Inguinal Hernia Repair Surgery Research Articles

Prospective Cohort Study to Evaluate Wound Healing after Skin Closure with Skin Staplers and Nylon Suture in Open Inguinal Hernia Repair Surgery

Prospective Cohort Study to Evaluate Wound Healing after Skin Closure with Skin Staplers and Nylon Suture in Open Inguinal Hernia Repair Surgery

Analgesia strategy for inguinal hernia repair in children: a systematic review and network meta-analysis of randomized clinical trials based on regional blocks.

Despite its acknowledged benefits, the selection of an optimal regional block for analgesia pediatric hernia surgery remains a subject of debate. This study endeavored to conduct a network meta-analysis and systematic review of randomized clinical trials, aiming to amalgamate insights from both direct and indirect comparisons concerning the analgesic effectiveness and safety of various regional blocks post-inguinal hernia repair in children. A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to 12 November 2022 by two independent reviewers, employing a standardized protocol. The inclusion criteria encompassed randomized trials focusing on children undergoing inguinal hernia repair utilizing either local infiltration analgesia or regional analgesia. The primary outcomes assessed were pain scores at 2, 6, and 24 h post-operation. The initial search yielded 281 records relating to 1,137 patients. The analysis of ranking probability indicated that Paravertebral Block (PVB) holds the highest likelihood (88% and 48%) of being the most effective in alleviating pain at 2 h and 6 h post-surgery. Trans vs. Abdominis Plane Block (TAPB) emerged as the superior choice for mitigating pain (83%) and decreasing morphine consumption (93%) at 24 h following the operation. Local Anesthetic Infiltration (LAI) was identified as the most effective in shortening the hospital stay, with a 90% probability. Regional anesthesia significantly enhances postoperative pain management in pediatric inguinal hernia repair surgery. For short-term postoperative pain relief, PVB emerges as the most effective technique. Meanwhile, TAPB provides more prolonged analgesia. Although TAPB does not exhibit a pronounced advantage in short-term analgesia, its simplicity and the absence of a need for a special position render it a viable option. However, the interpretation of these results should be approached with caution due to the presence of limited data and heterogeneity. PROSPERO (CRD42022376435; www.crd.york.ac.uk/prospero).

Challenges Encountered during Anaesthetic Management of a Patient with Congenital Methaemoglobinemia Posted for Laproscopic Inguinal Hernia Repair: A Case Report

Methaemoglobinemia is a rarely encountered haematological condition that can be congenital or acquired. Methaemoglobin is an abnormal type of haemoglobin that is oxidised and incapable of delivering oxygen to tissues. This can lead to cyanosis, hypoxia, acidosis, arrhythmias, and more, depending on the methaemoglobin concentration, and can be fatal. A thorough understanding of the disease process is essential to develop a suitable anaesthesia plan and prevent complications. Ensuring adequate tissue oxygenation, assessing oxygenation using appropriate monitoring tools, and avoiding trigger agents are the cornerstones of anaesthetic management. A co-oximeter is the gold standard for monitoring, as it detects and quantifies methaemoglobin levels. Methylene blue acts as an antidote, functioning as an oxidising agent that converts itself to leukomethylene blue, which reduces methaemoglobin back to haemoglobin. In the present case of a 60-year-old male, the authors present the anaesthetic management and challenges in a diagnosed case of congenital methaemoglobinemia undergoing laparoscopic inguinal hernia repair surgery. Methylene blue was administered prophylactically preoperatively. An arterial line was established before anaesthesia induction for close haemodynamic monitoring and quick blood gas and oxyhaemoglobin sampling, as a co-oximeter was not available. Adequate oxygenation during induction and emergence was ensured to prevent hypoxia, given the lower amount of normal haemoglobin in these patients. All potential trigger agents, such as nitrous oxide, local anaesthetics, nitrates, and metoclopramide, were avoided. The patient had an uneventful intraoperative and postoperative course and was discharged after one day.

