Continuous Transversus Abdominis Plane Block for Primary Open Inguinal Hernia Repair: A Randomized, Double-Blind, Placebo-Controlled Trial

James M. Flaherty, David B. Auyong, Stanley C. Yuan, Shin E. Lin, Adam W. Meier, Thomas R. Biehl, W. Scott Helton, April Slee, Neil A. Hanson

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Patients undergoing open inguinal hernia repair may experience moderate to severe postoperative pain. We assessed opioid consumption in subjects who received a continuous transversus abdominis plane block in addition to standard multimodal analgesia. Design: Randomized, double-blind, placebo-controlled. Setting: Tertiary academic medical center. Subjects: Adult patients undergoing open inguinal hernia repair at Virginia Mason Medical Center. A total of 90 patients were enrolled. Methods: Subjects presenting for surgery were randomized to receive either a continuous transversus abdominis plane block or a subcutaneous sham block. The primary outcome was opioid consumption within the first 48 hours after surgery. Secondary outcomes included pain scores, activities assessment scores, and opioid-related adverse events. Multimodal analgesia utilized in both groups included acetaminophen, nonsteroidal anti-inflammatory drugs, and surgical local anesthetic infiltration. Results: Eighty-two subjects, 42 from the block group and 40 from the sham group, completed the study, per protocol. The intention-to-treat analysis demonstrated no difference in 48-hour postoperative oxycodone equivalent consumption between the block and sham groups (27.8 mg ± 26.8 vs 32 mg ± 39.2, difference -4.4 mg, P = 0.55). There was a statistically significant reduction in pain scores at 24 hours in the block group. There were no other differences in secondary outcomes. Conclusions: Continuous transversus abdominis plane blocks provide modest improvements in pain after open inguinal hernia repair but fail to significantly reduce opioid consumption or improve functional activity levels in the setting of multimodal analgesia use.

Original languageEnglish (US)
Pages (from-to)E201-E207
JournalPain Medicine (United States)
Volume21
Issue number2
DOIs
StatePublished - 2020

Bibliographical note

Funding Information:
Funding sources: This research was supported by the Department of Anesthesiology at Virginia Mason Medical Center (Seattle, WA, USA) and the Wilske Center for Translational Research (Benaroya Research Institute, Seattle, WA, USA).

Publisher Copyright:
© 2019 American Academy of Pain Medicine. All rights reserved.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

  • Inguinal Hernia Repair
  • Regional Anesthesia
  • TAP Block
  • Transversus Abdominis Plane Block

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

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