Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
Medical School, Charité University Medicine Berlin, Berlin, Germany.
Hernia. 2020 Dec;24(6):1371-1378. doi: 10.1007/s10029-020-02156-z. Epub 2020 Mar 13.
Laparoscopic inguinal hernia repair (IHR) may lead to early postoperative pain. Therefore, opioid and non-opioid analgesic agents are often administered in the post-anesthesia care unit (PACU). To reduce the postoperative cumulative need of analgesic medication, as well as to accelerate the physical recovery time, the transversus abdominis plane (TAP) block has recently been studied. The TAP block is a regional anesthesia technique. Even though there is evidence about the efficacy of the block used in procedure such as an open inguinal hernia repair, the evidence regarding its use for the TAPP (transabdominal preperitoneal) technique remains low. We aim to provide more sufficient evidence regarding this topic.
A monocentric retrospective observational study investigating the effect of the TAP block prior to primary IHR in TAPP technique was conducted. The data of 838 patients who were operated on using this technique from June 2007 to February 2019 were observed. 72 patients were excluded because of insufficient information regarding their analgesic medication protocol. The patients' data were taken from their files.
The patients in the TAP block group (n = 364) did not differ statistically significantly compared to the control group (n = 402) in terms of gender, BMI and age. Individuals of the TAP block group experienced less postoperative pain in the PACU (p < 0.001) and received less analgesic medication (morphine, oxycodone, piritramide, acetaminophen; p < 0.001).
We assume that the TAP block is a sufficient approach to reduce postoperative pain and analgesic medication administration for IHR in TAPP technique.
腹腔镜腹股沟疝修补术（IHR）可能导致术后早期疼痛。因此，术后常给予阿片类和非阿片类镇痛药在麻醉后护理病房（PACU）。为了减少术后累积镇痛药物的需求，并加速身体康复时间，最近研究了腹横肌平面（TAP）阻滞。TAP 阻滞是一种区域麻醉技术。尽管有证据表明该阻滞在开放腹股沟疝修补术等手术中的疗效，但关于其在 TAPP（经腹腹膜前）技术中的应用证据仍然较少。我们旨在提供关于这一主题更充分的证据。
进行了一项单中心回顾性观察研究，调查 TAPP 技术中 TAP 阻滞对原发性 IHR 的影响。观察了 2007 年 6 月至 2019 年 2 月期间接受该技术手术的 838 名患者的数据。72 名患者因缺乏关于其镇痛药物方案的信息而被排除在外。患者的数据取自他们的档案。
与对照组（n=402）相比，TAP 阻滞组（n=364）的患者在性别、BMI 和年龄方面无统计学差异。TAP 阻滞组的个体在 PACU 中经历的术后疼痛较轻（p<0.001），接受的镇痛药物较少（吗啡、羟考酮、哌替啶、对乙酰氨基酚；p<0.001）。
我们假设 TAP 阻滞是一种减少 TAPP 技术中 IHR 术后疼痛和镇痛药物应用的有效方法。
