PT  - JOURNAL ARTICLE
AU  - Justin W. Heil
AU  - Brian M. Ilfeld
AU  - Vanessa J. Loland
AU  - NavParkash S. Sandhu
AU  - Edward R. Mariano
TI  - Ultrasound-Guided Transversus Abdominis Plane Catheters and Ambulatory Perineural Infusions for Outpatient Inguinal Hernia Repair
AID  - 10.1097/AAP.0b013e3181fa69e9
DP  - 2010 Oct 01
TA  - Regional Anesthesia & Pain Medicine
PG  - 556-558--556-558
VI  - 35
IP  - 6
4099  - http://rapm.bmj.com/content/35/6/556-558.short
4100  - http://rapm.bmj.com/content/35/6/556-558.full
SO  - Reg Anesth Pain Med2010 Oct 01; 35
AB  - Background and Objectives: Transversus abdominis plane (TAP) blocks anesthetize the lower abdominal wall, and TAP catheters have been used to provide prolonged postoperative analgesia after laparotomy. The use of TAP catheters on an outpatient basis has not yet been described. We present our experience with ultrasound-guided TAP perineural catheter insertion and subsequent management of ambulatory TAP local anesthetic infusions after inguinal hernia repair.Methods: Three patients scheduled for unilateral open inguinal hernia repair underwent preoperative posterior TAP catheter placement for postoperative pain management using a technique employing ultrasound guidance alone. A bolus of local anesthetic solution was injected via the catheter in divided doses, and block onset was confirmed before surgery. Postoperatively, a continuous infusion of ropivacaine 0.2% was delivered using a portable infusion pump, and patients were discharged with a prescription for oral analgesics for breakthrough pain and perineural infusion instructions. Patients were followed up daily by telephone.Results: All patients underwent successful TAP catheter insertion and maintained their catheters until postoperative day 2. All patients reported minimal pain for the duration of infusion without the need for any supplemental opioid analgesics, high satisfaction with postoperative analgesia, and no infusion-related complications.Conclusions: An ultrasound-guided TAP catheter and ambulatory local anesthetic perineural infusion are a promising option for prolonged postoperative analgesia after outpatient inguinal hernia repair. A posterior insertion permits preoperative placement by keeping the catheter away from the planned surgical field.