Nerve Anatomy Awareness and Recognition during Surgery for Anterior Inguinal Hernia Repair as a Preventive Measure for Chronic Postoperative Inguinal Pain

Nerve Anatomy Awareness and Recognition during Surgery for Anterior Inguinal Hernia Repair as a Preventive Measure for Chronic Postoperative Inguinal Pain

Robotic surgery for inguinal and ventral hernia repair: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the effectiveness of robotic surgery compared to laparoscopy or open surgery for inguinal (IHR) and ventral (VHR) hernia repair. PubMed and EMBASE were searched up to July 2022. Meta-analyses were performed for postoperative complications, surgical site infections (SSI), seroma/hematoma, hernia recurrence, operating time (OT), intraoperative blood loss, intraoperative bowel injury, conversion to open surgery, length of stay (LOS), mortality, reoperation rate, readmission rate, use of opioids, time to return to work and time to return to normal activities. Overall, 64 studies were selected and 58 were used for pooled data analyses: 35 studies (227 242 patients) deal with IHR and 32 (158 384 patients) with VHR. Robotic IHR was associated with lower hernia recurrence (OR 0.54; 95%CI 0.29, 0.99; I2: 0%) compared to laparoscopic IHR, and lower use of opioids compared to open IHR (OR 0.46; 95%CI 0.25, 0.84; I2: 55.8%). Robotic VHR was associated with lower bowel injuries (OR 0.59; 95%CI 0.42, 0.85; I2: 0%) and less conversions to open surgery (OR 0.51; 95%CI 0.43, 0.60; I2: 0%) compared to laparoscopy. Compared to open surgery, robotic VHR was associated with lower postoperative complications (OR 0.61; 95%CI 0.39, 0.96; I2: 68%), less SSI (OR 0.47; 95%CI 0.31, 0.72; I2: 0%), less intraoperative blood loss (- 95mL), shorter LOS (- 3.4day), and less hospital readmissions (OR 0.66; 95%CI 0.44, 0.99; I2: 24.7%). However, both robotic IHR and VHR were associated with significantly longer OT compared to laparoscopy and open surgery. These results support robotic surgery as a safe, effective, and viable alternative for IHR and VHR as it can brings several intraoperative and postoperative advantages over laparoscopy and open surgery.

THU575 The Canonical Wnt/β-catenin Pathway Is Not Involved In Estrogen-induced Skeletal Muscle Fibrosis In A Mouse Model Of Inguinal Hernia

Abstract Disclosure: T. You: None. H. Zhao: None. T. Potluri: None. P. Yin: None. S.E. Bulun: None. Inguinal hernias affect up to 27% of elderly men, with approximately 800,000 inguinal hernia repair surgeries performed annually. While these procedures are often effective, a significant subset of hernias are refractory to treatment, resulting in high mortality, high recurrence, and chronic pain. Until recently, little research has been done examining the molecular mechanisms that drive hernia-associated lower abdominal wall weakening. Our lab previously created a transgenic mouse model expressing the human aromatase gene (Aromhum) and showed that male Aromhum mice produced high levels of estrogen in the lower abdominal muscle (LAM) tissue, leading to extensive LAM fibrosis, muscle atrophy, and hernia formation. Single-cell analysis of fibrotic LAM tissue in these mice showed high expression of estrogen receptor alpha (ERα) in LAM fibroblasts as well as upregulation of Wnt signaling pathways in these ERα-positive fibroblasts. The canonical Wnt/β-catenin signaling pathway has been implicated in fibroblast activation and fibrosis in multiple organs, including the lung, heart, and skin. Thus, we hypothesized that canonical Wnt/β-catenin signaling acts as a downstream mediator of ERα to cause LAM fibroblast activation, tissue fibrosis, and hernia. To test our hypothesis, we cultured primary ERα-positive LAM fibroblasts from Aromhum mice in the presence of estrogen with or without siRNA knockdown (KD) of β-catenin. However, KD of β-catenin under these conditions did not alter fibroblast proliferation as measured by EdU assay, nor did it alter expression of genes involved in fibroblast activation or extracellular matrix formation. Furthermore, administration of LGK974, a Wnt signaling inhibitor, in male Aromhum mice did not prevent hernia development, decrease hernia size, or decrease the extent of LAM fibrosis and muscle atrophy. Thus, we concluded that the canonical Wnt/β-catenin signaling pathway does not serve as a downstream mediator of estrogen-induced skeletal muscle fibrosis in our Aromhum mouse model of inguinal hernia. Further studies are needed to evaluate the role of Wnt/β-catenin signaling in other inguinal hernia models or in humans. Presentation Date: Thursday, June 15, 2023

