The Effect of Transversus Abdominis Plane Block in Inguinal Hernioplasty on Chronic Pain

Alper Kilicaslan,Ahmet Topal,Mehmet Sargın

doi:10.15197/ejgm.01415

Alper Kilicaslan, Ahmet Topal + Show 1 more

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https://doi.org/10.15197/ejgm.01415

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Abstract

The aim of the current study was to retrospectively evaluate the efficacy of IV analgesia after general anesthesia, transversus abdominis plane (TAP) block after the induction of general anesthesia and before the surgery and spinal analgesia on development of chronic pain following inguinal hernia repair. Forty patients, who underwent hernioplasty for the first-time and for whom at least 6 months had passed since the operation date were included in the study, were included in each group as follows: Group G received IV analgesia with general anesthesia; Group T included patients who received TAP block with general anesthesia; and Group S received spinal anesthesia. The study evaluated early and chronic postoperative pain, as well as pain severity, nature of the pain, predisposing factors, and the effect on various activities. No difference was found in pain incidence among the groups in the early postoperative pain evaluation; whereas VAS scores were lower in Group T. Chronic pain incidence was found to be lower in Group T. However, there was no difference among the groups in terms of VAS scores, pain nature, frequency, its effect on daily activities and sleep for patients with chronic pain. The TAP block is an effective method to prevent chronic pain development after inguinal hernioplasty compared to the other two methods. Because of the retrospective nature of the study, further prospective clinical trials are required.

Highlights

Chronic pain is defined as pain lasting longer than 3-6 months, requiring long-term treatment, having a subjective and multi-dimensional nature, and involving sensory, emotional behavioral, and cognitive components [1]
The researchers of the current study found many studies on chronic pain after inguinal hernia repair during an extensive search of the literature [26,27,28,29]; most of these studies were related to surgical techniques and equipment, and limited to the analgesic technique
Patients, who underwent inguinal hernioplasty for the first time, were rated as class I-II according to the American Society of Anesthesiologists (ASA), and aged between 18-65 years were included in the study

Summary

Introduction

Chronic pain is defined as pain lasting longer than 3-6 months, requiring long-term treatment, having a subjective and multi-dimensional nature, and involving sensory, emotional behavioral, and cognitive components [1]. Chronic pain and continuous neuralgia have been accepted as complications after inguinal hernia repair [7]. Chronic pain was reported at a rate of up to 54% after inguinal hernia repair in some studies [5,8,9,10,11,12]. The prominent factors associated with chronic pain that develop after inguinal hernia repair are as follows: repeated hernia operations [10], early postoperative severe pain [8,10], surgeon's experience, and surgical technique [13]. The most important issue of interest among chronic pain developing mechanisms after inguinal hernia repair as a consequence of all these factors is damaged sensory nerves at the surgical site The origin of chronic pain after inguinal hernia repair was accepted to be neuropathic [5]. The association of delayed postoperative sensory dysfunction with chronic pain supports this statement [8,9]

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