Transversus abdominis plane block for laparoscopic inguinal hernia repair: a randomized trial - 21/08/16
: Additional Professor, Rajeshwari Subramaniam, MD a : Professor, Mahesh K. Arora, MD a : Professor, Mahesh C. Misra, MS b : Professor, Virender K. Bansal, MS b : ProfessorAbstract |
Background |
Pain after laparoscopic inguinal hernia surgery can be moderate to severe, interfering with return to normal activity. The study aimed to assess the efficacy of bilateral ultrasound-guided (USG) transversus abdominis plane (TAP) block for relieving acute pain after laparoscopic hernia repair as T10-L1 nerve endings are anesthetized with this block.
Methods |
Seventy-one American Society of Anesthesiologists I to II patients, aged 18 to 65 years, undergoing unilateral/bilateral laparoscopic hernia repair were randomized to port site infiltration (control, 36) and TAP block groups (35). All patients received general anesthesia (fentanyl 2 μg/kg intravenously at induction, 0.5 μg/kg on 20% increase in heart rate or mean blood pressure) and paracetamol 6 hourly. Postintubation, TAP group received bilateral USG TAP block (15-20 mL 0.5% ropivacaine, maximum 3 mg/kg) with 18-G Tuohy needle. Control group had 20 to 30 mL 0.5% ropivacaine infiltrated preincision, at port sites from skin to peritoneum. Postoperative patient-controlled analgesia fentanyl was provided for 6 hours; pain was assessed using 0- to 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 24 hours and telephonically at 1 week and 3 months.
Results |
Demographic profile of the 2 groups was comparable. Significantly more number of patients required intraoperative fentanyl in the control group (24/36) than in the TAP group (13/35); VAS at rest was lower in TAP than control patients in postanesthesia care unit at 0, 2, 6, and 24 hours (median VAS TAP group: 0, 0, 0, and 0; control: 10, 20, 10, and 10; P= .002, P= .001, P= .001, and P= .006, respectively); P< .01 was considered statistically significant. TAP group had significantly lower VAS on deep breathing at 6 hours and on knee bending and walking at 24 hours and lesser patient-controlled analgesia fentanyl requirement. No significant difference in pain scores was observed at 1 week and 3 months.
Conclusion |
TAP block reduced postoperative pain up to 24 hours after laparoscopic hernia repair.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Pain after laparoscopic hernia surgery (TAPP and TEP) can be moderate to severe. |
• | The median perioperative fentanyl requirement was lower in the TAP group. |
• | VAS at rest was lower in the TAP group for 24 hours postoperatively. |
• | VAS on deep breathing was lower in the TAP group at 6 and 24 hours. |
• | VAS on knee bending and walking was lower in the TAP group at 24 hours. |
Keywords : Analgesia, Hernia repair, Laparoscopy, Anesthetics, Local, Transversus abdominis block
Plan
| ☆ | None of the authors has any conflict of interest, and no one has received any financial aid for doing the study or writing the manuscript; resources used were from the All India Institute of Medical Sciences, New Delhi. |
| ☆☆ | Institutional review board contact information: Ethics Committee of the All India Institute of Medical Sciences, New Delhi, 110029. |
| ★ | Registered with Clinical Trial Registry of India: number CTRI/2014/07/004748. |
Vol 33
P. 357-364 - septembre 2016 Retour au numéro
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