Abstract
IntroductionChronic postoperative inguinal pain (CPIP) is defined as pain impacting daily activities lasting at least 3 months. With an incidence of 0.5–6.0%, chronic pain affects many patients who underwent inguinal hernia repair (IHR). Early severe postoperative pain has been described as a risk factor for CPIP. Thus, we aim to investigate the impact of the transversus abdominis plane (TAP) block on CPIP. MethodsFrom 2013 to 2019 we collected data from individuals who were operated on electively in TAPP technique and who received a preoperative TAP block. ResultsData from 289 patients were selected. 259 patients were male. The mean age was 59.93 years and the mean BMI was 25.72 kg/m2. 252 patients suffered from a primary inguinal hernia. No mesh fixation was conducted. 21 patients reported pain at rest, 26 pain under physical exertion and 13 patients required treatment of their pain. In 6.25% of cases patients reported CPIP. We compared our findings with data from the German Herniamed Registry (unilateral, primary IH, men, no mesh fixation; n = 8.799), because we assume that the majority of these patients did not receive a TAP block. The rate of pain under physical exertion (9.2% vs. 10.05%) and pain requiring treatment (2.45% vs. 2.95%) one year after surgery slightly differs without a statistical significance. ConclusionsWe assume that the TAP block may reduce CPIP, postoperative pain during physical exertion and pain requiring treatment following IHR in TAPP technique. Additional randomized clinical trials are mandatory to evaluate the hypothesis.
Highlights
Chronic postoperative inguinal pain (CPIP) is defined as pain impacting daily activities lasting at least 3 months
Like it has been recently published by different authors the transversus abdominis plane (TAP) block prior to inguinal hernia repair (IHR) in TAPP technique reduces the cumulative analgesic need medication and the pain level in the Post-Anesthesia Care Unit (PACU) [5]
The data of individuals who underwent elective IHR in TAPP technique from January 2013 to January 2019 were taken from their electronic files
Summary
Chronic postoperative inguinal pain (CPIP) is defined as pain impacting daily activities lasting at least 3 months. To reduce the analgesic medication, pain in the Post-Anesthesia Care Unit (PACU) and to accelerate the physical recovery time, the administration of local and regional anesthetic agents has been implemented in parts into the daily routine of hernia surgery Like it has been recently published by different authors the transversus abdominis plane (TAP) block prior to IHR in TAPP technique reduces the cumulative analgesic need medication and the pain level in the PACU [5]. This approach consists of the administration of local anesthetic in the layer between the internal oblique and transversus abdominis muscles. Target of this procedure are the sensory nerves innervating the abdominal wall originating from T7 to L1 (intercostal, ilioinguinal, subcostal, and iliohypogastric nerves) [6,7,8]
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