Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial

Abstract

Background and aims: Effective postoperative analgesia is a key element in reducing postoperative morbidity, accelerating recovery and avoiding chronic postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided Transversus Abdominis Plane (TAP) block, performed before surgical incision, in providing postoperative analgesia for patients undergoing open ventral hernia repair under general anaesthesia.

Methods: Seventy elective patients scheduled for open ventral hernia repair surgery under general anaesthesia were divided randomly into two equal groups: Group I received bilateral TAP block performed before surgical incision (n = 35); Group II received systemic postoperative analgesia with parenteral opioid (morphine) alone (n = 35). Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded.

Results: Postoperative pain scores at rest and mobilization/cough were significantly higher in patients without TAP block (p < 0.05). Mean intraoperative fentanyl consumption was comparable between the two groups: 0.75 ± 0.31 mg in group I (TAP) and 0.86 ± 0.29 mg in group II (MO), p = 0.1299. Patients undergoing preincisional TAP block had reduced morphine requirements during the first 24 hours after surgery, compared to patients from group II, without TAP block (p = 0.0001). There was no difference in the incidence of opioid related side effects (nausea, vomiting) in the both groups during the first 24 postoperative hours.

Conclusion: The use of preincisional ultrasound guided TAP block reduced the pain scores at rest and with movement/cough, opioid consumption and opioid-related side effects after ventral hernia repair when compared with opioid-only analgesia.

Keywords: pain management; postoperative pain; transversus abdominis plane block; ventral hernia.

Fig. 1.

Flow chart of the study

Fig. 2.

Mean visual analog scale (VAS) pain scores at rest over the first 24 postoperative hours in patients after surgery for ventral hernia repair. Data are presented as a mean (standard deviation); * indicates significant difference in VAS scores between groups (p < 0.05)

Fig. 3.

Mean visual analog scale (VAS) pain scores on movement/caught over the first 24 postoperative hours, in patients after surgery for ventral hernia repair. Data are presented as a mean (standard deviation); * indicates significant difference in VAS scores between groups (p < 0.05)

Fig. 4.

Ramsay sedation score in the postoperative period in patients after ventral hernia surgical repair. Data are presented as a mean (SD)