Transversus Abdominis Plane(TAP) Block, Local Infiltration and Intravenous Dexketoprofen in Inguinal Hernia Repair

Currently, multimodal techniques are used in inguinal hernia repairs in addition to pharmacological and regional techniques for postoperative analgesia.TAP block is performed on the principle of hydrodissection of the fascia between the internal oblique and transversus abdominis muscles of the abdominal wall muscles with local anesthetic drugs. Local anesthetic drugs provide analgesic effect up to 24 hours in the postoperative period by blocking the T6-L1 nerves in the facial plane. Local anesthetic infiltration which is one of the regional anesthetic techniques, is another method of postoperative analgesia. intravenous analgesic drug is also used as pharmacological postoperative analgesia method in most clinics.

• Transversus abdominis plane block (Other): Before surgery, Ultrasound-guided TAP block was performed preemptively to Group TAP patients.
• Local anesthetic infiltration (Other): Before surgery, Ultrasound-guided Local anesthetic infiltration to the surgical incision line was performed preemptively to Group Local patients.
• Intravenous dexketoprofen (Other): Before surgery, 50 mg intravenous dexketoprofen was performed preemptively to Group dexketoprofen patients.

Primary outcomes

• Postoperative rescue tramadol consumption [24 hours]: The mean tramadol consumption in the first 24 post-operative hours

Secondary outcomes

• Analgesic efficacy [24 hours]: Postoperative visual analog scale score recorded 0-10 (0 = no pain, 10 = severe pain) at 30. min, 1, 2, 4, 8, 12, 16 and 24 hours postoperatively
• Postoperative nausea-vomiting [24 hours]: Postoperative nausea-vomiting was evaluated with a 3-point system (0: no nausea and vomiting, 1: nausea, but no vomiting, 2: nausea with or without nausea) 24 hours postoperatively.

Sex: All, ages: 18 Years to 75 Years

Inclusion Criteria:

* Subject who aged 18-75 years
* American Society of Anesthesiologist (ASA) I-III
* Subject undergoing unilateral or bilateral inguinal hernia repair

Exclusion Criteria:

* Subject under 18 and over 75 years of age
* ASA IV
* History of allergy to agents
* Analgesic drug use in the last 48 hours
* Morbid obese (BMI> 35)
* Confusion
* Coagulopathy
* Local infection at the injection site
* Subject with heart, lung, hematologic, metabolic and endocrine disease
* Subject who did not want to be included in the study
* Subject who refused the spinal anesthesia
* Subject who failed the spinal anesthesia

• Results publication: Joshi GP, Rawal N, Kehlet H; PROSPECT collaboration; Bonnet F, Camu F, Fischer HB, Neugebauer EA, Schug SA, Simanski CJ. Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery. Br J Surg. 2012 Feb;99(2):168-85. doi: 10.1002/bjs.7660. Epub 2011 Sep 16. PMID 21928388
• Results publication: Petersen PL, Mathiesen O, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB. The effect of transversus abdominis plane block or local anaesthetic infiltration in inguinal hernia repair: a randomised clinical trial. Eur J Anaesthesiol. 2013 Jul;30(7):415-21. doi: 10.1097/EJA.0b013e32835fc86f. PMID 23549122

• Fikret Salık, Principal investigator, Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital