Pilot Study of Ambulatory Inguinal Hernia Repair under Ultrasound-guided Transversus Abdominis Plane Block Anesthesia Plus Conscious Sedation

Abstract

Aim: Transversus abdominis plane (TAP) block is mainly used as part of multimodal postoperative analgesia regimens in a wide variety of abdominal operations. Our purpose was to evaluate feasibility and safety of TAP block as anesthesia method for inguinal hernia repair. Methodology: Twenty patients scheduled to undergo ambulatory inguinal hernia repair were selected and consented to ultrasound-guided TAP block anesthesia plus conscious sedation. Twenty to 25 ml of ropivacaine 0.5% were administered into the TAP and sensory blockade of T11-L1 dermatomes was examined 30 minutes later. Data on intraoperative tolerance, postoperative pain levels, rescue analgesia requirements, ambulation and complications were recorded. Results: Nineteen blocks (95%) were successful. One patient (5%) required conversion to general anesthesia. One patient (5%) needed further local anesthetic infiltration before mesh fixation. Postoperative pain levels were excellent, with only one patient (5%) requiring rescue analgesia at home. No complications were observed and all patients were discharged on the evening of surgery. Conclusion: Inguinal hernias can be safely repaired under ultrasound-guided TAP block anesthesia. Preliminary data are encouraging, in terms of intraoperative anesthesia adequacy, postoperative pain levels and rescue analgesia requirements. The role of TAP block as anesthetic modality for abdominal wall operations should be further investigated.