Comparison of the Analgesic Efficacy of Ultrasound-Guided Quadratus Lumborum Block and Ilioinguinal-Iliohypogastric Nerve Block in Paediatric Patients After Inguinal Hernia Surgery: A Prospective Randomized Controlled Trial.

To compare the postoperative analgesic efficacy of quadratus lumborum block (QLB) and ilioinguinal-iliohypogastric nerve block (IIIHB) in paediatric patients who have undergone unilateral inguinal hernia surgery. This prospective randomized controlled study was designed in a single center and included 60 paediatric patients aged 2-7 years who had undergone inguinal hernia repair surgery and received an American Society of Anesthesiologists score of 1-2. Patients were randomized into two groups: those receiving ultrasound-guided QLB and those receiving IIIHB. The primary outcomes of the study were patients' face, legs, activity, cry, and consolability (FLACC) scores at 1, 2, 6, 12, and 24 hours post-surgery. The mean heart rate 15 and 30 minutes post-surgery in the QLB group was lower than that of the IIIHB group, and the difference at both times was statistically significant (P < 0.001). The mean FLACC score of the QLB group was lower than that of the IIIHB group at 6, 12, and 24 hours post-surgery, and the differences were statistically significant (P=0.004, P=0.006, and P < 0.001, respectively). Between the groups, there was no statistically significant difference in the number of patients who were administered rescue analgesics or oral ibuprofen, the time of first ibuprofen administration, or the frequency of complications (P=1.000, P=0.145, P=0.195, and P=1.000, respectively). Compared with IIIHB, QLB achieves superior postoperative analgesic effects in paediatric patients who have undergone inguinal hernia surgery, as evidenced by longer analgesic periods, lower pain scores, and lower analgesic consumption.

A randomized clinical study to compare postoperative pain relief in ilioinguinal nerve block versus transversus abdominis plane block following inguinal hernia repair surgery

Background: Inguinal hernia surgeries are associated with postoperative pain and discomfort. Transversus abdominis plane (TAP) block and Ilioinguinal/Iliohypogastric (IIIH) nerve blocks are widely used to control postoperative pain. In this study we have compared postoperative pain relief between TAP block and IIIH nerve block in the patients undergoing inguinal hernia surgery under spinal anesthesia. Aims and Objectives: The primary aim of this study was to compare postoperative pain relief of TAP block and IIIH block in patients undergoing inguinal hernia surgery. Secondary objectives were to observe hemodynamic parameters and to observe for postoperative side effects if any. Materials and Methods: Sixty patients of age group 18–65-year-old males, ASA grade I, II, were randomised into two groups TAP group (n=30) and IIIH group (n=30). TAP group received 30 mL of 0.25% ropivacaine TAP block and group IIIH received 20 mL, and wound infiltration with 10 mL of 0.25% ropivacaine. Duration of analgesia was recorded, visual analogue scale (VAS) score compared in first 24h postoperatively. Perioperative haemodynamic parameters were recorded. Results: VAS score was found significant at 1, 2, 3, 4, 5, 8, 10, 16 h (P&lt;0.001). The mean duration of analgesia was found to be 4.64±1.16 h and 6.3±1.84 h for IIIH group and TAP group respectively which was statistically significant (P&lt;0.001). Haemodynamic were stable and no complication was there in both the groups. Conclusion: As a part of multimodal analgesia regimen both TAP block and IIIH block provided good pain relief postoperatively in patients undergoing inguinal hernia. In this study TAP block provided prolonged pain relief than IIIH block after inguinal hernia repair.

