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Direct visualization transversus abdominis plane blocks offer superior pain control compared to ultrasound guided blocks following open posterior component separation hernia repairs

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Abstract

Purpose

Transversus abdominis plane (TAP) blockade with long-acting anesthetic can be used during open ventral hernia repair (VHR) with posterior component separation (PCS). TAP block can be performed under ultrasound guidance (US-TAP) or under direct visualization (DV-TAP). We hypothesized that US-TAP and DV-TAP provide equivalent postoperative analgesia following open VHR.

Methods

A retrospective review of patients undergoing open VHR with PCS who received TAP blocks with 266 mg of liposomal bupivacaine was performed. Data included demographics, comorbidities, length of stay (LOS), average postoperative day (POD) pain scores, and narcotic requirements (normalized to mg oral morphine). Statistical analysis utilized Student’s t test and Fisher’s exact test.

Results

Thirty-nine patients were identified (22 DV-TAP). There were no differences between the groups with respect to demographics, comorbidities, pre-operative pain medication usage (narcotic and non-narcotic) or herniorrhaphy-related data. The average POD0 pain score was lower for the DV-TAP group (2.35 vs 4.18; p = 0.019). Narcotic requirements on POD0 (48.0 vs 103.76 mg; p = 0.02), POD1 (128.45 vs 273.82 mg; p = 0.03), POD4 (54.29 vs 160.75 mg; p = 0.042), and during the complete hospitalization (408.52 vs 860.92 mg; p = 0.013) were lower in the DV-TAP group. There were no differences between initiation of diet or LOS. During the study, no changes were made to the VHR enhanced recovery pathway.

Conclusions

DV-TAP blocks appear to provide superior analgesia in the immediate postoperative period. To achieve similar post-operative pain scores, patients in the US-TAP group required significantly more narcotic administration during their hospitalization. The study highlights DV-TAP as a valuable addition to VHR recovery pathways.

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Funding

This study was conducted without any outside funding sources. This study will be presented at the Americas Hernia Society International Hernia Congress, March 2018, Miami, FL, USA.

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Authors and Affiliations

  1. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA, 17033-0850, USA

    J. A. Doble, J. S. Winder, S. R. Witte & E. M. Pauli

Authors
  1. J. A. Doble
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  2. J. S. Winder
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  3. S. R. Witte
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  4. E. M. Pauli
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Corresponding author

Correspondence to E. M. Pauli.

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The authors declare that no conflict of interest exists.

Ethical approval

Institutional review board approval was obtained for this study.

Human and animal rights

As a retrospective review, no experimental conditions were implemented. All human participants received standard of care treatments and; thus, no rights were violated. No animals were involved in this study.

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As a retrospective review, formal consent was not required.

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Doble, J.A., Winder, J.S., Witte, S.R. et al. Direct visualization transversus abdominis plane blocks offer superior pain control compared to ultrasound guided blocks following open posterior component separation hernia repairs. Hernia 22, 627–635 (2018). https://doi.org/10.1007/s10029-018-1775-3

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