Dataset Information

The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair a matched pair analysis.

ABSTRACT:

Purpose

Patients suffering from a ventral hernia can be treated by laparoscopic ventral hernia repair (VHR) with the intraperitoneal onlay mesh (IPOM) technique. To reduce early postoperative pain and the analgesic cumulative need for medication (CNM), the transversus abdominis plane (TAP) block has recently been investigated and implemented in hernia surgery. We aimed to investigate its impact when conducting a VHR in IPOM technique.

Methods

A single center retrospective observational matched pair analysis has been conducted from March to April 2020. The data of patients who underwent VHR in IPOM technique with prior TAP block administration were enrolled. The matching was performed using the variables age ( ±5 years), gender, type of surgery, BMI and ASA stage.

Results

52 patients were enrolled. Among the individuals of the TAP block group, (18 males, 8 females) the average age was 52.4 (15.9). The average BMI was 29.0 (3.95) kg/m². 14 patients suffered from an umbilical, 9 from an incisional, and three from an epigastric hernia. Except for COX-2-inhibitors, (TAP group: 41.9 mg (31.0), Control group 9.23 (22.1), p < 0.001) the analgesic CNM of both groups did not statistically differ from each other. The literature review yielded four relevant publications (n = 100). The authors stated a positive impact of the TAP block on early postoperative pain and analgesic medication consumption.

Conclusion

The TAP block prior to laparoscopic ventral hernia repair may reduce early postoperative pain and analgesic medication consumption in selected patients. More randomized clinical trials are needed to confirm these findings.

SUBMITTER: Paasch C

PROVIDER: S-EPMC7287190 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair a matched pair analysis.

Paasch C C Aljedani N N Ortiz P P Azarhoush S S Fiebelkorn J J Boettge K A KA Gauger U U Anders S S De Santo G G Strik M W MW

Annals of medicine and surgery (2012) 20200608

<h4>Purpose</h4>Patients suffering from a ventral hernia can be treated by laparoscopic ventral hernia repair (VHR) with the intraperitoneal onlay mesh (IPOM) technique. To reduce early postoperative pain and the analgesic cumulative need for medication (CNM), the transversus abdominis plane (TAP) block has recently been investigated and implemented in hernia surgery. We aimed to investigate its impact when conducting a VHR in IPOM technique.<h4>Methods</h4>A single center retrospective observat ...[more]

PMID: 32551101

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Project description:Background:Postoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action. Objectives:This study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy. Methods:A prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded. Results:Patients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001). Conclusions:The three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.

Project description:BACKGROUND:Pain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression. OBJECTIVES:The current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound. PATIENTS AND METHODS:Retrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression. RESULTS:Mean surgical time was 162 minutes in group A and 92 minutes in group B (P < 0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P = 0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P = 0.58); while the means of sufentanil use were 9.8 ?g and 6.0 ?g in groups A and B, respectively (P = 0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P = 0.001) and sufentanil use (+6.2 ?g [95% CI, 2.3 - 10.2], P = 0.003). There was no difference in morphine use on multivariate analysis (P = 0.99). CONCLUSIONS:TAP-block in conjunction with laparoscopic nephrectomy did not reduce pain or opioid consumption. On the contrary, it seemed to prolong surgical time.

Dataset Information

The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair a matched pair analysis.

Purpose

Methods

Results

Conclusion

Publications

The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair a matched pair analysis.

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