title: Transversus abdominis plane block for laparoscopic inguinal hernia repair: a randomized trial.
abstract: BACKGROUND
  Pain after laparoscopic inguinal hernia surgery can be moderate to severe, interfering with return to normal activity. The study aimed to assess the efficacy of bilateral ultrasound-guided (USG) transversus abdominis plane (TAP) block for relieving acute pain after laparoscopic hernia repair as T10-L1 nerve endings are anesthetized with this block.
  
  
  METHODS
  Seventy-one American Society of Anesthesiologists I to II patients, aged 18 to 65 years, undergoing unilateral/bilateral laparoscopic hernia repair were randomized to port site infiltration (control, 36) and TAP block groups (35). All patients received general anesthesia (fentanyl 2 μg/kg intravenously at induction, 0.5 μg/kg on 20% increase in heart rate or mean blood pressure) and paracetamol 6 hourly. Postintubation, TAP group received bilateral USG TAP block (15-20 mL 0.5% ropivacaine, maximum 3 mg/kg) with 18-G Tuohy needle. Control group had 20 to 30 mL 0.5% ropivacaine infiltrated preincision, at port sites from skin to peritoneum. Postoperative patient-controlled analgesia fentanyl was provided for 6 hours; pain was assessed using 0- to 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 24 hours and telephonically at 1 week and 3 months.
  
  
  RESULTS
  Demographic profile of the 2 groups was comparable. Significantly more number of patients required intraoperative fentanyl in the control group (24/36) than in the TAP group (13/35); VAS at rest was lower in TAP than control patients in postanesthesia care unit at 0, 2, 6, and 24 hours (median VAS TAP group: 0, 0, 0, and 0; control: 10, 20, 10, and 10; P= .002, P= .001, P= .001, and P= .006, respectively); P< .01 was considered statistically significant. TAP group had significantly lower VAS on deep breathing at 6 hours and on knee bending and walking at 24 hours and lesser patient-controlled analgesia fentanyl requirement. No significant difference in pain scores was observed at 1 week and 3 months.
  
  
  CONCLUSIONS
  TAP block reduced postoperative pain up to 24 hours after laparoscopic hernia repair.
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shubhangi
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: anjolie5@hotmail.com.
authors.forename: Anjolie
authors.initials: A
authors.lastname: Chhabra
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajeshwari
authors.initials: R
authors.lastname: Subramaniam
authors.affiliation: Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mahesh K
authors.initials: MK
authors.lastname: Arora
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Mahesh C
authors.initials: MC
authors.lastname: Misra
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Virender K
authors.initials: VK
authors.lastname: Bansal
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000577:Amides; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; 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*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D000077212:Ropivacaine; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl
keywords: Analgesia; Anesthetics; Hernia repair; Laparoscopy; Local; Transversus abdominis block