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The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: A randomised clinical trial

Petersen, Pernille L.; Mathiesen, Ole; Stjernholm, Pia; Kristiansen, Viggo B.; Torup, Henrik; Hansen, Egon G.; Mitchell, Anja U.; Moeller, Ann; Rosenberg, Jacob; Dahl, Joergen B.

European Journal of Anaesthesiology (EJA): July 2013 - Volume 30 - Issue 7 - p 415–421
doi: 10.1097/EJA.0b013e32835fc86f
Postoperative pain

CONTEXT 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).

DESIGN Randomised controlled trial.

SETTING Single centre trial. Study period from June 2010 to November 2011.

PATIENTS 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.

INTERVENTIONS Ninety patients were allocated to one of three groups: group TAP, group infiltration (ilioinguinal nerve block and wound infiltration) and group placebo.

MAIN OUTCOME MEASURES 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.

CONCLUSION Ultrasound-guided TAP block did not reduce postoperative pain after inguinal hernia repair.

TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01052285. EudraCT number 2010–018403-29.

From the Department of Anaesthesia, Centre of Head and Orthopaedics (PLP, JBD), Section of Acute Pain Management, Copenhagen (OM), Department of Anaesthesia, Copenhagen University Hospital, Glostrup (PS), Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre (VBK), Department of Anaesthesia (HT, EGH, AUM, AM), Department of Surgery, Copenhagen University Hospital, Herlev, Denmark (JR)

Correspondence to Pernille L. Petersen, MD, Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark E-mail: pernille.lykke.petersen@dadlnet.dk

Published online 1 April 2013

© 2013 European Society of Anaesthesiology