Ultrasound-guided TAP Block with or without Dexmedetomidine vs. Local Infiltration of the Wound after Open Herniorrhaphy: A Randomized Prospective Controlled Study

Abstract

Objectives: Transversus abdominis plane (TAP) block and local anesthetic wound infiltration (LAI) can provide a variable effective pain relief at the wound site after surgery. This prospective study was designed to evaluate the postoperative analgesic efficacy of TAP with or without dexmedetomidine compared with LAI of the wound after herniorrhaphy. Materials and methods:Sixty adult patients were divided into 3 groups of 20 patients each. Group1 (TAPD): Patients received single shot ultrasound-guided (US) TAP block using 15 mL of levobupivacaine 0.5% mixed with 0.9 μg/kg of dexmedetomidine. Group 2 (TAP): Patients received single shot US guided TAP block using 15 mL of levobupivacaine 0.5%. Group 3 (LAI): Patients received local anesthetic infiltration (LAI) patients received local infiltration using 15 mL of levobupivacaine 0.5%. The following parameters were assessed at, 2, 10, 18 and 24 h postoperatively: postoperative duration of analgesia, analgesic pain scores using the visual analogue scale (VAS) for pain, amount of supplemental intravenous morphine, postoperative nausea and vomiting during 24 h. Results:We found that a lower significant difference (P<0.05) of VAS pain scores at rest and on movement between group TAPD and group TAP at time 24 h postoperatively. Also, there was a lower significant difference (P<0.05) of VAS pain scores at rest and on movement between group TAPD and group LAI at 10, 18 and 24 h. Moreover, there was a lower significant difference (P<0.05) between group TAP and group LAI at times 10 and 18 h. Also, supplemental morphine consumption within 24 h was a statistically higher (P<0.05) in group LAI compared to groups TAPD and TAP. Conclusion:Using dexmedetomidine as an additive to levobupivacaine in ultrasound-guided TAP block for herniorrhaphy provides prolonged duration of postoperative analgesia, and lowered VAS pain scores. Also local anesthetic infiltration can give accepted postoperative analgesia but with shorter duration than TAP block

The analgesic efficacy of transversus abdominis plane block vs. wound infiltration after inguinal and infra-umbilical hernia repairs

“…Secondary pain-related outcomes were all significantly reduced with the exception of rest pain score at 24 postoperative hours, dynamic pain score at 12 postoperative hours, and intravenous morphine consumption at 2 postoperative hours (Table 2). One study reported zero incidence of postoperative haematoma and visceral injury 20 . The incidence of postoperative infection or local anaesthetic systemic toxicity was not reported by any study, and neither was duration of hospital stay.…”

“…24 Five studies included patients undergoing inguinal hernia repair only, [18][19][20]22,24 while two included patients undergoing inguinal or infra-umbilical hernia repair, 21,23 without presenting data for surgical subgroups. Inguinal or infra-umbilical hernia repair was performed with an open surgical approach in five studies 18,20,21,23,24 and with laparoscopy in two studies. 19,22 All interventions were performed under general anaesthesia and maintained with inhalation agents.…”

“…Of the 1123 trials identified from the literature search, seven met the inclusion criteria, [18][19][20][21][22][23][24] including a total of 420 patients (Supplementary Fig. 1, http://links.lww.…”

“…Rest pain score at 12 h po (analogue scale, 0 to 10) 4 Abd-El Hamid 2016, 18 Eldegwy 2017, 20 Mishra 2016, 21 18 Arora 2016, 19 Eldegwy 2017, 20 Mughal 2013, 22 Sanad 2018, 23 18 Arora 2016, 19 Eldegwy 2017, 20 18 Arora 2016, 19 Eldegwy 2017, 20 Mughal 2013, 22 Secondary pain-related outcomes were all significantly reduced with the exception of rest pain score at 24 postoperative hours, dynamic pain score at 12 postoperative hours, and intravenous morphine consumption at 2 postoperative hours (Table 2). One study reported zero incidence of postoperative haematoma and visceral injury.…”

Addition of dexmedetomidine to bupivacaine in Transversus Abdominis Plane Block in Inguinal Hernia Repair: A Perspective Double Blind Study

“…3 Ultrasound guided TAP block produces good pain relief and reduces intraoperative and postoperative opioid requirement. 7,8 TAP block duration is limited to the effect of administered local anaesthetics, so to prolong the duration of block adjuvants are added, and dexmedetomidine is a good choice. Dexmedetomidine is a highly selective alpha 2 adrenergic receptor agonist, ten times more selective than clonidine.…”