The Postoperative Analgesic Effect Of Transversus Abdominis Plane Block Undergoing inguinal Hernia Repair: A Randomized Controlled Study

Abstract

Giriş Pre-insizyonel Transversus Abdominis Plane (TAP) bloğun genel anestezi altında inguinal herni onarımı yapılan hastalarda analjezik etkinliğini, hemodinami üzerine etkisini, periopertaif opioid tüketimini ve postoperatif kurtarıcı analjezik ihtiyacını araştırdık. Gereç ve Yöntemler Bu prospektif randomize kontrollü çalışmaya 18- 75 yaş aralığında toplam 60 hasta dahil edildi. Hastalar TAP blok yapılmayan (Grup I, n=30) ve TAP blok yapılan (GrupII, n=30) olarak ikiye ayrıldı. Ultrasonagrafi eşliğinde normal salin (1 mL) internal oblik ve transvers abdominal kas arasına enjekte edilerek ayrılması görüldükten sonra 20 mL %0,25 bupivakain ile blok sağlandı. Tüm hastaların vizüel ağrı skorları (VAS), perioperatif hemodinamik verileri, perioperatif opioid kullanım miktarı, postoperatif kurtarıcı analjezik başlama süresi ve sayısı kaydedildi. Postoperatif parasetamol 1 gr her 6 saatte bir verildi ve Vizüel Analog Skoru (VAS) 4’ün üzeri ise kurtarıcı analjezik olarak Tramadol HCl uygulandı. Sonuç Gruplar arasında demografik verilerde fark yoktu. Peroperatif kullanılan toplam remifentanil dozu Grup II’de Grup I’ den düşüktü (p=0,012). VAS değeri ölçülen tüm zamanlarda Grup II’de Grup I’e göre düşük bulundu (p<0,05). Kurtarıcı analjezik uygulanan hasta sayısı Grup I’de Grup II’ye göre yüksek bulundu (p<0,05). Postoperatif verilen kurtarıcı analjezik ihtiyacı ve uygulama sayısı Grup II’de Grup I’e göre düşük bulundu (p=0,047). Postoperatif ilk kurtarıcı analjezik uygulama zamanı Grup II’de Grup I’e göre daha geç bulundu (p=0,032). Postoperatif bulantı-kusması gelişen hasta sayısında anlamlı farklılık saptanmadı (p>0,05). Tartışma Çalışmamızda insizyon öncesi US eşliğinde TAP bloğunun perioperatif opioid tüketimini ve postoperatif dönemde kurtarıcı analjezi ihtiyacını azalttığı sonucuna vardık. Ayrıca analjezik ihtiyacını gidermek için gereken süreyi geciktirmeye de yardımcı oldu. İnguinal herni onarımı yapılan hastalarda TAP bloğun güvenilir bir analjezi yöntemi olduğunun daha büyük çalışmalarla doğrulanması gerekir.

Keywords

• hernia
• inguinal
• transversus abdominis plane block
• postoperative analgesia

The Postoperative Analgesic Effect of Transversus Abdominis Plane Block in Inguinal Hernia Repair: A Randomized Controlled Study.

Abstract

Aim: The objective of this study was to investigate the effect of preincisional (preemptive) Transversus Abdominis Plane (TAP) block on perioperative opioid consumption, hemodynamic parameters and postoperative rescue anal¬gesic consumption in patients undergoing inguinal hernia repair. Methods: 60 adult patients were included in this prospective randomized controlled study. The patients were divided into two groups: those who received conventional systemic analgesia (Group C) and those who received US-guided TAP block (Group TAP). By ultrasonography, normal saline (1 mL) was injected between the internal oblique and transverse abdominal muscles, and after separation was observed, 20 mL of 0.25% bupivacaine was administered. Postoperatively, 1mg/kg Tramadol HCl was given to all patients as a rescue analgesic. Perioperative hemodynamic data, perioperative total amount of remifentanil consumption amount, postoperative Visual Ana¬logue Scale (VAS) scores, starting time and number of rescue analgesics were recorded. Results: There was no difference in demographic data. Intraoperative remifentanil dose, VAS values at all times, need for rescue analgesics and the number of applications were significantly lower in Group TAP than in Group C (p=0.012, p<0.05, p=0.047). The number of patients who received rescue analgesics was significantly higher in Group C than in Group TAP (p<0.05). It was found that the first rescue analgesic administration time was needed later in Group TAP than in Group C (p=0.032). No difference was found in postoperative nausea and vomiting (p>0.05). Conclusions: We concluded that preincisional TAP block is a safe and effective analgesia technique for postoper¬ative pain control in patients undergoing unilateral inguinal hernia repair and our findings should be supported by advanced controlled randomized studies.

Keywords

• Hernia
• Inguinal
• transversus abdominis plane block
• analgesia

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