Opioid sparing effect of transversus abdominis plane (TAP) block in open ventral hernia repair: case series

Abstract

Background: Open ventral hernia repair surgery is characterised with pain that arises from skin, muscles of the anterior abdominal wall and parietal peritoneum. Transversus abdominis plane (TAP) block can be suitable for these operations and can lower usage of opioids during surgery and in the postoperative period. Case report: We represent five patients, all ASA classification 2, scheduled for open ventral hernia repair surgery. After induction to standard general anesthesia with 2 mg midazolam, 100 µgr fentanyl, propofol 2 mg/kg, and rocuronium bromide 0.6 mg/kg, ultrasoundguided TAP block was performed with 20 ml 0.25% bupivacaine + 4 mg dexamethasone on both sides before surgical midline incision. Anesthesia was maintained with sevoflurane 0.7-1 MAC. Pain was measured first 48 hours after surgery with numeric rating score (NRS) from 1 to 10, where for NRS 4-6/10 1 gr metamizol was given, and for NRS 7-10/10 1 mg/kg tramadol was administered. Opioid consumption during surgery and in the postoperative period was measured too. The first three patients have pain 22 hours after surgery with NRS 4/10, other two patients have pain 25 hours after surgery with NRS 6/10 and all received 1 gr metamizol. Next complaint was 34 and 46 hours after surgery in all patients with NRS 4-5/10 and 1 gr metamizol was given. Total opioid consumption during surgery in all patients was 150 µgr fentanyl and none of the patients received opioids in the postoperative period. Discussion: Pain in open ventral hernia repair operations is from somatic origin and can lead to high pain scores in the postoperative period, bigger opioid consumption and prolonged stay in hospital.1 Bilateral TAP block is ideal for treatment of somatic pain and given together with dexamethasone can prolong analgesia in first 48 hours after surgery. References: 1. Zhang D, Zhou C, Wei D, Ge L, Li Q. Dexamethasone added to local anesthetics in ultrasound-guided transversus abdominis plain (TAP) block for analgesia after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE 14(1): e0209646. https://doi.org/10.1371/journal.pone.0209646 Learning points: TAP block given with steroids before surgical incision achieves prolonged analgesia during and after surgery, minimise opioid consumption and better pain control.