The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospective randomized double-blind study

Abstract

PurposeIn 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.MethodsAfter 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 L3-L4 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 VA S > 3. Total analgesic consumption and morphine requirement in 24 hours were recorded.ResultsTAP 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).ConclusionSemi-blind TAP block provided effective analgesia, reducing total 24-hour postoperative analgesic consumption and morphine requirement in patients undergoing elective unilateral inguinal hernia repair.

Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

“…In both studies, mean VAS scores in the placebo/no TAP infiltration group appeared to peak at around 6 hours postsurgery and declined thereafter; between-group differences remained statistically significant through 24 hours after surgery in the study by Salman et al8 The lack of a control group and small sample size in the current study limits the ability to compare our results with those of these controlled studies, but the pattern of VAS scores in the TAP infiltration groups in the controlled studies was broadly similar to those we observed.…”

“…In a randomized, double-blind study (n=64), Salman et al8 compared a semi-blind approach to TAP infiltration using bupivacaine 0.25% with placebo infiltration in patients undergoing inguinal hernia repair. Compared with placebo, TAP infiltration was associated with a significant reduction in pain intensity scores ( P <0.001), postsurgical opioid use ( P <0.001), and intravenous acetaminophen use ( P <0.02) during the 24-hour postsurgical period.…”

Transversus abdominis-plane block versus local anesthetic wound infiltration in lower abdominal surgery: a systematic review and meta-analysis of randomized controlled trials

“…Multiple methods have been put into use to achieve the ideal of pain-free recovery such as LAI [ 20 ], epidural analgesia [ 24 ], peripheral nerve block [ 25 ], and intravenous patient-controlled analgesia [ 26 ]. TAP block, which can be easily performed under ultrasound guidance [ 27 ] or using a landmark-based approach [ 28 , 29 ], is becoming more and more commonly applied in lower abdominal surgeries to decrease postoperative pain. TAP block is currently described as an effective technique for reducing postoperative pain and morphine consumption after lower abdominal surgery [ 17 , 30 , 31 ].…”

International guidelines for groin hernia management

“…Four randomized studies comparing TAP blocks with either placebo, local anesthetic infiltration, or no treatment reported conflicting results with respect to early postoperative pain and analgesic use. 123 , 654 , 678 , 679 A 2010 Cochrane Database Systematic Review found only limited evidence to suggest that the use of perioperative TAP blocks is opioid sparing or reduces pain scores after abdominal surgery. 680…”