Laparoscopic-guided psoas blockade as a novel analgesic method during inguinal herniorrhaphy: a clinical trial

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Tammam T.F.; Salama A.F.

Journal: Acta Anaesthesiologica Scandinavica

Publisher: Blackwell Munksgaard

Publication Date: 30 November 2016

Volume / Issue: Volume 61 / Issue 2

Pages: 232–240

ISSN: 15172

DOI: 10.1111/aas.12842

Scopus: View on Scopus

PubMed: 27900771

Document Type: Article

Authors and Affiliations

Tammam T.F., Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University Hospital, Portsaid, Egypt; Salama A.F., Department of General and Digestive Surgery, TBRI (Theodor Bilharz Research Institute), Cairo, Egypt

Abstract

Background: Under laparoscopic guidance, block of ilioinguinal, iliohypogastric, and genitofemoral nerves can be possible with anesthetic injection in the plane between psoas major and the fasciae covering its anterior aspects [laparoscopic-assisted psoas (LAP) blockade]. This observer-blinded trial aimed to compare the opioid-sparing effect of LAP block with transversus abdominis plane (TAP) block after laparoscopic inguinal herniorrhaphy. Methods: Forty-five male patients were randomly assigned to receive LAP block, group LAP (n = 23), or ultrasound-guided TAP block, group TAP (n = 22). Primary outcome measure was the analgesic requirements in the first 36 post-operative hours. Post-operative pain scores and sensory blockade were recorded. Results: Median (interquartile range) total morphine requirement was significantly less in patients who underwent LAP blockade 0 (0, 4) than in patients who underwent TAP blockade 21 (10, 27; P < 0.001). LAP group showed significantly less pain at rest and on coughing compared with TAP group. The median number of dermatomes blocked was 3 (2–4) in LAP group and 3 (3–4) in TAP group (P < 0.05). The highest sensory-level blockade was at T12 (T11-L1) in LAP group, while it was at T10 (T10-T11) in TAP group. The most distal dermatome involvement was at L2 (L2-L2) in LAP group and at L1 (T12-L1) in TAP group. Conclusion: A single injection LAP blockade significantly reduces the post-operative analgesic requirements and provides longer pain relief compared with TAP block after laparoscopic inguinal herniorrhaphy. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd

Keywords

Abdominal Muscles; Adolescent; Adult; Femoral Nerve; Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Male; Middle Aged; Nerve Block; Pain, Postoperative; bupivacaine; morphine; ondansetron; Article; clinical article; controlled study; coughing; dermatome; dysesthesia; hematoma; human; inguinal hernia; laparoscopic guided psoas block; laparoscopic surgery; micturition disorder; nausea and vomiting; pain assessment; patient controlled analgesia; postoperative pain; priority journal; prospective study; randomized controlled trial; single blind procedure; transversus abdominis plane block; abdominal wall musculature; innervation; procedures

Citation Information

Scopus Citations: 5

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