Feasibility of totally extraperitoneal inguinal hernia repair in patients with previous prostatectomy.

Laparoscopic totally extraperitoneal inguinal hernia repair (TEP) surgery technique includes three key steps: reaching the preperitoneal space, reducing hernias, and placement of mesh. However, reaching the preperitoneal space can be complicated in patients with previous lower abdominal surgeries. This study aimed to assess the feasibility of laparoscopic inguinal TEP in patients with previous prostatectomies. Inguinal hernia patients who underwent laparoscopic TEP between January 2015 and February 2021 at Koç University Faculty of Medicine, Department of General Surgery, were included in this retrospective study. The operations were performed by five senior surgeons experienced in laparoscopy. Patients were divided into two study groups, as the radical prostatectomy (RP) group which included patients with previous prostatectomy non-RP which included patients without previous radical prostatectomy. Operative time (OT), length of hospital stay (LOS), and postoperative complications were compared within two groups. Three hundred and forty-nine patients underwent laparoscopic TEP, and 27 had previous prostatectomies. Among them, 190 patients had unilateral inguinal hernias, and 159 had bilateral inguinal hernias. Mean age of the patients in the non-RP and RP groups was 58.1 ± 14.7 and 73.9 ± 9.6 years, respectively. Only one (3.7%) case was complicated with urinary tract infection in the RP group, and 10 (3.1%) were complicated in the non-RP group. Complications for the non-RP group include hematomas in six cases, urinary tract infection in three cases, and urinary retention in one case. No significant difference in mean operative time was seen between non-RP and RP groups (p= 0.43). There was no significant difference in the means of the length of hospital stay between the two groups (p= 0.7). Laparoscopic TEP in patients with a previous prostatectomy can be performed safely without prolonging the operative time and increasing the length of hospital stay.

A STUDY OF SINGLE DOSE PRE-OPERATIVE ANTIBIOTIC PROPHYLAXIS VERSUS CONVENTIONAL MULTIPLE DOSE POST OPERATIVE ANTIBIOTIC THERAPY IN INGUINAL HERNIA REPAIR SURGERY

Background: Elective inguinal hernioplasty is considered to be a clean procedure which does not require antibiotic prophylaxis but prosthetic material like polypropylene mesh is routinely used during procedure. This makes the topic debatable because the use of prosthetic material like mesh increases the risk of surgical site infection. The incidence of surgical site infection (SSI) after inguinal hernioplasty ranges from 0% to 14 % in international literature. It is also more controversial whether single dose antibiotic or conventional multiple doses of antibiotics for 5 to 7 days is effective. Hence our study aims to compare the efficacy of single dose versus multiple dose antibiotic prophylaxis in open inguinal hernioplasty Patients And Methods: A total of 120 cases of inguinal hernia admitted in Gadag Institute of Medical Sciences in the Department of general surgery underwent Lichtenstein tension free mesh hernioplasty and received either pre-op single dose or post-op multiple dose antibiotic therapy. The two groups were then compared for SSI. Conclusion: Our study shows that a single dose of antibiotics given half an hour prior to open surgery in elective uncomplicated inguinal hernia repair surgery is as effective as multiple doses of antibiotics post-operatively in preventing post-operative surgical site infection.

