Preperitoneal bupivacaine instillation in addition to TAP block for pain control in laparoscopic inguinal hernia repair: a randomised controlled trial.
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Abstract
Purpose: Enhanced Recovery After Surgery (ERAS) protocols highlight the importance of effective perioperative pain management to facilitate early ambulation and discharge following laparoscopic inguinal hernia repair. While transversus abdominis plane (TAP) block provides effective analgesia, its duration is typically limited to 24 h. This study aimed to evaluate whether adding preperitoneal instillation of bupivacaine to TAP block improves early postoperative pain control.
Methods: This triple-blinded, randomised controlled trial included adult patients undergoing elective laparoscopic inguinal hernia repair at Vajira Hospital. All patients received a TAP block with 0.25% bupivacaine. After mesh placement, patients were randomised to receive either preperitoneal instillation of 10 mL normal saline (control group) or 10 mL of 0.25% bupivacaine (intervention group). Primary outcome was pain intensity (VAS score) at 6 and 24 h postoperatively. Secondary outcomes included operative time, estimated blood loss, postoperative complications, and length of hospital stay.
Results: Sixty patients were randomised (30 per group). The groups were comparable in baseline characteristics and surgical variables. The intervention group also had significantly lower VAS scores at 48 h (1.03 ± 1.12 vs 2.10 ± 1.36; p = 0.002). Functional recovery parameters and satisfaction scores were similar between groups. There were no significant differences in operative time, blood loss, or postoperative complications.
Conclusion: The addition of preperitoneal bupivacaine instillation to TAP block significantly improves early postoperative pain control after laparoscopic inguinal hernia repair without increasing complication rates. This simple and safe technique complements multimodal analgesia strategies and supports ERAS objectives in minimally invasive hernia surgery.
目的：增强术后恢复（ERAS）方案强调了有效的围手术期疼痛管理的重要性，以促进腹腔镜腹股沟疝修补术后早期下床和出院。虽然经腹平面（TAP）阻滞提供了有效的镇痛，但其持续时间通常限制在24小时。本研究旨在评估在TAP阻滞中加入腹膜前灌注布比卡因是否能改善术后早期疼痛控制。方法：这项三盲、随机对照试验纳入了在Vajira医院接受选择性腹腔镜腹股沟疝修补术的成年患者。所有患者均接受含有0.25%布比卡因的TAP阻滞。补片放置后，患者被随机分配接受腹膜前灌注10ml生理盐水（对照组）或10ml 0.25%布比卡因（干预组）。主要结局是术后6和24小时的疼痛强度（VAS评分）。次要结局包括手术时间、估计失血量、术后并发症和住院时间。结果：60例患者随机分组（每组30例）。两组在基线特征和手术变量上具有可比性。干预组48 h VAS评分也显著低于对照组（1.03±1.12 vs 2.10±1.36;p = 0.002）。两组间功能恢复参数和满意度评分相似。两组在手术时间、出血量和术后并发症方面无显著差异。结论：在TAP阻滞中加入腹膜前布比卡因可明显改善腹腔镜腹股沟疝修补术后早期疼痛控制，且未增加并发症发生率。这种简单而安全的技术补充了多模式镇痛策略，并支持ERAS在微创疝手术中的目标。
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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