Laparoscopic-Guided Transversus Abdominis Plane Block for Better Postoperative Pain Relief in Laparoscopic Ventral Hernia Repair: An Observational Study.

Abstract

Background and objective Laparoscopic ventral hernia repair (LVHR) has been the standard procedure for abdominal wall hernia repair. However, it is associated with considerable postoperative pain attributed to the transfascial sutures and tackers used in the laparoscopic approach for this surgery. The transversus abdominis plane (TAP) block is a technique of regional anesthesia that provides analgesia to the parietal peritoneum along with the skin and muscles of the anterior abdominal wall. It helps in early recovery and reduces post-operative pain. We conducted a prospective observational single-blinded study to assess the effectiveness of this technique. Methods A total of 50 patients were allocated to two groups: (1) the Test Group, in which a laparoscopic TAP block was given with 0.25% bupivacaine; and (2) the Control Group, which was given the same block with normal saline. The visual analog scale (VAS) score was checked postoperatively to assess the postoperative pain score and documented at two, six, 12, 24, and 48 hours postoperatively. Results There were no significant differences between the Test Group (n=25) and the Control Group (n=25) in population characteristics. Postoperatively, the Test Group had lower pain scores than the Control Group (p<0.0001), and the difference was statistically significant. Test Group patients used fewer opioids than those in the Control Group after six hours postoperatively (p<0.0001). At 24 (p>0.05) and 48 hours postoperatively (p>0.05), no significant correlation in pain scores was observed. Conclusions We observed a significant difference in terms of immediate postoperative pain, the adequate time of the first ambulation, the need for any rescue medication, and the early readiness for discharge between patients who were given a TAP block compared to patients who did not receive it.