Analgesic Sparing Effect of Dexamethasone with Levobupivacaine in Quadratus Lumborum Block in Patients Undergoing Unilateral Inguinal Hernia Repair

Abstract Background The QLB is an effective analgesic technique for various abdominal wall incisinos. The QLB covers T7 to L2 dermatomes. Levobupivacaine is a long-acting LA agent, commonly used for peripheral nerve block due to its better safety profile than that of bupivacaine. Dexamethasone as an adjuvant to LA has been shown to prolong the duration of pain-free period, less requirement for rescue opioids consumption, more patient satisfaction and lesser incidence of nausea and vomiting. Objective To assess the analgesic sparing effect of adding dexamethasone to levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair under general anesthesia. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this prospective double blind randomized clinical trial study was conducted in Ain Shams University Hospitals. Sixty patients scheduled for elective ingunial surgeries under general anesthesia were included in this study. Results Our study did not have any complications associated with the use of dexamethasone with levobupivacaine in QLB. Type 1 QLB failed to provide postoperative analgesia in surgeries involving dissection in the retroperitoneal area as there were high chances of damaging the thoracolumbar fascia. Conclusion The addition of dexamethasone to levobupivacaine in QLB in unilateral inguinal hernia repair surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to levobupivacaine alone group.

Modified Frailty Index and Albumin-Fibrinogen Ratio Predicts Postoperative Seroma After Laparoscopic TAPP.

Postoperative seroma is the most common minor complication after inguinal hernia repair surgery and can have negative consequences. The objective of this study was to identify potential risk factors for postoperative seroma. This study consecutively included 354 elderly patients with inguinal hernia who underwent laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP). Seroma diagnosis was conducted by the same experienced surgeon based on the physical examinations combined with ultrasound. Risk factors for seroma were identified through univariate analysis and subsequently included in the binary multivariate logistic regression model. A total of 40 patients experienced postoperative complications of seroma, with an incidence rate of 11.3% (40/354). The binary logistic regression analysis revealed that obesity (OR: 2.98, 95% CI: 1.20-7.41, P = 0.018), disease duration ≥ 4.5 years (OR: 4.88, 95% CI: 2.14-11.18, P < 0.001), albumin-fibrinogen ratio (AFR) level < 9.25 (OR: 6.13, 95% CI: 2.00-18.76, P = 0.001), and modified frailty index (mFI) score ≥ 0.225 (OR: 6.38, 95% CI: 2.69-15.10, P < 0.001) were four independent risk factors for postoperative seroma. Obesity, prolonged disease duration, decreased AFR level, and increased mFI score independently predict postoperative seroma after laparoscopic TAPP.

The Impact of Surgical Technique on Recurrence Rates After Inguinal Hernia Repair: a Retrospective Analysis

Inguinal hernia repair is a common surgical procedure to treat the condition of inguinal hernia, which is the escape of internal organ tissue through a gap or weakness in the lower abdominal wall. After undergoing surgery, the recurrence rate of inguinal hernia may vary. Therefore, it is important to conduct a retrospective analysis to understand the impact of surgical techniques on inguinal hernia recurrence rates. The aim of this study was to analyze the impact of surgical techniques on the recurrence rate of inguinal hernia. This study used a retrospective analysis method. Data were collected from questionnaires and medical records of patients who had undergone inguinal hernia repair surgery at X hospital. The data obtained included information about the surgical technique used, patient characteristics, such as age and gender, and the rate of recurrence of inguinal hernia that occurred after surgery. The collected data will be statistically analyzed using the IBM SPSS program. The results showed that surgical techniques with laparoscopic methods have a lower inguinal hernia recurrence rate than conventional methods. This can be seen from the results of the regression coefficient test with a recurrence rate of 28.7% compared to the conventional method of 32.6%.

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial

BackgroundModified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP). MethodsPatients with American Society of Anesthesiologists (ASA) physical status I–II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period. ResultsThe global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001). ConclusionIn our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP. Register NumberNCT05199922.

Enriched environment ameliorates postsurgery sleep deprivation-induced cognitive impairments through the AMPA receptor GluA1 subunit.

