Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair.

Abstract

BACKGROUND:

Transversus abdominis plane (TAP) block has been reported to provide effective analgesia after lower abdominal surgery, but there are few data comparing ilioinguinal/iliohypogastric nerve (IHN) block with ultrasound-guided TAP block in patients undergoing inguinal hernia repair.

METHODS:

Two hundred and seventy-three patients undergoing day-case open inguinal hernia repair with a mesh were randomly allocated to receive either ultrasound-guided TAP block or blind IHN block with levobupivacaine 0.5%, before surgery. Patients were monitored for visual analogue scale (VAS) scores at rest (in the post-anaesthesia care unit, and at 4 and 12 h) and at rest and during movement (at 24, 48 h, 3 and 6 months). Pain at 6 months was also assessed using the DN4 questionnaire for neuropathic pain.

RESULTS:

Median VAS pain scores at rest were lower in the ultrasound-guided TAP group at 4 h (11 vs 15, P=0.04), at 12 h (20 vs 30, P=0.0014), and at 24 h (29 vs 33, P=0.013). Pain after the first 24 h, at 3 and 6 months after surgery, and DN4 scores were similar in both groups (P=NS). The proportion of patients with VAS >40 mm on movement at 6 months was comparable {18.2% [95% CI (12.2-26.1%)] vs 22.4% (15.8-30.6%) in the TAP and IHN groups, respectively, P=0.8}. Postoperative morphine requirements were lower during the first 24 h in the TAP block group (P=0.03).

CONCLUSIONS:

Ultrasound-guided TAP block provided better pain control than 'blind' IHN block after inguinal hernia repair but did not prevent the occurrence of chronic pain.

• Authors: C Aveline, H Le Hetet, A Le Roux, P Vautier, F Cognet, E Vinet, C Tison, F Bonnet
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 106 Issue 3 Pg. 380-6 (Mar 2011) ISSN: 1471-6771 [Electronic] England
• PMID: 21177284 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Local
• Levobupivacaine
• Bupivacaine

Topics

• Abdominal Muscles (diagnostic imaging)
• Adult
• Aged
• Aged, 80 and over
• Ambulatory Surgical Procedures
• Anesthesia, General (methods)
• Anesthetics, Local (administration & dosage)
• Bupivacaine (administration & dosage, analogs & derivatives)
• Hernia, Inguinal (surgery)
• Humans
• Levobupivacaine
• Male
• Middle Aged
• Nerve Block (methods)
• Pain Measurement (methods)
• Pain, Postoperative (prevention & control)
• Ultrasonography, Interventional