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

Year 2023, , 375 - 381, 31.08.2023
https://doi.org/10.36516/jocass.1256502

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.

References

  • 1.Kehlet H, Bay-Nielsen M. Anaesthetic practice for groin hernia repair— a nation-wide study in Denmark 1998-2003. Acta Anaesthesiol Scand. 2005;49:143-6.
  • 2. Petersen PL, Mathiesen O, Stjernholm P, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol. 2013;30(7):415-21.
  • 3. Joshi GP, Rawal N, Kehlet H, et al. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012;99(2):168-85. 4. Dunn LK, Durieux ME, Nemergut EC. Non-opioid analgesics: Novel approaches to perioperative analgesia for major spine surgery. Best Pract Res Clin Anaesthesiol. 2016, 30, 79–89.
  • 5. Gritsenko K, Khelemsky Y, Kaye AD, et al. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28(1):59−79.
  • 6. Reisli R, Akkaya ÖT, Arıcan Ş, et al. Akut postoperatif ağrının farmakolojik tedavisi: Türk Algoloji-Ağrı Derneği klinik uygulama kılavuzu. Agri. 2021;33(1):1–51.
  • 7.Reinoso-Barbero F, Población G, Bulies LM, Castro LE, Lahoz AI. Successful ultrasound guidance for transversus abdominis plane blocks improves postoperative analgesia after open appendicectomy in children. Eur J Anaesthesiol. 2012;29(8):402-4.
  • 8.Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig M. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth. 2011;23(1):7-14.
  • 9.Erdogan MA, Ozgul U, Uçar M, et al Effect of transversus abdominis plane block in combination with general anesthesia on perioperative opioid consumption, hemodynamics, and recovery in living liver donors: The prospective, double-blinded, randomized study. Clin Transplant. 2017;31(4).
  • 10.Rafi AN. Abdominal field block via the lumbar triangle revisited. Anaesthesia. 2012;67(12):1399-401.
  • 11.Fredrickson MJ, Seal P. Ultrasound-guided transversus abdominis plane block for neonatal abdominal surgery. Anaesth Intensive Care. 2009;37(3):469–72. 12.Akyol Beyoğlu C, Ozdilek A, Erbabacan E, et al. Evaluation of the effects of subcostal transversus abdominis plane block on acute and subacute pain development following inguinal herniography: Randomized clinical study. Agri 2018;30(3):123–9. 13.McDonnell JG, O'Donnell BD, Farrell T, et al. Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med. 2007;32(5):399-404.
  • 14.De Oliveira GS, Jr., Castro-Alves LJ, Nader A, et al. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(2):454–63.
  • 15.Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367 (9522):1618−25.
  • 16.Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opinion. 2014;30:149-6.
  • 17.Canakci E, Cihan M, Altinbas A, et al. Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study. Braz J Anesthesiol. 2021;71(5):538-44. 18.Venkatraman R, Abhinaya RJ, Shakthivel A, Sivarajan G. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair. Local Reg Anesth. 2016;18;9:7-12.
  • 19. Aveline C, Le Hetet H, Le Roux A, et al. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011;106(3):380–6.
  • 20.Petersen PL, Mathiesen O Stjerholm P, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol. 2013;30(7):415-21.
  • 21.Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005; 94:505-13.
  • 22.Toms L, McQuay HJ, Derry S, et al: Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev. 2008;CD004602.
  • 23.Ong C.K, Seymour RA, Lirk P et. al: Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010; 110:1170-9.
  • 24.Jain S, Kalra S, Sharma B, et al. Evaluation of Ultrasound‐Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Intraperitoneal Onlay Mesh Repair. Anesth Essays Res. 2019;13:126-31.
  • 25.El-Dawlatly AA, Turkistani A, Kettner S, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009;102(6):763-7.
  • 26. M.Farooq, M. Carey. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain. Med 33 2008;274–5.
  • 27. Z. Jankovic, N. Ahmad, N. Ravishankar, et al. Transversus abdominis plane block: how safe is it? Anesth Analg. 2008;1758–9.

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

Year 2023, , 375 - 381, 31.08.2023
https://doi.org/10.36516/jocass.1256502

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.