As a common postsurgery complication, sleep deprivation (SD) can severely deteriorate the cognitive function of patients. Enriched environment (EE) exposure can increase children's cognitive ability, and whether EE exposure could be utilized to alleviate postsurgery SD-induced cognitive impairments is investigated in this study. Open inguinal hernia repair surgery without skin/muscle retraction was performed on Sprague-Dawley male rats (9-week-old), which were further exposed to EE or standard environment (SE). Elevated plus maze (EPM), novel object recognition (NOR), object location memory (OLM), and Morris Water Maze assays were utilized to monitor cognitive functions. Cresyl violet acetate staining in the Cornusammonis 3 (CA3) region of rat hippocampus was used to detect neuron loss. The relative expression of brain-derived neurotrophic factor (BDNF) and synaptic glutamate receptor 1 (GluA1) subunits in the hippocampus were detected with quantitative reverse transcription polymerase chain reaction (RT-qPCR), Western blots, enzyme-linked immunosorbent assay (ELISA), and immunofluorescence. EE restored normal levels of time spent in the center, time in distal open arms, open/total arms ratio, and total distance traveled in the EPM test; EE restored normal levels of recognition index in the NOR and OLM test; EE restored normal levels of time in the target quadrant, escape latencies, and platform site crossings in the Morris Water Maze test. EE exposure decreased neuron loss in the CA3 region of the hippocampus with increased BDNF and phosphorylated (p)-GluA1 (ser845) expression. EE ameliorates postsurgery SD-induced cognitive impairments, which may be mediated by the axis of BDNF/GluA1. EE exposure could be considered as an aid in promoting cognitive function in postsurgery SD.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

The ANZ hernia repair practices study: low consensus on inguinal and small ventral hernia management and infrequent long-term follow-up.

SURGICAL MANAGEMENT OF BILATERAL INGUINAL HERNIAS: A PROSPECTIVE STUDY OF LICHTENSTEIN, STOPPAS AND TEP REPAIR.

BACKGROUND: The choice of surgery for bilateral inguinal hernia repair still remains a debatable question for surgeons. This study was aimed at analysing the effectives as well as comparing Lichtenstein, Stoppas and laparoscopic TEP(total extraperitoneal repair) approaches for Bilateral inguinal hernia. Prospective study invol MATERIALS AND METHODS: ving 60 patients of Bilateral inguinal hernia, were divided into 3 groups, 20 patients each in Lichtenstein, Stoppas and TEP. As per relevant rating scales, parameters analysed were duration of surgery, post operative pain, post operative analgesia requirement, duration of hospital stay, return to normal activity, cost effectiveness, surgical complications, recurrence over 6months. Minor complications such as seroma, scrotal RESULTS: oedema, wound infection were common in Lichtenstein compared to Stoppas and TEP. Shorter duration of surgery, early discharge and early return to normal activities was seen in Stoppas and TEP compared to Lichtenstein. One recurrence was seen in TEP and Lichtenstein. Post operative pain was least with TEP than the other two groups. Open surgery proved to be more cost effective than TEP. TEP in CONCLUSION: comparison with Stoppas and Lichtenstein is safer with lesser complications and earlier recovery, but less cost effective than open surgery. In developing countries, where cost effectiveness plays a crucial role in deciding the surgery, Stoppas is safe with minimal complications and rapid recovery. This study also demonstrates the effect of surgeon's experience on clinical outcome, with learning curve being shorter in open vs TEP repair

Efficacy of landmark based blind transverse abdominis plane block for post-operative pain relief in inguinal hernia

Background: Pain after open hernia surgery can be moderate-to-severe and is known to be associated with prolonged hospital stay and delayed return to normal daily activities. Aims and Objectives: We aimed to investigate the effect of a blind landmark-based approach of transversus abdominis plane (TAP) block on patients undergoing elective inguinal hernia repair surgery under spinal anesthesia. Materials and Methods: This was a prospective, randomized, controlled, and clinical trial consisting of 60 patients scheduled for inguinal hernia repair under spinal anesthesia. Patients in Group-1 received TAP block by landmark based blind technique, whereas those in Group-2 did not receive TAP block. Pain assessments were scored for all patients at rest and movement at 2, 4, 6, 12, and 24 h after surgery using visual analog scale. Results: The pain scores in the post-operative period, during rest and movement, were significantly lower in patients that received TAP block. Significant number of cases reported nausea and vomiting or headache in Group-2 due to increase requirement of analgesics for pain relief during first the 24 h of post-operative period. Conclusion: Landmark-based blind TAP block may be an effective way of providing analgesia in patients undergoing elective open inguinal hernia repair under spinal anesthesia.

