Ultrasound guided transversus abdominis plane (TAP) block is better than local wound infiltration for postoperative pain management in inguinal hernia repair
Abstract
Background & Objective: Transversus abdominis plane (TAP) block has been shown to provide
good postoperative pain relief following various abdominal and inguinal surgeries. We evaluated the
effectiveness of ultrasound guided TAP block against conventional local anesthetic wound infiltration for
better postoperative analgesia in patients undergoing inguinal hernia repair.
Methodology: This prospective randomized controlled study was conducted after approval from ethical
review board. A total of 100 adult male patients, American Society of Anesthesiologists (ASA) physical
status 1 or 2 were randomized either to Group I (TAP) (n = 50) receiving ultrasound guided TAP block
with 0.5% bupivacaine 1.5 mg/kg or Group II (LAI) (n = 50) receiving similar dose as conventional
local anesthetic wound infiltration. Inj. tramadol was used as rescue analgesic if needed. Pain score was
recorded by visual analogue scale (VAS) on emergence, then 2 hourly for 8 hours followed by 4 hourly for
24 hours postoperatively. Mean pain score, total dose of rescue analgesic/24 hours and procedure related
complications, including postoperative nausea / vomiting, were recorded.
Results: There was no significant difference between the baseline characteristics of both groups. Mean
pain scores in Group I (TAP) and II (LAI) were 2.1 ± 1.2 and 4.8 ± 1.5 respectively (P < 0.001) and
corresponding opiate requirement was significantly less in Group I (TAP) 17.2 ± 68.4 mg of tramadol vs
136.4 ± 86.3mg of tramadol in Group II (LAI) (P < 0.001). Nausea / vomiting were observed in 21.7 vs.
78.3% of patients in Group I (TAP) and Group II (LAI) respectively. No procedure related complications
were noted in any patient.
Conclusion: Ultrasound guided TAP block is found to be safe and an effective modality of providing
postoperative analgesia with significantly less post-operative nausea vomiting and opiate requirement
when compared to local anesthetic wound infiltration.
