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.
RCT Entities:
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: S Yasuo; Y Kenichi; N Ueno; A Arimoto; M Hosono; T Yoshikawa; A Toyokawa; Y Kakeji; Y Tsai; C Tsai; J Sul; M Lim; J Park; C E Jang; O Santilli; D Tripoloni; H Santilli; N Nardelli; A Greco; M Estevez; S Sakurai; S Ryu; G Cesana; F Ciccarese; M Uccelli; G Grava; G Castello; D Carrieri; G Legnani; S Olmi; M Naito; H Yamamoto; Y Sawada; Y Mandai; H Asano; H Ino; K Tsukuda; T Nagahama; M Ando; K Ami; K Arai; M Miladinovic; A Kitanovic; M Lechner; F Mayer; M Meissnitzer; R Fortsner; D Öfner; G Köhler; T Jäger; Y Kumata; R Fukushima; T Inaba; Y Yaguchi; M Horikawa; E Ogawa; T Katayama; P S Kumar; D Unal; C Caparlar; T Akkaya; U Mercan; H Kulacoglu; J Jorge Barreiro; I García Baer; L Solar García; P Lora Cumplido; L J García Florez; P Fernandez Muñiz; K Fujino; K Mita; E Ohta; K Takahashi; M Hashimoto; K Nagayasu; R Murabayashi; H Asakawa; K Koizumi; G Hayashi; H Ito; F Felberbauer; S Strobl; I Kristo; S Riss; G Prager; H El Komy; A El Gendi; W Nabil; M Karam; S El Kayal; N Chihara; H Suzuki; M Watanabe; E Uchida; T Chen; J Wang; H Wang; N Bouchiba; T Elbakary; A Ramadan; M Elakkad; C Berney; V Vlasov; I Babii; O Pidmurnyak; M Prystupa; N Asakage; P Molinari; E Contino; L Guzzetti; M Oggioni; M Sambuco; M Berselli; L Farassino; E Cocozza; A Crespi; A Ambrosoli; Y Zhao Journal: Hernia Date: 2015-04 Impact factor: 4.739