Combining Transversus Abdominis Plane and Rectus Sheath Blocks in Open Inguinal Hernia Surgery Anesthesia: A Retrospective Cohort Analysis.

Abstract

Background: Lichtenstein hernia repair is a common surgical procedure. Previously, combined rectus sheath (RS) and transversus abdominis plane (TAP) blocks have been shown to be beneficial in laparoscopic inguinal hernia surgery. Our hypothesis is that combining the two blocks will also be beneficial in open Lichtenstein hernioplasty day-case procedures.

Methods: This retrospective study analyzed data from 186 patients undergoing inguinal hernia surgery chosen using the propensity score matching. Primary endpoint was intraoperative and postoperative opioid consumption. Secondary endpoints were conversion of the anesthetic method, postoperative nausea and vomiting (PONV), unscheduled hospitalization or emergency room visits, perioperative duration, analysis of the patient flow, and surgical complications.

Results: Ninety-three patients treated with the blocks (study group) and 93 controls were analyzed. The study group had significantly lower opioid use in the operating room (2.5-7.5 mg vs. 5.0-7.5 mg and p < 0.01) and in the recovery room (0.0-2.0 mg vs. 1.0-10.6 mg and p < 0.0001). There was no difference in postoperative recovery room times nor in the patient flow. Postoperative hospitalization due to pain was 9.1% in the control group, whereas no patients in the study group were hospitalized (p < 0.01).

Conclusions: RS and TAP blocks reduce postoperative pain in inguinal hernia surgery, resulting in significantly lower postoperative opioid use and hospitalization rates. The blocks are technically easy and quick to perform and should be considered for pain management in inguinal hernia day-case surgery.