Efficacy of laparoscopic-installed rectus sheath block for postoperative pain reduction in transabdominal preperitoneal inguinal hernia repair: a double-blind, randomised-controlled trial.

INTRODUCTION Postoperative pain management plays a crucial role in early recovery after laparoscopic inguinal hernia repair, particularly as most repairs are done as day-case surgery. The aim of this study was to evaluate the anaesthetic effect of a laparoscopically-guided rectus sheath block on postoperative pain. METHODS Within this prospective, double-blinded, randomised controlled trial, patients planned for inguinal hernia repair using the transabdominal preperitoneal patch plastic were recruited. Patients were assigned randomly to either a control group or an intervention group. Both received standardised pre-emptive anaesthesia during the surgical procedure with self-fixating mesh. In the intervention group, an intra-operatively implemented rectus sheath block was performed for postoperative pain control. The primary outcome was the postoperative pain score 3 h after surgery. RESULTS Thirty-five patients were included in the study; 17 patients were randomised to the intervention group and 18 to the control group. Patient demographics and procedural times were similar in both groups. Postoperative median (IQR [range]) pain scores were not significantly different between the groups 3 h after surgery (intervention group 3.0 (3.0-5.0 [1.0-8.0]) vs. control group 3.5 (2.25-4.75 [1.0-8.0]); p = 0.854). The median (IQR [range]) oxycodone requirement after surgery was not different between the groups (intervention group 0 (0-3 [0-7]) mg vs. control group 0 (0-3 [0-7]) mg; p = 0.869). DISCUSSION This study has shown that a laparoscopic rectus sheath block has no beneficial effect in postoperative pain management following laparoscopic transabdominal inguinal hernia repair.