The Postoperative Analgesic Effect Of Transversus Abdominis Plane Block Undergoing inguinal Hernia Repair: A Randomized Controlled Study (original) (raw)

2023, Çukurova anestezi ve cerrahi bilimler dergisi

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.