Comparison the Analgesic Efficacy of Ultrasonographic Bilateral TAP and Anesthetic Infiltration Into the Surgery Field for Laparoscopic Unilateral TEP Herniorrhaphy
Comparison of Postoperative Analgesic Efficacy of Ultrasonographic Bilateral TAP (Transversus Abdominis Plane) Block and Anesthetic Infiltration Into Preperitoneal and the Surgical Field in Laparoscopic Unilateral TEP (Total Extraperitoneal) Herniorraphy
Başakşehir Çam & Sakura City Hospital
60 participants
Sep 4, 2025
INTERVENTIONAL
Conditions
Summary
Laparoscopic inguinal hernia repair is a common surgical procedure, but postoperative pain management remains a challenge. This prospective, randomized study aims to compare the analgesic efficacy of preperitoneal and surgical site anesthetic infiltration with ultrasound-guided bilateral transversus abdominis plane (TAP) block in patients undergoing laparoscopic unilateral total extraperitoneal (TEP) herniorrhaphy. Sixty patients will be randomly allocated into two groups: Group-I will receive preperitoneal and surgical site infiltration with bupivacaine, while Group-II will receive ultrasound-guided bilateral TAP block with bupivacaine. The primary outcomes will be postoperative pain scores assessed using the visual analog scale (VAS) and additional analgesic requirements. Secondary outcomes will include postoperative hospital stay duration and cost-effectiveness. Demographic data, ASA scores, comorbidities, and operation times will be recorded. Postoperative pain will be managed with a multimodal approach, including paracetamol and NSAIDs. Rescue analgesia will be provided with intravenous paracetamol. Statistical analysis will be performed using t-tests, ANOVA, Wilcoxon-Mann-Whitney tests, and chi-square tests, as appropriate. This study aims to determine the optimal and most beneficial method for postoperative pain management and patient comfort following laparoscopic inguinal hernia repair.
Eligibility
Inclusion Criteria14
- Consenting patients,
- She will undergo laparoscopic hernia repair surgery,
- ASA-I-II,
- Between the ages of 18 and 65,
- No history of anticoagulant or antiaggregant drug use,
- Regional anesthesia is not contraindicated and the anesthesiologist deems -appropriate for regional anesthesia,
- Under general anesthesia and will undergo laparoscopic surgery,
- Fully oriented and cooperative,
- Unilateral inguinal hernia,
- No previous surgery for inguinal hernia,
- No incision in the lower abdomen,
- Not using alcohol and drugs,
- No preoperative pain and
- Patients without symptoms of strangulated hernia will be included in the study.
Exclusion Criteria16
- Patients without consent
- Regional anesthesia is contraindicated,
- Those who will undergo open abdominal surgery,
- Not in the appropriate age range,
- Chronic diseases such as uncontrolled DM and HT,
- Drug allergy,
- Taking anticoagulant or antiaggregant drugs,
- History of chronic analgesic use,
- Presence of active infection in the area to be blocked,
- Will not be able to comply with postoperative pain /VAS follow-up,
- Patients with ASA-III-IV,
- Patients with bilateral inguinal and scrotal hernias,
- Patients who have been previously operated for inguinal hernia and have an incision in the lower abdomen,
- Those with a history of alcohol and drug abuse
- Preoperative pain and
- Those with symptoms of strangulated hernia will not be included in this study.
Interested in this trial?
Get notified about updates and connect with the research team.
Interventions
In laparoscopic hernia repairs, patients are positioned supine, and the surgical area is cleansed with povidone iodine and covered with sterile green drapes. A 1-centimeter incision will be made 1 centimeter below the umbilical border. A 10-mm trocar will be inserted into the preperitoneal space. The operation was filmed from the front with a 30-degree camera. After observing the preperitoneal space, two five-mm working trocars will be placed midline, two and six centimeters inferior to the symphysis pubis. Next, the cord structures and Cooper ligament will be exposed and the hernia sac freed from surrounding anatomical structures.Prolene mesh will be spread over the preperitoneal area to cover all hernia defects and secured to the Cooper ligament and abdominal wall with an absorbable fixation device. Group 1 patients undergo desufflation via 50 mg of bupivacaine into the preperitoneal space, followed by 10 mg of bupivacaine into each trocar incision and skin closure with sutures.
After the surgery, the anesthesiologist will use a TAP block under ultrasound guidance. Before the patient wakes up, the Hitachi ultrasound probe will be sterilized and positioned between the iliac wing and the costae. An ultrasound shows the skin, fat beneath it, the six abdominal muscle layers, and a support muscle.A thin needle goes through the skin from one side to the other to reach the muscle layers. The location of the block is confirmed by injecting 1-2 ml of 0.09% NaCl followed by negative aspiration. Patients receive 15-20 ml (40-50 mg per quadrant) of bupivacaine 0.5% concentration in a controlled manner with negative aspiration every 5 ml. The block is performed bilaterally.
Locations(1)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT06894420