A double-blinded randomized controlled trial to evaluate the efficacy of ultrasound-guided transversus abdominis plane block after laparoscopic ventral hernia repair

Abstract

BACKGROUND: Laparoscopic ventral hernia repair (LVHR) is a widely recognized procedure for treating ventral hernias, yet managing postoperative pain remains difficult. To enhance pain control following LVHR, we conducted a prospective evaluation of the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block.

PATIENTS AND METHODS: Our study was a prospective double-blinded randomized controlled trial conducted from March 2021 to June 2022 which included 52 subjects, randomized into two groups (Groups T and P) of 26 each, by computer-generated simple randomization. After taking written informed consent, an ultrasound bilateral TAP block was given to both the groups in which Group T received the drug (0.375% of levobupivacaine 40mL), and Group P was a placebo (received 0.9% normal saline). Visual Analog Scale (VAS) for pain, the need for rescue analgesia, the time to ambulation within 24h, and the length of postoperative stay were used to assess the primary outcomes of the study.

RESULTS: The mean age was 56.5 years (SD = 8.814) in Group T and 53.57 years (SD = 9.161) in Group P. The average duration of surgery was 77.5min for Group T and 75.96min for Group P. Postoperative stay averaged 26.76h (SD = 7.941) in Group T and 31h (SD = 12.109) in Group P. It was observed that there was a statistically significant difference in VAS, the requirement for rescue analgesia, and ambulation between the two groups at 2, 6, and 12h. However, no significant difference was observed at 24h or in the averaged postoperative stay.

CONCLUSION: LVHR with mesh is a proven technique, but controlling postoperative pain remains a difficulty. An ultrasound-guided TAP block with a long-lasting local anesthetic, such as bupivacaine, can markedly lessen early postoperative pain and decrease the reliance on narcotics after LVHR.

TRIAL REGISTRATION: Clinical trial registry information: Clinical trial registry name: CTRI. Trial number: CTRI/2020/09/007897 (Registered on 04/09/2020) trial registered prospectively.

Keywords

Early ambulation / laparoscopic ventral hernia repair / postoperative pain control / rescue analgesia / transversus abdominis plane block / Visual Analog Score

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International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press