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4897
A Randomized Double-Blind Study Evaluating Continuous Transversus Abdominis Plane Block for Open Inguinal Hernia Repair
Session: EX-08
Fri, April 20, 7:30-7:40 am
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A Randomized Double-Blind Study Evaluating Continuous Transversus Abdominis Plane Block for Open Inguinal Hernia Repair
Andrew M. Walters MD, James M. Flaherty MD, David B. Auyong MD, Stan C. Yuan MD, Shin-E Lin MD, Thomas BiehlMD, Scott Helton MD, Neil A. Hanson MD
Virginia Mason Medical Center, Seattle WA

Background

Open inguinal hernia repair can be associated with considerable postoperative discomfort and potentially lead to the development of chronic, debilitating pain. Transversus abdominis plane (TAP) blocks have shown some success in reducing pain following abdominal surgery. This study evaluated the analgesic efficacy of a continuous TAP block in reducing opioid consumption postoperatively compared to sham procedure. Secondary outcomes included pain scores, opiate related side effects, and activity assessment scores.

Methods

Randomized, double-blind, placebo controlled study.

72 patients undergoing open inguinal hernia repair recruited.

Catheters placed preoperatively under ultrasound guidance.

Sham Group

•Catheter placed subcutaneously
•Bolused 5cc 0.9% NaCl on insertion
•Infusion of 0.9% NaCl at 1ml/hr

Block Group

•Catheter placed between Transverse Abdominis and Internal Oblique
•Bolused 20cc 1.5% mepivacaine
•Infusion of 0.2% ropivacaine at 8ml/hr

Discussion

•TAP catheters after open inguinal hernia repair do not significantly decrease opiate consumption or opiate-related side effects.
•Though a statistical difference is seen in pain scores, the difference is minimally relevant from a clinical perspective.
•Opiate consumption in both groups was much lower than prior literature and our initial power analysis. Possible factors include adherence to postop multimodal regimen, healthier patient population, or the recent emphasis on decreased narcotic usage.

References
1.Joshi GP, Rawal N, KehletH. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. BJS. 2012; 99:168-185.
2.Heil JW, IlfeldMB, LolandVJ, Sandhu NS, Mariano ER. Ultrasound-guided transversus abdominis plane catheters and ambulatory perineural infusions for outpatient inguinal hernia repair. Reg AnesthPain Med. 2010;35:556-558.
3.McCarthy M, et al. Assessment of Patient Functional Status after Surgery. J Am Coll Surg. 2005;201:171-178.

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