The Effect of Intraoperative Transversus Abdominis Plane Blocking on Postoperative Pain After Laparoscopic Transabdominal Pre-peritoneal (TAPP) Groin Hernia Repair.

Alexandros Chamzin,Evaggelia Kouskouni,George Gkiokas,Maximos Frountzas,Theodoros Xanthos,Nikolaos V Michalopoulos

doi:10.3389/fsurg.2022.834050

Abstract

BackgroundManaging postoperative pain even after laparoscopic groin hernia repair still remains an interesting challenge for clinicians especially for patients of high risk. Plenty of operative techniques and analgesic methods have been proposed in order to minimize postoperative pain after laparoscopic groin hernia repair. The aim of the present study is to compare transverse abdominis plane (TAP)-block with local analgesic infiltration at trocar entry sites in the terms of reducing postoperative pain.MethodsPatients that underwent laparoscopic trans-abdominal pre-peritoneal (TAPP) groin hernia repair in a high-volume university hospital were included. Patients were divided in two groups depending on the analgesic method used. Pain was assessed using Visual Numerical Scale (VNS) score.ResultsThirty patients were included. Intraoperative TAP-block seemed to be superior in terms of decreasing pain at the hernia area and at the trocar insertion site (p < 0.05) compared to local analgesic infiltration at the trocar insertion site at 6, 12 and 24 h after surgery (p < 0.05). In addition, pain reduction was more effective in rest rather than in motion for both analgesic methods.ConclusionIntraoperative TAP-block under direct vision seems to be an effective, fast and easy technique in order to reduce postoperative pain after laparoscopic groin hernia repair, but more studies are required to validate these results in a prospective and randomized context.

Highlights

Groin hernia repair was the most common surgical operation during 2018, as more than 20 million procedures had been performed worldwide [1]
The purpose of this study is to investigate whether intraoperative transverse abdominis plane (TAP)-block under direct vision could be an effective method of reducing postoperative pain after laparoscopic groin hernia repair
Inguinal hernia was present in 96.7% of patients, mainly on the right side (51.7%), whereas 3.3% of patients presented with femoral hernia on the left side

Summary

Introduction

Groin hernia repair was the most common surgical operation during 2018, as more than 20 million procedures had been performed worldwide [1]. Surgical community needs to pay more attention toward the management of postoperative pain after laparoscopic groin hernia repair in order to improve patient satisfaction [5]. Several studies have reported that laparoscopic repair of groin hernias combined with ultrasound (US)-guided transverse abdominis plane (TAP) blocking might have promising outcomes in alleviating postoperative pain [6, 7]. During this technique, an injection of local anesthetic agents is performed under US-guidance between transverse and internal oblique muscle in order to infiltrate nerve fibers T7-L1, which innervate the anterior and lateral abdominal wall [8, 9]. The aim of the present study is to compare transverse abdominis plane (TAP)-block with local analgesic infiltration at trocar entry sites in the terms of reducing postoperative pain

Objectives

Methods

Results

Conclusion