Subarachnoid block with continuous TAP catheter analgesia produces less chronic pain and better functional outcome after inguinal hernioplasty: a randomized controlled observer-blinded study

Abstract

Background and objectivesThe major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty.MethodsSeventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale.ResultsSix months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively.ConclusionsA subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia.Clinical trial registrationCTRI/2016/09/007238.

Ultrasound-guided posterior quadratus lumborum block can reduce postoperative opioid consumption and promote rapid recovery in patients undergoing sutureless laparoscopic partial nephrectomy: A triple-blind, randomized, controlled study

“…The primary outcome measures were the total consumption of sufentanil within 12 h and the 15-item quality of postoperative recovery (QoR-15) scores at 48 h after surgery (the time to reach the PACU was defined as 0 h). Secondary outcome measures were (1) NRS at rest (NRSr) and movement (NRSm) after surgery (rest was defined as supine position and movement was defined as six alternate leg lifts off the bed) (2), sufentanil consumption and number of patients requiring additional rescue analgesia (3), the time of the first compression of the analgesic pump (the time from patient's arrival at the PACU to first compression of PCIA device [min]) (4), blood sugar and cortisol concentrations (5), the time of the patient's first excretion, ambulation, and drainage tube and urinary catheter removal (the time from patient's arrival in the PACU to event occurrence [d]), and the number of days of hospitalization after surgery (the time from patient's arrival in the PACU to discharge [d]) (6), adverse events such as nausea, vomiting, hypotension (blood pressure below 30% of baseline value), bradycardia (heart rate below 60 bpm), excessive sedation (patient slow or unresponsive to loud stimuli), femoral nerve block (decreased quadriceps muscle strength, manifested as lower extremity weakness or falls), pruritus, or generalized local anesthetic toxicity.…”

“…The NRSr of the intervention group was lower at 0 h, 6 5A). The consumption of sufentanil within 48 h in the intervention group was lower compared with the control group (72.80 [65.00 to 81.00] vs. 88.80 [81.98 to 117.78], p < 0.001), the pseudo-median difference and 95% CI was −19.68 (−33.80 to −10.60) (Figure 5B).…”

“…In recent years, the ultrasound-guided regional block has been an essential part of multimodal analgesia. Several studies (4)(5)(6) have shown that regional block can reduce postoperative opioid consumption and pain scores, reduce the postoperative bed rest time and hospitalization time, and improve patient clinical outcomes. Regional block has become a hot topic of postoperative analgesia treatment.…”