by a Likert-based patient questionnaire. Results: NRS scores were lower in the IINB group compared to the TAP block group both at rest and during movement. The difference in dynamic pain scores was statistically significant (P=0.017). In addition, analgesic satisfaction was significantly greater in the IINB group than the TAP block group (mean score 2.43 vs 1.84, P=0.001). Postoperative opioid requirements did not differ between the two groups. Conclusion: This study demonstrated that compared to TAP block, local blockade of ilioinguinal and iliohypogastric nerves provides better pain control after open repair of inguinal hernia when both blocks were administered under US guidance. Greater satisfaction scores also reflected superior analgesia in patients receiving IINB.
Background: For postoperative pain relief in patients undergoing open inguinal hernia repair both TAP block and combined ilioinguinal-iliohypogastric blocks are used under ultrasound guidance. Materials and Methods: In this prospective randomised controlled study, 60 patients of ASA physical status I and II belonging to age group of 18-60years undergoing elective open inguinal hernia repair surgery under sub-arachnoid block were randomly allocated into 2 groups o30patients each, Group A (Transversesabdominisplane block) and Group B (Ilioinguinal-iliohypogastricnerve block). Group A received 20ml of 0.25%Bupivacaine for transversesabdominis planeblock and group B received 20ml of 0.25% Bupivacaine for ilioinguinal-iliohypogastric nerve block.Both groups of patients were monitored for postoperative pain for the next 24 hours.Postoperative rescue analgesia was with intravenous tramadol for the first 4 hrs and later with injection diclofenac intramuscularly.Total analgesic consumption in the first 24 hours postoperative period was the primary objective,.secondary objectives were intraoperative hemodynamics,number of attempts,time required for performing the block and postoperative pain scores were evaluated. Results: There was no difference in age, BMI,and duration of surgery between two groups. Postoperative analgesia was better with ilioinguinal-iliohypogastric block when compared to transverse abdominis plane block and rescue analgesia was lesser with groupB when compared to groupA. The postoperative analgesia was significantly prolonged with ilioinguinal-iliohypogastric group (p<0.05) when compared to transverse abdominis group. Conclusion: Ilioinguinal-iliohypogastric nerveblock provide better postoperative analgesia when compared to TAP block for open inguinal hernia repair.
Medical Archives, 2020
Introduction: Pain management after open inguinal hernia repair has become an issue that physicians deal with on a daily basis. Aim: The purpose of this study was to investigate the analgesic effect of three different regimens of analgesics administered to patients undergoing open inguinal hernia repair. Methods: A total of 259 patients undergoing open inguinal hernia repair were enrolled. Patients were randomly allocated to one of three groups on admission, which would determine the prescribed post-operative analgesic regimen. Patients allocated to group A receiving a combination of 1gr/8hours intravenous (IV) acetaminophen and 50mg/6hours intramuscular (IM) pethidine, patients in group B receiving a combination of 1gr/8hours IV acetaminophen and 40mg/12hours IV parecoxib, while patients of group C received 1gr/8hours IV acetaminophen monotherapy. All patients remained overnight at the hospital and discharged the day after. Analgesic therapy was administered at regular intervals. Pain was evaluated utilizing the numeric rating scale (NRS) at 5 time points: the first assessment was done at 45 minutes, the second at 2 hours, the third at 6 hours, the fourth at 12 hours and the fifth at 24 hours post-administration. The postoperative pain intensities measured by NRS within groups and between groups at each time were analyzed using one-way repeat measured ANOVA and Post Hoc Test-Bonferroni Correlation. Results: The analgesic regimens of groups A and B (combination regimens consisting of IV acetaminophen and intramuscular pethidine and IV acetaminophen and IV parecoxib, respectively) were found to be of equivalent efficacy (P-value=1.000). In contrast, patients in group C (acetaminophen monotherapy) had higher NRS scores, compared to both patients in groups A (P-value<0.0001) and B (P-value<0.0001). Conclusion: The combinations of IV acetaminophen with either intramuscular pethidine or IV parecoxib are superior to IV acetaminophen monotherapy in achieving pain control in patients undergoing open inguinal hernia repair.
Asian Journal of Medical Sciences
Background: Inguinal hernia surgeries are associated with postoperative pain and discomfort. Transversus abdominis plane (TAP) block and Ilioinguinal/Iliohypogastric (IIIH) nerve blocks are widely used to control postoperative pain. In this study we have compared postoperative pain relief between TAP block and IIIH nerve block in the patients undergoing inguinal hernia surgery under spinal anesthesia. Aims and Objectives: The primary aim of this study was to compare postoperative pain relief of TAP block and IIIH block in patients undergoing inguinal hernia surgery. Secondary objectives were to observe hemodynamic parameters and to observe for postoperative side effects if any. Materials and Methods: Sixty patients of age group 18–65-year-old males, ASA grade I, II, were randomised into two groups TAP group (n=30) and IIIH group (n=30). TAP group received 30 mL of 0.25% ropivacaine TAP block and group IIIH received 20 mL, and wound infiltration with 10 mL of 0.25% ropivacaine. Durat...
Cureus
Introduction Laparoscopic inguinal hernia repair is the most commonly performed surgery in many hospitals. This study aimed to compare the outcome of the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques in unilateral, uncomplicated inguinal Hernia. Material and methods This prospective randomized study was conducted in a tertiary care hospital in North India from November 2018 to March 2020. Sixty-eight male patients of unilateral, uncomplicated inguinal hernia were enrolled for laparoscopic hernia repair. The first group of 34 patients underwent TAPP repair and the second group of 34 patients underwent TEP repair under general anesthesia (GA). Both groups were compared for intraoperative or postoperative complications, analgesic requirements, postoperative pain, length of hospital stay, resumption of routine activity, and patient satisfaction scores. Fisher's exact test or Chi-square test were used for nominal data and the median or interquartile range was used for ordinal data. Results The mean operative time for TAPP was more than that for the TEP group (101 vs 76, p<0.001). The TAPP group exhibited significantly less postoperative pain at six hours, 24 hours and seven days than TEP (p<0.001) and an insignificant difference at three months of the follow-up period (p=0.188). Additional analgesics requirement was less in the TAPP group, although the difference was not significant (p=0.099). Seroma formation was found in four patients (11.8%) in the TEP group and two patients (5.9%) in the TAPP group (p= 0.672). Length of postoperative hospital stay (p=0.907), resumption of routine activity (p=0.732), and patient satisfaction scores (p=0.492) during follow-up were similar in both groups and were also insignificant. Conclusion The TAPP technique is slightly better than TEP for inguinal hernia in terms of lesser postoperative pain with similar chances of complications and other outcomes.