Laparoscopically guided TAP-block. A comparative analysis of the efficiency of laparoscopically guided TAP block in patients who have undergone transabdominal preperitoneal (TAPP) repair of inguinal hernia

Abstract

Inguinal hernia repair remains one of the most common surgical procedures in the world. Due to the rapid development of minimally invasive technologies in surgery, transabdominal preperitoneal (TAPP) repair of inguinal hernia become more popular. TAPP repair of inguinal hernia made it possible to significantly reduce the level of postoperative pain, accelerate the patient’s recovery after surgery and reduce the number of days of the patient’s hospital stay. Postoperative pain is one of the primary indicator, which patients use to evaluate the quality of the surgery and anesthesia, and it determines the timing of the patient’s recovery and the speed of their return to normal life. That is why both surgeons and anesthesiologists, including our team, think daily about how to reduce the level of postoperative pain. The inguinal region is innervated by the anterior branches of the thoracolumbar nerves, which run in the space between the transverse and internal oblique abdominal muscles, making this area an attractive target for surgeons and anesthesiologists in terms of reducing postoperative pain. The Transversus Abdominis Plane (TAP) block involves injecting a local anesthetic into the space between the transverse and internal oblique abdominal muscles to block the nerves that innervate the anterior abdominal wall. The most popular and accepted method of TAPblock is its performance under ultrasound guidance. Despite the accuracy, safety and apparent simplicity of the procedure, this method has not been successfully implemented into routine practice yet. There are several objective reasons for this: the lack of an ultrasound machine in the operating room; the necessity for medical staff trained to operate the ultrasound machine; the time required to set up the machine; the potential risk of compromising the sterility of the surgical field during the procedure. That is why, in our routine practice, we use the TAPblock technique under laparoscopic guidance – a method we have validated, which is more accessible and safer – during most laparoscopic procedures. Our study analyzed 28 patients with monolateral inguinal hernias who underwent transabdominal preperitoneal TAPP inguinal hernia repair. The patients were divided equally into an experimental group (who received a TAP-block) and a control group (who did not receive a TAP-block). In the postoperative period, the level of pain was assessed using the Numerical Rating Scale (NRS) at rest and during movement (coughing, getting out of bed) at 4, 8, and 24 hours. In the experimental group, statistically significant (p < 0.05) differences were observed between the experimental (D) and control (C) groups during the survey, which we presented in two tables. The results demonstrate significant advantages of the laparoscopically guided TAP-block, manifested by lower pain levels (on the NRS scale), faster patient mobilization (4 hours post-surgery), and higher satisfaction with anesthesia