Ultrasound-Guided Transversus Abdominis Plane Block Versus Single-Shot Epidural Block for Postoperative Analgesia in Patients Undergoing Inguinal Hernia Surgery.

Background Transversus abdominis plane (TAP) block and epidural analgesia are two frequently used regional anaesthesia techniques that attenuate postoperative pain after inguinal hernia repair. Aim To compare the analgesic efficacy between the single-shot epidural block and TAP block for postoperative analgesia in patients undergoing inguinal hernia repair surgery. Methods Forty patients of either gender undergoing elective inguinal hernia surgery of American Society of Anesthesiologists (ASA) class Ⅰ and Ⅱ were randomly allocated into two groups. Group E received a single-shot epidural with 20 ml of 0.25% bupivacaine. Group T received a TAP block with 20 ml of 0.25% bupivacaine under ultrasound guidance. Postoperative pain was evaluated by the visual analog scale (VAS). Rescue analgesia was given on VAS score ≥ 4 or on-demand in the postoperative period. The primary outcome included VAS score at 15 min, 1st h, 2nd h, 6th h, 12th h, and 24th h after the block. The secondary outcome was the analgesia duration, the total rescue analgesia dose required, and the patient satisfaction level. Results The VAS pain scores were significantly lower in the epidural group compared to the TAP group at the 2nd, 6th, 12th, and 24th h postoperatively (p<0.0001). The mean duration of analgesia was significantly more in Group E (576.75±96.64 min) compared to Group T (276.75±105.56 min). The total analgesic consumption was seen significantly more in 24 h in Group T than in Group E. Patient satisfaction score was significantly higher with a mean value of 5.55±0.6 in group E compared to 4.75±0.72 in group T. Conclusion A single-shot epidural provides better postoperative pain control than a TAP block. The duration of the first analgesic demand was prolonged, with less analgesic consumption in the epidural group.

Dexmedetomidine adjunct to ropivacaine for ultrasound-guided transversus abdominis plane block for open inguinal hernia repair in the older adults: A randomised clinical trial.

The aim of this study was to evaluate the effect of adding dexmedetomidine to ropivacaine on pain relief and quality of recovery in older patients undergoing open inguinal hernia repair surgeries. This was a prospective and randomised clinical trial of 102 patients aged over 65 years who received an ultrasound-guided transversus open mesh herniorrhaphy abdominis plane (TAP) block with either 0.375% ropivacaine 20 ml (Group R, n = 47) or 0.375% ropivacaine combined with 1 μg/kg dexmedetomidine 20 ml (Group RD, n = 45) in the pre-anaesthesia care unit before elective open inguinal hernia surgeries. The primary outcome measure was Visual Analogue Scale (VAS) pain scores at rest and on movement at 2, 4, 8, 12 and 24 h and at 1 and 3 months' postoperatively. The secondary outcome measures were the incidence of post-operative delirium (POD), nausea and vomiting and the occurrence of side effects or complications on post-operative day 1. Group RD had lower VAS scores at rest and on movement at 8 and 12 h postoperatively and a lower incidence of POD on the post-operative day 1 than Group R. Transient bradycardia was more frequent in Group RD than in Group R, and side effects or post-operative complications were reported in either group. The addition of dexmedetomidine to ropivacaine in a TAP block enhances postoperative analgesia during hospitalisation and improves the quality of recovery without affecting chronic pain in older patients undergoing open inguinal hernia repair surgery.