Transversus abdominis plane block for laparoscopic inguinal hernia repair: a randomized trial

Pain after laparoscopic inguinal hernia surgery can be moderate to severe, interfering with return to normal activity. The study aimed to assess the efficacy of bilateral ultrasound-guided (USG) transversus abdominis plane (TAP) block for relieving acute pain after laparoscopic hernia repair as T10-L1 nerve endings are anesthetized with this block. Seventy-one American Society of Anesthesiologists I to II patients, aged 18 to 65 years, undergoing unilateral/bilateral laparoscopic hernia repair were randomized to port site infiltration (control, 36) and TAP block groups (35). All patients received general anesthesia (fentanyl 2 μg/kg intravenously at induction, 0.5 μg/kg on 20% increase in heart rate or mean blood pressure) and paracetamol 6 hourly. Postintubation, TAP group received bilateral USG TAP block (15-20 mL 0.5% ropivacaine, maximum 3 mg/kg) with 18-G Tuohy needle. Control group had 20 to 30 mL 0.5% ropivacaine infiltrated preincision, at port sites from skin to peritoneum. Postoperative patient-controlled analgesia fentanyl was provided for 6 hours; pain was assessed using 0- to 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 24 hours and telephonically at 1 week and 3 months. Demographic profile of the 2 groups was comparable. Significantly more number of patients required intraoperative fentanyl in the control group (24/36) than in the TAP group (13/35); VAS at rest was lower in TAP than control patients in postanesthesia care unit at 0, 2, 6, and 24 hours (median VAS TAP group: 0, 0, 0, and 0; control: 10, 20, 10, and 10; P= .002, P= .001, P= .001, and P= .006, respectively); P< .01 was considered statistically significant. TAP group had significantly lower VAS on deep breathing at 6 hours and on knee bending and walking at 24 hours and lesser patient-controlled analgesia fentanyl requirement. No significant difference in pain scores was observed at 1 week and 3 months. TAP block reduced postoperative pain up to 24 hours after laparoscopic hernia repair..

Medienart:	Artikel

Erscheinungsjahr:	2016
Erschienen:	2016

Enthalten in:	Zur Gesamtaufnahme - volume:33
Enthalten in:	Journal of clinical anesthesia - 33(2016), Seite 357-364

Sprache:	Englisch

Beteiligte Personen:	Arora, Mahesh K [VerfasserIn] Arora, Shubhangi [Sonstige Person] Chhabra, Anjolie [Sonstige Person] Subramaniam, Rajeshwari [Sonstige Person] Misra, Mahesh C [Sonstige Person] Bansal, Virender K [Sonstige Person]

Links:	Volltext www.sciencedirect.com www.ncbi.nlm.nih.gov

BKL:	44.00

doi:	10.1016/j.jclinane.2016.04.047

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	OLC1982930306