Background: The transverses abdominals plane block (TAP) is a regional anesthesia technique that provided analgesia to the parietal peritoneum, skin and muscles of the anterior abdominal wall. The aim of this randomized double-blind study was to evaluate postoperative analgesia on patients undergoing open inguinal hernia repair under general anesthesia (GA), (GA + TAP) block preformed with ropivacaine and (GA + TAP-D) block preformed with ropivacaine and 4 mg dexamethasone.
Methods: 90 (ASA I-II) adult patients for unilateral open inguinal hernia repair were included in this study. In group I (n = 30) patents received only general anesthesia (GA). Patients in group II (n = 30) received GA and unilateral TAP block with 25 ml of 0.5% ropivacaine and the patients in group III (n = 30) received GA and unilateral TAP-D block with 25 ml of 0.5% ropivacaine + 4 mg Dexamethadsone. In this study we assessed the pain score - VAS at rest at 2, 4, 6, 12 and 24 hours after the operation and the total analgesic consumption of morphine over 24 hours.
Results: There were statistically significant differences in the VAS scores between group I, group II and group III at all postoperative time points - 2hr, 4hr, 6hr, 12hr and 24hr. (p < 0.00001). The cumulative 24 hours morphine consumption after the operation was significantly lower in group III (5.53 1.21 mg) than in group II (6.16 2.41 mg) and group I (9.26 2.41 mg). This difference is statistically significant (p < 0.00001).
Conclusion: Concerning the inguinal hernia repair we found better postoperative pain scores and 24 hours reduction of the morphine consumption in group III (GA and TAP-D block) compared with group I (GA) and group II (GA + TAP block).
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Jankovic Z. Transversus abdominis plane block: The holy grail of anesthesia for (lower) abdominal surgery. Periodicum biologicum Vol. III, No 2; 2009: 203-208.
2. Bonnet F, Berger J, and Aveline C. Transversus abdominis plane block: what is its role in postoperative analgesia? British Journal of Anaesthesia. 2009; 103 (4): 468-70.
3. MC Donnell JG, Curlry G, Carney J, Benton A, Costello J, Maharaj CH, Laffey JG. The analgesic efficacy of transversus abdominis plane block after Caesarean delivery: A randomized controlled trial. Anesth Analg. 2008; 106: 186-191.
4. Carney J, MCDonnnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg. 2008; 107: 2056-2060.
5. O′Donnell BD. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006; 31(1): 91.
6. E. Allcock, E. Spencer, R. Frazer, G. Applegate, and C. Buckenmaier III, "Continuous transversus abdominis plane (TAP) block catheters in a combat surgical environment", Pain Medicine, vol. 11, no. 9, 2010; pp. 1426-1429.
7. O′Connor K and Renfrew C, Subcostal transversus abdominis plane block, Anaesthesia, vol. 65, no. 1, 2010; 91-92.
8. Adhikary SD, Armstrong K, Chin KJ. Perineural entrapment of an interscalene stimulating catheter. Anaesth Intensive Care. 2012; 40: 527-30.
9. Aveline C, Le Hetet H, Le Roux A, et al. Perineural ultrasound-guided catheter bacterial colonization: a prospective evaluation in 747 cases. Reg Anesth Pain Med. 2011; 36: 579-84.
10. Bowens C Jr, Briggs ER, Malchow RJ. Brachial plexus entrapment of interscalene nerve catheter after uncomplicated ultrasoundguided placement. Pain Med. 2011; 12: 1117-20.
11. Attardi B, Takimoto K, Gealy R, Severns C, Levitan ES. Glucocorticoid induced up-regulation of a pituitary K+ channel mRNA in vitro and in vivo. Receptors Channels. 1993; 1: 287-93.
12. Eker HE, Cok OY, Aribogan A, Arslan G. Management of neuropathic pain with methylprednisolone at the site of nerve injury. Pain Med. 2012; 13: 443-51.
13. Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990; 34: 335-8,
14. Carney J, Finnerty O, Rauf J, Curley G, McDonnell JG, Laffey JG. Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial. Anesth Analg. 2010; 111: 998-1003.
15. Wang PH, Tsai CL, Lee JS, Wu KC, Cheng KI, Jou IM. Effects of topical corticosteroids on the sciatic nerve: an experimental study to adduce the safety in treating carpal tunnel syndrome, J Hand Surg Eur. 2011; Vol 36: 236-43.
16. Shishido H, Kikuchi S, Heckman H, Myers RR. Dexamethasone decreases blood flow in normal nerves and dorsal root ganglia. Spine. 2002; 27: 581-6.
18. Choi S, Rodseth R, McCartney CJ. Effects of dexamethasone as a local anaesthetic adjuvant for brachial plexus block: a systematic review and meta-analysis of randomized trials. Br J Anaesth, Mar. 2014; 112(3): 427-39.
20. M. Desmet, H. Braems, M. Reynvoet S. Plasschaert, J. Van Cauwelaert, H. Pottel, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br. J. Anaesth. 2013; 111 (3): 445-452.