Paasch C, Aljedani N, Ortiz P, Azarhoush S, Fiebelkorn J, Boettge K A, Gauger U, Anders S, De Santo G, Strik M W
Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
No Insurance Surgery, 9121 W Russell Rd Ste 115, Las Vegas, 89148, USA.
Ann Med Surg (Lond). 2020 Jun 8;55:294-299. doi: 10.1016/j.amsu.2020.05.044. eCollection 2020 Jul.
Patients suffering from a ventral hernia can be treated by laparoscopic ventral hernia repair (VHR) with the intraperitoneal onlay mesh (IPOM) technique. To reduce early postoperative pain and the analgesic cumulative need for medication (CNM), the transversus abdominis plane (TAP) block has recently been investigated and implemented in hernia surgery. We aimed to investigate its impact when conducting a VHR in IPOM technique.
A single center retrospective observational matched pair analysis has been conducted from March to April 2020. The data of patients who underwent VHR in IPOM technique with prior TAP block administration were enrolled. The matching was performed using the variables age ( ±5 years), gender, type of surgery, BMI and ASA stage.
52 patients were enrolled. Among the individuals of the TAP block group, (18 males, 8 females) the average age was 52.4 (15.9). The average BMI was 29.0 (3.95) kg/m. 14 patients suffered from an umbilical, 9 from an incisional, and three from an epigastric hernia. Except for COX-2-inhibitors, (TAP group: 41.9 mg (31.0), Control group 9.23 (22.1), p < 0.001) the analgesic CNM of both groups did not statistically differ from each other. The literature review yielded four relevant publications (n = 100). The authors stated a positive impact of the TAP block on early postoperative pain and analgesic medication consumption.
The TAP block prior to laparoscopic ventral hernia repair may reduce early postoperative pain and analgesic medication consumption in selected patients. More randomized clinical trials are needed to confirm these findings.
患有腹侧疝的患者可通过腹腔镜腹侧疝修补术（VHR）及腹膜内补片植入修补术（IPOM）进行治疗。为减轻术后早期疼痛以及减少药物止痛累积需求量（CNM），近来对腹横肌平面（TAP）阻滞进行了研究并应用于疝修补手术中。我们旨在研究其在IPOM技术行VHR中的作用。
于2020年3月至4月进行了一项单中心回顾性观察配对分析。纳入了在IPOM技术下行VHR且预先进行TAP阻滞的患者数据。使用年龄（±5岁）、性别、手术类型、体重指数（BMI）和美国麻醉医师协会（ASA）分级等变量进行配对。
共纳入52例患者。在TAP阻滞组患者中（18例男性，8例女性），平均年龄为52.4岁（15.9岁）。平均BMI为29.0（3.95）kg/m²。14例患者患有脐疝，9例患有切口疝，3例患有上腹疝。除环氧化酶-2抑制剂外（TAP组：41.9毫克（31.0），对照组：9.23毫克（22.1），p<0.001），两组的止痛CNM在统计学上无差异。文献综述得出4篇相关出版物（n = 100）。作者指出TAP阻滞对术后早期疼痛和止痛药物消耗有积极影响。
腹腔镜腹侧疝修补术前的TAP阻滞可能会减轻部分患者的术后早期疼痛和止痛药物消耗。需要更多随机临床试验来证实这些发现。
