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  • Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial

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Regional anesthesia and acute pain
Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial
  1. Marius Keller1,
  2. Friederike Dinkel2,3,
  3. Johann Jacoby4,
  4. Barbara Kraft5,
  5. Anne Haas6,
  6. Peter Rosenberger1 and
  7. Rainer Meierhenrich2
  1. 1Department of Anesthesiology and Intensive Care Medicine, Eberhard Karls Universität Tübingen, Tübingen, Baden-Württemberg, Germany
  2. 2Department of Anesthesia and Intensive Care Medicine, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
  3. 3School of Medicine, Eberhard Karls Universität Tübingen, Tübingen, Baden-Württemberg, Germany
  4. 4Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls Universität Tübingen, Tübingen, Baden-Württemberg, Germany
  5. 5Department of General and Visceral Surgery, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
  6. 6Dispensary, Diakonie-Klinikum Stuttgart, Stuttgart, Germany
  1. Correspondence to Dr Marius Keller, Department of Anesthesiology & Intensive Care Medicine, Eberhard Karls Universität Tübingen, Tübingen, Baden-Württemberg, Germany; marius.keller{at}uni-tuebingen.de

Abstract

Background A bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.

Methods In a single-centre, prospective, placebo-controlled, double-blind study, patients scheduled for sublay mesh hernia repair were randomized to receive oblique subcostal transverse abdominis plane blocks with either 60 ml of 0.375% ropivacaine (n=19) or isotonic saline (placebo, n=17). The primary outcome was patient-controlled total morphine consumption at 8:00 p.m. on the second postoperative day (POD), while secondary outcomes included the total morphine consumption during the post-anesthesia care unit stay and the occurrence of adverse events.

Results Total morphine consumption at 8:00 p.m. on the second POD was higher in patients receiving ropivacaine (39 mg, IQR 22, 62) compared with placebo (24 mg, IQR 7, 39), p value = 0.04. In contrast, the ropivacaine group received 2 mg less morphine during the post-anesthesia care unit stay (4 mg, IQR: 4, 9 mg vs 2 mg, IQR: 2,6 mg, p = 0.04). Patients receiving ropivacaine used more morphine (8:00 p.m. on the first POD until 8:00 a.m. on the second POD: 8 mg, IQR: 4, 18 mg vs 2 mg, IQR: 0, 9 mg, p = 0.01) and reported higher maximum pain scores since the last assessment (8:00 a.m. on the second POD: 5, IQR: 4, 7 vs 4, IQR: 3, 5, p = 0.03). There were no differences in adverse events between groups.

Conclusions Bilateral oblique subcostal transverse abdominis plane blocks in patients undergoing sublay mesh hernia repair were not associated with a prolonged reduction in patient-controlled total morphine consumption in the evening of the second POD in this study. Rebound pain might explain the additional excess opioid required by the ropivacaine group.

  • Nerve Block
  • Pain, Postoperative
  • REGIONAL ANESTHESIA

Data availability statement

Data are available upon reasonable request.

Data availability statement

The data are available upon reasonable request in accordance with German privacy regulations.

https://doi.org/10.1136/rapm-2024-105596

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    Data availability statement

    Data are available upon reasonable request.

    Data availability statement

    The data are available upon reasonable request in accordance with German privacy regulations.

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    Footnotes

    • Contributors MK conceived and designed the study, collected the data, performed data analysis, wrote the manuscript, contributed to revision of the manuscript and is responsible for the overall content as guarantor. FD collected the data, performed data analysis and contributed to revision of the manuscript. JJ served as statistical consultant, provided analysis tools and strategies, performed data analysis and contributed to revision of the manuscript. BK contributed to interpretation of the results and revision of the manuscript. AH contributed to interpretation of the results and revision of the manuscript. PR contributed to interpretation of the results and revision of the manuscript. RM conceived and designed the study, supervised the study, performed data analysis, wrote the manuscript and contributed to revision of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.