Analgesic Efficacy of TAP Block Versus Wound Subfascial Infiltration After Inguinal Hernia Surgery: Randomized Prospective Study

Abstract

Introduction: The main objective of this study is to compare TAP block with subfascial wound infiltration in the prevention of acute and chronic postoperative pain after surgical repair of inguinal hernia. Materials and methods: This is a prospective randomized study. After approval by the local ethics committee and obtaining informed patients consent, ASA I or ASA II patients proposed for a simple inguinal hernia cure are included. Patients were randomized into two groups: Subfascial cicatricial infiltration with 0.5% bupivacaine (20 ml) during wall closure (Group 1); a TAP block (by the technique of two projections) with 0.5% bupivacaine (20 ml) on the operated side (Group 2). Postoperative analgesia is provided by systematic Paracetamol and Nefopam and morphine titration. Apart from demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patients’ satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed. Results: Concerning demographic parameters, ASA class and secondary effects, we didn’t find any meaningful difference. However, there was a significant reduction of postoperative pain in the TAP group whether at rest as coughing. Gr 1 patients asked for more morphine consumption and they were less satisfied and accused more chronic pain. Conclusion: This study shows that the TAP block is as simple and effective technique in reducing acute postoperative pain and preventing chronic pain after inguinal hernia surgery. This technique seems well tolerated and more effective than a single subfascial infiltration injection.