Efficacy of Transversus Abdominis Plane Block and Rectus Sheath Block in Laparoscopic Inguinal Hernia Surgery

We aimed to assess the efficacy of transversus abdominis plane (TAP) block and rectus sheath (RS) block in patients undergoing laparoscopic inguinal hernia surgery. Few studies have addressed the efficacy and safety associated with TAP block and RS block for laparoscopic surgery. Thirty-two patients underwent laparoscopic inguinal hernia surgery, either with TAP and RS block (Block⁺ group, n = 18) or without peripheral nerve block (Block⁻ group, n = 14). Preoperatively, TAP and RS block were performed through ultrasound guidance. We evaluated postoperative pain control and patient outcomes. The mean postoperative hospital stays were 1.56 days (Block+ group) and 2.07 days (Block⁻ group; range, 1–3 days in both groups; P = 0.0038). A total of 11 patients and 1 patient underwent day surgery in the Block⁺ and Block⁻ groups, respectively (P = 0.0012). Good postoperative pain control was more commonly observed in the Block⁺ group than in the Block⁻ group (P = 0.011). TAP and RS block was effective in reducing postoperative pain and was associated with a fast recovery in patients undergoing laparoscopic inguinal hernia surgery.Key words: TAP block, RS block, Inguinal hernia, Laparoscopic surgeryInguinal hernia repair is one of the most frequently performed surgical operations. The debate regarding the best repair technique for inguinal hernia is ongoing. Several trials have compared the efficacy of the Lichtenstein and laparoscopic approach for inguinal hernia repair.^1–6 Laparoscopic repair of inguinal hernia has certain advantages over open repair, such as reduced postoperative pain and morbidity, early recovery, rapid return to work, and better quality of life.^3–7 Several strategies have been reported to ameliorate postoperative pain in laparoscopic surgery.⁸The transversus abdominis plane (TAP) block is a regional anesthetic technique that provides analgesia to the parietal peritoneum as well as to the skin and muscles of the anterior abdominal wall.^9,10 Despite a relatively low risk of complications and a high success rate using modern techniques, TAP block remains overwhelmingly underused. Although the technique is technically straightforward, it has not been adopted in clinical practice.^9,11 Moreover, rectus sheath (RS) block has been reported to be effective for pain management in patients undergoing umbilical hernia repair surgery.¹²Generally, in laparoscopic inguinal hernia surgery, the sites of port incision are on the umbilical and bilateral middle abdomen. Those sites are associated with considerable postoperative discomfort. Thus, we performed TAP and RS block to ameliorate postoperative pain and improve patient outcomes. Here, we aimed to assess the efficacy of TAP and RS block in patients undergoing laparoscopic inguinal hernia surgery.     

Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block After Laparoscopic Bariatric Surgery: a Double Blind, Randomized, Controlled Study

Background

The efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block as a part of multimodal analgesia was evaluated in morbidly obese patients undergoing laparoscopic bariatric surgery.

Methods

We studied 100 patients with body mass index >35 kg/m². They were randomly allocated to study (USG-TAP) and control groups. Pain scores at rest and on movement at various time points up to 24 postoperative hours were compared. Other parameters evaluated were patients requiring Tramazac hydrochloride (TMZ) as rescue analgesic, sedation score, time to ambulate, any adverse events, and patient satisfaction.

Results

The median visual analogue scale pain score of the study (USG-TAP) group was consistently lower at 1, 3, 6, 12, and 24 h at rest and on movement, in the postoperative period. Number of patients requiring TMZ required in the first, third, and sixth hour was significantly lower in the USG-TAP group. The prolonged sedative effect of the TMZ affected the time to ambulate. Patients in the control group remained more sedated. Four patients in the control group required BIPAP support postoperatively; no adverse event was observed. Time to ambulate was 6.3?±?1.8 h in USG-TAP and 8?±?1.8 h in control groups; P?<?0.001. Patient satisfaction scores were significantly higher in the USG-TAP group; P?<?0.001.

Conclusions

Our study demonstrates that the USG-TAP as part of multimodal analgesic technique in morbidly obese patients undergoing laparoscopic gastric bypass reduces opioid requirement, improves pain score, decreases sedation, promotes early ambulation, and has greater patient satisfaction.