Transversus abdominis plane blocks curb hernia repair pain

Last Updated: 2015-05-08

By David Douglas

NEW YORK (Reuters Health) - Regional anesthesia of the transversus abdominis plane (TAP) curbs pain in patients undergoing laparoscopic ventral hernia repair (LVHR), according to New York-based researchers.

As Dr. Celia M. Divino told Reuters Health by email, "Laparoscopic TAP blocks provide effective postoperative analgesia after LVHR. We've demonstrated that they significantly decrease both short-term postoperative opioid use and the pain experienced by patients."

In a report online April 21 in the Journal of the American College of Surgeons, Dr. Divino and colleagues at The Mount Sinai Medical Center note that LVHR has become the standard of care for such injuries. However, the approach involves considerable postoperative pain, and medication patches and percutaneous pumps have had limited success in alleviating this.

They add that TAP blocks have proven effective in controlling postoperative pain in a variety of laparoscopic abdominal surgeries. To investigate the situation in LVHR, the team randomized 100 patients to receive either TAP blocks with 0.25% bupivacaine or saline placebo at the start of the procedure.

Following surgery they were brought to the postanesthesia care unit (PACU) and in keeping with routine practice, recovery room nurses administered IV fentanyl boluses to patients as needed. If patients were staying overnight, they were offered morphine or dilaudid via patient-controlled anesthesia machines.

No complications related to the block were reported in either group. In the PACU, the TAP block group had lower pain scores on a scale from 0 to 10, both at rest (5.19 vs. 6.46, p=0.02) and with movement (6.15 vs. 7.73, p=0.008).

They also required significantly less opiates than the control group at every time point after six hours postoperatively. At 12 hours, for instance, they used 16.09 mg of morphine compared to 32.24 mg (p=0.018).

At 24 hours, there was no significant difference in pain scores between groups, but by that point morphine consumption in the TAP block group was 40% less than that of controls.

The researchers call for further studies, but Dr. Divino concluded that the findings have "important implications for length of stay in the hospital and faster recovery."

The authors declared no conflicts of interest.

SOURCE: http://bit.ly/1KoPDuN

J Am Coll Surg 2015.