Background: There is still no consensus on perioperative pain control techniques in patients undergoing laparoscopic surgery; protocols of conventional therapy can be improved by the use of perioperative anaesthesiologic techniques, such as epidural or loco‑regional analgesic administration as transversus abdominis plane (TAP) block. The aim of this evaluation was to investigate the role of laparoscopic‑assisted TAP block during repair of diastasis recti associated with primary midline hernias in term of post‑operative pain relief. Materials and Methods: This was a retrospective evaluation of a prospectively maintained database including patients undergoing laparoscopic repair of diastasis recti associated with primary ventral hernia. Patients were divided into two groups: Group A patients (n = 34) received laparoscopic‑assisted bilateral TAP‑block of 7.5 mg/ml ropivacaine for each side and Group B patients (n = 29) received conventional post‑operative therapy. All patients received 24 h infusion of 20 mg morphine; pain was checked at 6, 24 and 48 h after surgery by numeric rating scale (NRS) score. A rescue analgesia by was given if NRS score was >4 or on patient request. Results: No differences in operative time, complications and post‑operative stay, no complications related to TAP‑block technique were found. Post‑operative pain scores (determined by NRS) were found to be significantly different between groups. Group A patients showed a significant reduction in NRS score at 6, 24 and 48 h (P < 0.005) and in the number of patients requiring further analgesic drugs administration (P < 0.005) compared to Group B patients. Conclusions: Laparoscopic‑guided TAP‑block can be considered safe and effective in the management of post‑operative pain and in the reduction of analgesic need in patients undergoing laparoscopic repair of diastasis recti and ventral hernias. The non‑randomised nature of the study and the lack of a consistent series of patients require further evaluations.

Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia / Cavallaro, Giuseppe; Gazzanelli, Sergio; Iorio, Olga; Iossa, Angelo; Giordano, Luca; Esposito, Luca; Crocetti, Daniele; Tarallo, Mariarita; Sibio, Simone; Brauneis, Stefano; Polistena, Andrea. - In: JOURNAL OF MINIMAL ACCESS SURGERY. - ISSN 0972-9941. - 19:2(2023), pp. 207-211. [10.4103/jmas.jmas_111_22]

Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia

Cavallaro, Giuseppe;Gazzanelli, Sergio;Iorio, Olga;Iossa, Angelo;Giordano, Luca;Esposito, Luca;Crocetti, Daniele;Tarallo, MariaRita;Sibio, Simone;Brauneis, Stefano;Polistena, Andrea
2023

Abstract

Background: There is still no consensus on perioperative pain control techniques in patients undergoing laparoscopic surgery; protocols of conventional therapy can be improved by the use of perioperative anaesthesiologic techniques, such as epidural or loco‑regional analgesic administration as transversus abdominis plane (TAP) block. The aim of this evaluation was to investigate the role of laparoscopic‑assisted TAP block during repair of diastasis recti associated with primary midline hernias in term of post‑operative pain relief. Materials and Methods: This was a retrospective evaluation of a prospectively maintained database including patients undergoing laparoscopic repair of diastasis recti associated with primary ventral hernia. Patients were divided into two groups: Group A patients (n = 34) received laparoscopic‑assisted bilateral TAP‑block of 7.5 mg/ml ropivacaine for each side and Group B patients (n = 29) received conventional post‑operative therapy. All patients received 24 h infusion of 20 mg morphine; pain was checked at 6, 24 and 48 h after surgery by numeric rating scale (NRS) score. A rescue analgesia by was given if NRS score was >4 or on patient request. Results: No differences in operative time, complications and post‑operative stay, no complications related to TAP‑block technique were found. Post‑operative pain scores (determined by NRS) were found to be significantly different between groups. Group A patients showed a significant reduction in NRS score at 6, 24 and 48 h (P < 0.005) and in the number of patients requiring further analgesic drugs administration (P < 0.005) compared to Group B patients. Conclusions: Laparoscopic‑guided TAP‑block can be considered safe and effective in the management of post‑operative pain and in the reduction of analgesic need in patients undergoing laparoscopic repair of diastasis recti and ventral hernias. The non‑randomised nature of the study and the lack of a consistent series of patients require further evaluations.
2023
diastasis recti; hernia; laparoscopy; transversus abdominis plane block
01 Pubblicazione su rivista::01a Articolo in rivista
Laparoscopic transversus abdominis plane block is useful in pain relief after laparoscopic stapled repair of diastasis recti and ventral hernia / Cavallaro, Giuseppe; Gazzanelli, Sergio; Iorio, Olga; Iossa, Angelo; Giordano, Luca; Esposito, Luca; Crocetti, Daniele; Tarallo, Mariarita; Sibio, Simone; Brauneis, Stefano; Polistena, Andrea. - In: JOURNAL OF MINIMAL ACCESS SURGERY. - ISSN 0972-9941. - 19:2(2023), pp. 207-211. [10.4103/jmas.jmas_111_22]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1680085
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