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Subarachnoid block with continuous TAP catheter analgesia produces less chronic pain and better functional outcome after inguinal hernioplasty: a randomized controlled observer-blinded study
  1. Sivashanmugam Thiyagarajan1,
  2. Jaya Velraj1,
  3. M I Hussain Ahmed2 and
  4. Ravishankar Murugesan2
  1. 1 Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute (MGMC and RI), Sri Balaji Vidyapeeth University, Puducherry, India
  2. 2 AI Mana General Hospital, AI Rowda, AI Hofoof wal Mubarraz, Al-Mubarraz, Saudi Arabia
  1. Correspondence to Jaya Velraj, Department of Anesthesiology, Mahatma Gandhi Medical College and Research Institute (M.G.M.C & R.I), Sri Balaji Vidyapeeth (Deemed to be University), Puducherry 607 403, India; jayav{at}


Background and objectives The major concern after inguinal hernioplasty is chronic postsurgical pain and impaired quality of life due to central sensitization. Preoperative, intraoperative, and postoperative pre-emptive analgesia using regional techniques may help prevent the development of central sensitization. This study evaluated the effect of regional anesthesia followed by continuous regional analgesia on postoperative pain and functional outcome following inguinal hernioplasty.

Methods Seventy-two consecutive patients scheduled to undergo open mesh inguinal hernioplasty were randomly allocated to one of three groups: subarachnoid block alone (group SAB), general anesthesia alone (group GA), or subarachnoid block combined with a continuous transverse abdominis plane block (group TAP). Pain and functional outcome was assessed before and 6 months following the surgery using the Core Outcome Measures Index score adapted for patients with hernia (COMI-hernia). During the first 72 hours postoperatively, pain was assessed at rest and during five different activities using the numerical rating scale.

Results Six months following the surgery, the COMI-hernia score was lower in group TAP than in group GA or group SAB (0.54±0.41 vs 0.88±0.43 and 1.00±0.54, respectively; p<0.02). Pain at rest (p<0.02) and during activities (p<0.001) was lowest in group TAP during the first 72 hours postoperatively.

Conclusions A subarachnoid block combined with continuous postoperative analgesia via a transverse abdominis plane catheter provided better pain control and functional outcome 6 months following inguinal hernioplasty as well as better postoperative analgesia.

Clinical trial registration CTRI/2016/09/007238.

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  • Presented at This work was presented in part as a free paper at PONCON 2016, a state-level conference.

  • Funding Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Pondicherry.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This prospective, observer-blinded study was approved by the Institutional Research Council and Institutional Human Ethics Committee of Mahatma Gandhi Medical College and Research Institute, Pondicherry, India (MD/MS/2013/02) and registered with the Clinical Trial Registry of India (CTRI/2016/09/007238).

  • Provenance and peer review Not commissioned; externally peer reviewed