Laparoscopic-assisted transversus abdominis plane block as an effective analgesic in total extraperitoneal inguinal hernia repair: a double-blind, randomized controlled trial

A Mughal, A Khan, J Rehman, H Naseem, R Waldron, M Duggan, W Khan, K Barry, I Z Khan, A Mughal, A Khan, J Rehman, H Naseem, R Waldron, M Duggan, W Khan, K Barry, I Z Khan

Abstract

Purpose: Laparoscopic inguinal hernia repair has facilitated early mobilization. Management of post-operative pain is paramount in these day case procedures. The aim of this study was to compare laparoscopic-assisted transversus abdominis plane (TAP) block with periportal local anaesthetic infiltration in managing post-operative pain.

Methods: A double-blind, randomized controlled trial was conducted with patients undergoing elective laparoscopic inguinal hernia repair (January 2016-October 2017). The intervention group received laparoscopic-assisted TAP block with 30 ml 0.25% Bupivacaine. The control group received 15ml of 0.5% Bupivacaine at the periportal sites. Primary outcome measure was assessment of post-operative pain scores using numerical rating on visual analogue scale (VAS) at rest and on coughing at 3 h. Efficacy of TAP block was assessed as reduction in mean pain scores in the order of 2 points using the VAS.

Results: 60 (57 males and 3 females) were enrolled; 30 patients were randomized to each group. Patient demographics, anaesthetic and surgical times were similar in both groups. Mean pain scores were significantly reduced in the intervention group at 3 (3.1 vs 1.1 p < 0.001) and 6 h (4.1 vs 1.7 p < 0.001) at rest and on coughing at 3 (4.8 vs 2.1 p < 0.001) and 6 h (5.4 vs 3.0 p < 0.001). Patient satisfaction was higher (8.0 vs 6.8 p < 0.001) and rescue analgesic requirements (169.4vs 71.3 p < 0.001) lower in the intervention group.

Conclusions: This analysis has demonstrated the therapeutic benefit of laparoscopic-assisted TAP block in initial post-operative pain management for patients undergoing elective laparoscopic inguinal hernia repair.

Keywords: Laparoscopic-assisted transversus abdominis Plane block; Periportal; Total extraperitoneal inguinal hernia repair; Visual analogue scale.

Conflict of interest statement

Conflict of interest

Dr. AM declares no conflict of interest related to the submitted work. Dr. AK declares no conflict of interest related to the submitted work. Dr. JR declares no conflict of interest related to the submitted work. Dr. MR declares no conflict of interest related to the submitted work. Dr. HN declares no conflict of interest related to the submitted work. Dr. RW declares no conflict of interest related to the submitted work. Dr. MD declares no conflict of interest related to the submitted work. Dr. WK declares no conflict of interest related to the submitted work. Dr. KB declares no conflict of interest related to the submitted work. Dr. IZK declares no conflict of interest related to the submitted work.

Ethical approval

Ethical approval was agreed by the ethical committee of our institution, Mayo University Hospital (MUH) Castlebar, Ireland.

Human and animal rights

Study including human participants has been performed in accordance with ethical standards of Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients prior to all surgical procedures.

Figures

Fig. 1
Fig. 1
Study flow diagram. TAP, transversus abdominis plane
Fig. 2
Fig. 2
Surface landmarks for TAP block. Needle is inserted anterior to midaxillary line
Fig. 3
Fig. 3
Bulge after injection of local anaesthetic, visualized through laparoscope within the space of Bogros

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