Ultrasonografi Eşliğinde Uygulanan Transversus Abdominis Plan Bloğunun İnguinal Herni Cerrahisi Sonrası Gelişen Kronik Ağrı Üzerine Etkisi: Retrospektif Kohort Çalışma

Amaç: Bu retrospektif çalışmanın amacı, inguinal herni onarımı esnasında ultrasonografi eşliğinde uygulanan transversus abdominis plan (TAP) bloğun postoperatif oluşan kronik ağrı üzerine etkinliğini değerlendirmektir. Yöntem: Temmuz 2018 ile Ekim 2019 tarihleri arasında genel anestezi altında Lichtenstein tekniğiyle tek taraflı elektif greftli inguinal herni ameliyatı olan hastaların retrospektif olarak kayıtları incelendi. Hastalar intraoperatif TAP blok uygulanmayan (Grup 1, n=38) ve uygulanan olarak (Grup 2, n=32) iki gruba ayrıldı (n=70). Postoperatif 6. aydan sonra hastalar telefonla aranarak; ameliyattan önce kronik ağrı varlığı, varsa ağrının karakteri, günlük aktivitelerini sınırlayıp sınırlamadığı öğrenildi ve not edildi. Kronik ağrı ölçümü için Sayısal Derecelendirme Ölçeği ağrı skoru kullanıldı; 3 ve üzeri değerler kronik ağrı olarak kabul edildi. Bulgular: Bu çalışmaya Grup 1‘de 38 ve Grup 2’de 32 hasta olmak üzere toplam 70 hasta dâhil edildi. Postoperatif 6. ayda kronik ağrı görülen hasta oranı (n=21) %30’du. Gruplar arasında kronik ağrı gelişimi açısından anlamlı bir fark yoktu [Grup 1 (n=14, %36,8 ); Grup 2 (n=7, %21,8)]. Hastaların ağrı karakterlerinin en sık yanıcı tarzda olduğu gözlendi. Sonuç: Ultrasonografi eşliğinde uygulanan TAP bloğun kronik ağrı gelişimi üzerine anlamlı bir etkisinin olmadığı sonucuna vardık.

The Effect of Ultrasound-Guided Transversus Abdominis Plane Block on Chronic Pain Experienced After Inguinal Hernia Surgery: A Retrospective Cohort Study

Objective: The purpose of this retrospective study was to see how efficient ultrasound-guided transversus abdominis plane (TAP) block was on the incidence of chronic postoperative pain developing after inguinal hernia surgery. Methods: The records of patients who had unilateral elective grafted inguinal hernia surgery with the Lichtenstein procedure under general anesthesia between July 2018 and October 2019 were examined retrospectively. The patients were placed into two groups (total=70): those who did not receive intraoperative TAP block (Group 1, n=38) and those who received (Group 2, n=32). The patients were contacted by phone 6 months after the procedure, and it was learned and recorded whether they had chronic pain before the operation, the nature of the pain if any, whether it limited their daily activities or not. The Numerical Rating Scale was used to measure chronic pain, and values of 3 and above were considered chronic pain. Results: This study comprised a total of 70 participants, with 38 patients in Group 1 and 32 patients in Group 2. Patients with chronic pain incidence in the postoperative 6th month (n=21) accounted for 30% of all patients. There was no significant difference between the groups regarding chronic pain development [Group 1 (n=14, 36.8% ), Group 2 (n=7, 21.8%)]. It was observed that the patients’ pain was predominantly in the burning style. Conclusion: We concluded that the ultrasound-guided TAP block had no significant effect on the development of chronic pain.

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1. Axman E, Holmberg H, Nordin P, Nilsson H. Chronic pain and risk for reoperation for recurrence after inguinal hernia repair using self-gripping mesh. Surgery 2020;167(3):609-13.
2. Karaman Y, Özkarakaş H, Karaman S, et al. İnguinal herni onarımı sonrası kronik ağrı insidansı. Agrı 2015;27(2):97-103.
3. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: A systematic review. Am J Surg 2007;194(3):394-400.
4. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: Risk factors and prevention. Lancet 2006;367(9522):1618- 25.
5. Theodoraki K, Papacharalampous P, Tsaroucha A, Vezakis A, Argyra E. The effect of transversus abdominis plane block on acute and chronic pain after inguinal hernia repair. A randomized controlled trial. Int J Surg 2019;63(2):63-70.
6. Fränneby U, Sandblom G, Nordin P, Nyrén O, Gunnarsson U. Risk factors for long-term pain after hernia surgery. Ann Surg 2006;244(2):212-9.
7. Finnerty O, Sharkey A, Mc Donnell JG. Transversus abdominis plane block for abdominal surgery. Minerva Anestesiol 2013;79(12):1415-22.
8. Tsai HC, Yoshida T, Chuang TY, et al. Transversus abdominis plane block: An updated review of anatomy and techniques. Biomed Res Int 2017;2017:8284363.
9. McDonnell JG, O’Donnell B, Curley G, Heffernan A, Power C, Laffey JG. The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective randomized controlled trial. Anesth Analg 2007;104(1):193-7.
10. Okur O, Tekgul ZT, Erkan N. Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: A prospective randomized controlled open-label. J Anesth 2017;31(5):678-85.
11. Aasvang E, Kehlet H. Chronic postoperative pain: The case of inguinal herniorrhaphy. Br J Anaesth 2005;95(1):69-76.
12. Schachtrupp A, Klinge U, Junge K, Rosch R, Bhardwaj RS, Schumpelick V. Individual inflammatory response of human blood monocytes to mesh biomaterials. Br J Surg 2003;90(1):114-20.
13. Alfieri S, Amid PK, Campanelli G, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia 2011;15(3):239-49.
14. Ferzli GS, Edwards ED, Khoury GE. Chronic pain after inguinal herniorrhaphy. J Am Coll Surg 2007;205(2):333-41.
15. van Hanswijck de Jonge P, Lloyd A, Horsfall L, Tan R, O’Dwyer PJ. The measurement of chronic pain and health-related quality of life following inguinal hernia repair: A review of the literature. Hernia 2008;12(6):561-9.
16. Urigel S, Molter J. Transversus abdominis plane (TAP) blocks. AANA J 2014;82(1):73-9.
17. Massaron S, Bona S, Fumagalli U, Battafarano F, Elmore U, Rosati R. Analysis of post-surgical pain after inguinal hernia repair: A prospective study of 1,440 operations. Hernia 2007;11(6):517-25.
18. Lange JFM, Kaufmann R, Wijsmuller AR, et al. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia 2015;19(1):33- 43.