title: Laparoscopic-guided psoas blockade as a novel analgesic method during inguinal herniorrhaphy: a clinical trial.
abstract: BACKGROUND
  Under laparoscopic guidance, block of ilioinguinal, iliohypogastric, and genitofemoral nerves can be possible with anesthetic injection in the plane between psoas major and the fasciae covering its anterior aspects [laparoscopic-assisted psoas (LAP) blockade]. This observer-blinded trial aimed to compare the opioid-sparing effect of LAP block with transversus abdominis plane (TAP) block after laparoscopic inguinal herniorrhaphy.
  
  
  METHODS
  Forty-five male patients were randomly assigned to receive LAP block, group LAP (n = 23), or ultrasound-guided TAP block, group TAP (n = 22). Primary outcome measure was the analgesic requirements in the first 36 post-operative hours. Post-operative pain scores and sensory blockade were recorded.
  
  
  RESULTS
  Median (interquartile range) total morphine requirement was significantly less in patients who underwent LAP blockade 0 (0, 4) than in patients who underwent TAP blockade 21 (10, 27; P < 0.001). LAP group showed significantly less pain at rest and on coughing compared with TAP group. The median number of dermatomes blocked was 3 (2-4) in LAP group and 3 (3-4) in TAP group (P < 0.05). The highest sensory-level blockade was at T12 (T11-L1) in LAP group, while it was at T10 (T10-T11) in TAP group. The most distal dermatome involvement was at L2 (L2-L2) in LAP group and at L1 (T12-L1) in TAP group.
  
  
  CONCLUSIONS
  A single injection LAP blockade significantly reduces the post-operative analgesic requirements and provides longer pain relief compared with TAP block after laparoscopic inguinal herniorrhaphy.
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University Hospital, Portsaid, Egypt.
authors.forename: T F
authors.initials: TF
authors.lastname: Tammam
authors.affiliation: Department of General and Digestive Surgery, TBRI (Theodor Bilharz Research Institute), Cairo, Egypt.
authors.forename: A F
authors.initials: AF
authors.lastname: Salama
mesh_terms: D000009:Abdominal Muscles / Q000294:innervation; D000293:Adolescent; D000328:Adult; D005267:Femoral Nerve; 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*