title: Totally extraperitoneal (TEP) endoscopic inguinal hernia repair with TAP (transversus abdominis plane) block as a day-case: a prospective cohort study.
abstract: BACKGROUND
  Totally extraperitoneal (TEP) endoscopic inguinal hernia repair is indicated for recurrent and bilateral inguinal hernias and traditionally is performed under general anesthesia. However, interventions that minimize pain and reduce opioid consumption have certain advantages for patients by avoiding side effects such as nausea and vomiting. The transversus abdominis plane (TAP) block has been used to minimize pain in a diverse range of surgical procedures but its safety on patients undergoing TEP repair has yet to be investigated.
  
  
  OBJECTIVE
  To assess the results of outpatient TEP repair with TAP block without curare.
  
  
  METHODS
  Consecutive patients undergoing elective TEP procedure were prospectively enrolled. Patients in two institutes received a similar anesthetic, surgical, and analgesic treatment protocol.
  
  
  RESULTS
  Fifty consecutive day-case patients were included in this series. The TEP repair was successful in 49 patients and there was one conversion to transabdominal pre-peritoneal (TAPP) endoscopic inguinal hernia repair. The mean duration of surgery was 20min for unilateral hernia and 40min for bilateral hernia.
  
  
  CONCLUSIONS
  These preliminary results suggest that day-case endoscopic hernia repair (TEP) with TAP block without curare is effective, safe, reproducible and can be proposed in all patients.
authors.affiliation: Abdominal Wall Repair Center, General Surgeon, Samaritano Hospital, São Paulo, Brazil. Electronic address: alberto.meyer@usp.br.
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.affiliation: Clinique Mutualiste Chirurgicale, Saint-Étienne, France.
authors.forename: L
authors.initials: L
authors.lastname: Bonnet
authors.affiliation: Clinique Mutualiste Chirurgicale, Saint-Étienne, France.
authors.forename: M
authors.initials: M
authors.lastname: Bourbon
authors.affiliation: Clinique Mutualiste Chirurgicale, Saint-Étienne, France.
authors.forename: P
authors.initials: P
authors.lastname: Blanc
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D010537:Peritoneum; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Inguinal hernia repair; Laparoscopic hernia repair; Laparoscopic total extraperitoneal inguinal hernia repair; Transversus abdominis plane block