title: The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial.
abstract: BACKGROUND
  The analgesic effect of transversus abdominis plane (TAP) block after inguinal hernia repair is unclear.
  
  
  OBJECTIVE
  The aim of this randomised and double-blind study was to evaluate the analgesic effect of a TAP block in patients scheduled for primary inguinal hernia repair. The TAP block was evaluated versus placebo and versus an active comparator (ilioinguinal block and wound infiltration).
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Single centre trial. Study period from June 2010 to November 2011.
  
  
  METHODS
  Adults (18 to 75 years) with American Society of Anesthesiologists' status 1-3 scheduled for primary inguinal hernia repair as day case surgery were included in the study.
  
  
  METHODS
  Ninety patients were allocated to one of three groups: group TAP, group infiltration (ilioinguinal nerve block and wound infiltration) and group placebo.
  
  
  METHODS
  The primary outcome measure was pain scores while coughing between group TAP and group placebo calculated as area under the curve for the first 24  h (AUC24 h). Secondary outcomes were pain scores while coughing and at rest, opioid consumption and side effects in groups TAP, infiltration and placebo.
  
  
  RESULTS
  Visual analogue pain scores while coughing and at rest demonstrated no difference between groups. Pain scores in groups infiltration, TAP and placebo were 19 versus 22 versus 15  mm at rest (P = 1.00) and 37 versus 41 versus 37  mm while coughing (P = 1.00). Pain scores at 6 h (AUC6 h) were significantly lower in group infiltration than in group TAP (10 versus 25 mm at rest, P < 0.001; 17 versus 40  mm while coughing, P < 0.001), and than in group placebo (10 versus 20  mm at rest, P = 0.003; 17 versus 38  mm while coughing, P < 0.001). Median morphine consumption was lower in group infiltration than in group placebo (0 versus 5 mg, P < 0.003). No differences among groups were demonstrated for ketobemidone consumption or side effects.
  
  
  CONCLUSIONS
  Ultrasound-guided TAP block did not reduce postoperative pain after inguinal hernia repair.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01052285. EudraCT number 2010-018403-29.
authors.affiliation: Department of Anaesthesia, Centre of Head and Orthopaedics, Section of Acute Pain Management, Copenhagen, Denmark. pernille.lykke.petersen@dadlnet.dk
authors.forename: Pernille L
authors.initials: PL
authors.lastname: Petersen
authors.forename: Ole
authors.initials: O
authors.lastname: Mathiesen
authors.forename: Pia
authors.initials: P
authors.lastname: Stjernholm
authors.forename: Viggo B
authors.initials: VB
authors.lastname: Kristiansen
authors.forename: Henrik
authors.initials: H
authors.lastname: Torup
authors.forename: Egon G
authors.initials: EG
authors.lastname: Hansen
authors.forename: Anja U
authors.initials: AU
authors.lastname: Mitchell
authors.forename: Ann
authors.initials: A
authors.lastname: Moeller
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Joergen B
authors.initials: JB
authors.lastname: Dahl
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects / Q000294:innervation*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000777:Anesthetics / Q000627:therapeutic use*; D019540:Area Under Curve; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy; D011184:Postoperative Period; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000777:Anesthetics