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Purpose <p>Laparoscopic transabdominal preperitoneal hernia inguinal repair (TAPP) is a well-standardized surgical procedure, but postoperative pain management lacks clear standardizations. Intravenous Anesthesia (IA) can be combined with intraoperative local anesthesia procedures like the Erector Spinae (ESP) or the Transversus Abdominis Plane (TAP) block. The association of local pain control and low pneumoperitoneum (8-10mmHg) appears to reduce postoperative pain and improve patient and nurse satisfaction.</p> Methods <p>Between January and December 2023, 903 TAPP were performed at Vittorio Veneto Hospital (TV). 60 patients were collected and divided into three groups: TAPP under IA alone, IA plus ESP block, and IA plus TAP block. We monitored Numeric Rating Scale (NRS) for pain at T0 (at the end of surgery), T1 (after 6&#xa0;h) and T2 (after 12&#xa0;h), along with postoperative analgesic consumption.</p> Results <p>No significant differences in comorbidities were observed among groups, and no conversions occurred. Compared to IA alone, both ESP and TAP block groups reported significantly less pain at T0 (<i>p</i> = 0.01) and T1 (<i>p</i> = 0.036), but not at T2 (p = NS). ESP and TAP block groups also had lower consumption of Ketorolac and less nausea at T0 (<i>p</i> = 0.02 and <i>p</i> = 0.09) due to reduced intraoperative opioid use. These differences were not observed at T1 and T2. Operative time was significantly shorter in IA-only group compared to TAP; no difference was noticed between TAP and ESP.</p> Conclusions <p>Adding ESP or TAP block to IA during elective laparoscopic TAPP for uni-/bilateral inguinal hernias, along with low pneumoperitoneum, is feasible and may reduce early postoperative pain, opioid and other analgesic consumption, and nausea. Further evidence-based studies, like RCTs, are required to support these findings.</p>

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Laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair in a second level hospital setting: a novel anesthesiologic approach to reduce postoperative pain

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月7日

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  • Giulia Montori,
  • Flavio Badii,
  • Elisabetta Serra,
  • Irene Recchia,
  • Giuseppa Procida,
  • Alessandra Versaci,
  • Matteo Tolot,
  • Andrea Dal Borgo,
  • Tobia Gobbi,
  • Giorgio Mazzarolo,
  • Edelweiss Licitra,
  • Michelangelo Salemi,
  • Ferdinando Agresta

摘要

Purpose

Laparoscopic transabdominal preperitoneal hernia inguinal repair (TAPP) is a well-standardized surgical procedure, but postoperative pain management lacks clear standardizations. Intravenous Anesthesia (IA) can be combined with intraoperative local anesthesia procedures like the Erector Spinae (ESP) or the Transversus Abdominis Plane (TAP) block. The association of local pain control and low pneumoperitoneum (8-10mmHg) appears to reduce postoperative pain and improve patient and nurse satisfaction.

Methods

Between January and December 2023, 903 TAPP were performed at Vittorio Veneto Hospital (TV). 60 patients were collected and divided into three groups: TAPP under IA alone, IA plus ESP block, and IA plus TAP block. We monitored Numeric Rating Scale (NRS) for pain at T0 (at the end of surgery), T1 (after 6 h) and T2 (after 12 h), along with postoperative analgesic consumption.

Results

No significant differences in comorbidities were observed among groups, and no conversions occurred. Compared to IA alone, both ESP and TAP block groups reported significantly less pain at T0 (p = 0.01) and T1 (p = 0.036), but not at T2 (p = NS). ESP and TAP block groups also had lower consumption of Ketorolac and less nausea at T0 (p = 0.02 and p = 0.09) due to reduced intraoperative opioid use. These differences were not observed at T1 and T2. Operative time was significantly shorter in IA-only group compared to TAP; no difference was noticed between TAP and ESP.

Conclusions

Adding ESP or TAP block to IA during elective laparoscopic TAPP for uni-/bilateral inguinal hernias, along with low pneumoperitoneum, is feasible and may reduce early postoperative pain, opioid and other analgesic consumption, and nausea. Further evidence-based studies, like RCTs, are required to support these findings.