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Laparoscopic-guided distal loco-regional anesthetic infiltration technique in TAPP inguinal hernia repair: a double-blind randomized clinical trial

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Abstract

Background

Ultrasound-guided transversus abdominis plane block (US-TAP) is an important component of multimodal analgesia in laparoscopic inguinal hernia repair, although it has certain limitations. To overcome them, surgeons have developed several techniques to perform local anesthetic infiltration under laparoscopic guidance, but no trials evaluating these in transabdominal preperitoneal (TAPP) hernia repair were conducted till the date. The aim of this study was to compare the efficacy of a novel laparoscopic-guided local anesthetic infiltration technique (LDAI) with US-TAP in postoperative pain control and analgesic consumption for patients undergoing elective TAPP hernia repair.

Methods

This was a double-blind randomized controlled trial conducted at a single tertiary academic center between 2019 and 2020 on adult patients undergoing elective laparoscopic TAPP inguinal hernia repair. Postoperative pain and analgesic consumption were compared for LDAI vs. US-TAP up to 30 postoperative days.

Results

62 patients were included (31 LDAI, 31 US-TAP). Female gender was significantly higher in the LDAI group (8, 25.81%; US-TAP 0; p = 0.005). Mean anesthetic time (US-TAP group: 142.2 min, SD = 17.7; LDAI group: 127.1 min, SD = 15.5; p < 0.001) and mean operative time (US-TAP group: 117.2 min, SD = 15.9; LDAI group: 103.8 min, SD = 15.2; p < 0.001) were significantly shorter in the LDAI group. Pain scores assessed at the first-hour postoperative, at the moment of discharge, and at 8, 24, and 48 postoperative hours showed no significant differences between both groups. No significant difference was found regarding postoperative analgesic rescue administration in the recovery room and analgesic consumption after discharge between groups.

Conclusion

LDAI is a safe and effective local anesthetic technique in elective TAPP hernia repair. Pain control is similar to US-TAP block, with shorter anesthesthetic and surgical time and better health resources allocation.

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Acknowledgements

The authors would like to thank Dr. Cristina Elizondo and Dr. Federico Waisberg for their contributions and continuous support.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. General Surgery Department, Hospital Italiano de Buenos Aires, Tte. Gral Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, Argentina

    José Viñas

  2. Microsurgery and Abdominal Wall Reconstruction Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Emilio Díaz, Rodolfo Scaravonati, Sebastián Roche, Claudio Brandi & Santiago Bertone

  3. Colorectal Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Juan Campana

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  1. José Viñas
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  2. Emilio Díaz
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  5. Claudio Brandi
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Correspondence to José Viñas.

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Drs. José Viñas, Emilio Díaz, Rodolfo Scaravonati, Sebastián Roche, Claudio Brandi, Juan Campana, and Santiago Bertone have no conflict of interest or financial ties to disclose.

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Viñas, J., Díaz, E., Scaravonati, R. et al. Laparoscopic-guided distal loco-regional anesthetic infiltration technique in TAPP inguinal hernia repair: a double-blind randomized clinical trial. Surg Endosc 36, 4312–4320 (2022). https://doi.org/10.1007/s00464-021-08775-6

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  • DOI: https://doi.org/10.1007/s00464-021-08775-6

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