References

  • 1.Kehlet H, Bay-Nielsen M. Anaesthetic practice for groin hernia repair— a nation-wide study in Denmark 1998-2003. Acta Anaesthesiol Scand. 2005;49:143-6.
  • 2. Petersen PL, Mathiesen O, Stjernholm P, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol. 2013;30(7):415-21.
  • 3. Joshi GP, Rawal N, Kehlet H, et al. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012;99(2):168-85. 4. Dunn LK, Durieux ME, Nemergut EC. Non-opioid analgesics: Novel approaches to perioperative analgesia for major spine surgery. Best Pract Res Clin Anaesthesiol. 2016, 30, 79–89.
  • 5. Gritsenko K, Khelemsky Y, Kaye AD, et al. Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014;28(1):59−79.
  • 6. Reisli R, Akkaya ÖT, Arıcan Ş, et al. Akut postoperatif ağrının farmakolojik tedavisi: Türk Algoloji-Ağrı Derneği klinik uygulama kılavuzu. Agri. 2021;33(1):1–51.
  • 7.Reinoso-Barbero F, Población G, Bulies LM, Castro LE, Lahoz AI. Successful ultrasound guidance for transversus abdominis plane blocks improves postoperative analgesia after open appendicectomy in children. Eur J Anaesthesiol. 2012;29(8):402-4.
  • 8.Siddiqui MR, Sajid MS, Uncles DR, Cheek L, Baig M. A meta-analysis on the clinical effectiveness of transversus abdominis plane block. J Clin Anesth. 2011;23(1):7-14.
  • 9.Erdogan MA, Ozgul U, Uçar M, et al Effect of transversus abdominis plane block in combination with general anesthesia on perioperative opioid consumption, hemodynamics, and recovery in living liver donors: The prospective, double-blinded, randomized study. Clin Transplant. 2017;31(4).
  • 10.Rafi AN. Abdominal field block via the lumbar triangle revisited. Anaesthesia. 2012;67(12):1399-401.
  • 11.Fredrickson MJ, Seal P. Ultrasound-guided transversus abdominis plane block for neonatal abdominal surgery. Anaesth Intensive Care. 2009;37(3):469–72. 12.Akyol Beyoğlu C, Ozdilek A, Erbabacan E, et al. Evaluation of the effects of subcostal transversus abdominis plane block on acute and subacute pain development following inguinal herniography: Randomized clinical study. Agri 2018;30(3):123–9. 13.McDonnell JG, O'Donnell BD, Farrell T, et al. Transversus abdominis plane block: a cadaveric and radiological evaluation. Reg Anesth Pain Med. 2007;32(5):399-404.
  • 14.De Oliveira GS, Jr., Castro-Alves LJ, Nader A, et al. Transversus abdominis plane block to ameliorate postoperative pain outcomes after laparoscopic surgery: a meta-analysis of randomized controlled trials. Anesth Analg. 2014;118(2):454–63.
  • 15.Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367 (9522):1618−25.
  • 16.Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opinion. 2014;30:149-6.
  • 17.Canakci E, Cihan M, Altinbas A, et al. Efficacy of ultrasound-guided Transversus Abdominis Plane (TAP) block in inguinal hernia surgery and the immunomodulatory effects of proinflammatory cytokines: prospective, randomized, placebo-controlled study. Braz J Anesthesiol. 2021;71(5):538-44. 18.Venkatraman R, Abhinaya RJ, Shakthivel A, Sivarajan G. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair. Local Reg Anesth. 2016;18;9:7-12.
  • 19. Aveline C, Le Hetet H, Le Roux A, et al. Comparison between ultrasound-guided transversus abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. Br J Anaesth. 2011;106(3):380–6.
  • 20.Petersen PL, Mathiesen O Stjerholm P, et al. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol. 2013;30(7):415-21.
  • 21.Remy C, Marret E, Bonnet F. Effects of acetaminophen on morphine side-effects and consumption after major surgery: meta-analysis of randomized controlled trials. Br J Anaesth. 2005; 94:505-13.
  • 22.Toms L, McQuay HJ, Derry S, et al: Single dose oral paracetamol (acetaminophen) for postoperative pain in adults. Cochrane Database Syst Rev. 2008;CD004602.
  • 23.Ong C.K, Seymour RA, Lirk P et. al: Combining paracetamol (acetaminophen) with nonsteroidal antiinflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain. Anesth Analg. 2010; 110:1170-9.
  • 24.Jain S, Kalra S, Sharma B, et al. Evaluation of Ultrasound‐Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Intraperitoneal Onlay Mesh Repair. Anesth Essays Res. 2019;13:126-31.
  • 25.El-Dawlatly AA, Turkistani A, Kettner S, et al. Ultrasound-guided transversus abdominis plane block: description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy. Br J Anaesth. 2009;102(6):763-7.
  • 26. M.Farooq, M. Carey. A case of liver trauma with a blunt regional anesthesia needle while performing transversus abdominis plane block. Reg Anesth Pain. Med 33 2008;274–5.
  • 27. Z. Jankovic, N. Ahmad, N. Ravishankar, et al. Transversus abdominis plane block: how safe is it? Anesth Analg. 2008;1758–9.
There are 23 citations in total.

Details

Primary Language English
Subjects Anaesthesiology
Journal Section Articles
Authors

Selda Çelik İlhan 0000-0003-3398-482X

Zeliha Tuncel 0000-0001-9577-6765

Mehtap Özdemir 0000-0002-3727-6591

Özlem Deligöz 0000-0002-5651-9827

Publication Date August 31, 2023
Acceptance Date August 31, 2023
Published in Issue Year 2023

Cite

APA Çelik İlhan, S., Tuncel, Z., Özdemir, M., Deligöz, Ö. (2023). The Postoperative Analgesic Effect of Transversus Abdominis Plane Block in Inguinal Hernia Repair: A Randomized Controlled Study. Journal of Cukurova Anesthesia and Surgical Sciences, 6(2), 375-381. https://doi.org/10.36516/jocass.1256502
https://dergipark.org.tr/tr/download/journal-file/11303