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  • Ultrasound-Guided Transversus Abdominis Plane Catheters and Ambulatory Perineural Infusions for Outpatient Inguinal Hernia Repair

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BRIEF TECHNICAL REPORT
Ultrasound-Guided Transversus Abdominis Plane Catheters and Ambulatory Perineural Infusions for Outpatient Inguinal Hernia Repair
  1. Justin W. Heil, MD, PhD*,
  2. Brian M. Ilfeld, MD, MS*,
  3. Vanessa J. Loland, MD*,
  4. NavParkash S. Sandhu, MD, MS* and
  5. Edward R. Mariano, MD, MAS†
  1. From the *Department of Anesthesiology, University of California, San Diego, CA; and the
  2. †Department of Anesthesiology and Perioperative Care Service, Stanford University School of Medicine, Palo Alto, CA.
  1. Address correspondence to: Edward R. Mariano, MD, MAS, UCSD Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801 Miranda Ave (112A), Palo Alto, CA 94304 (e-mail: emariano{at}stanford.edu).

Abstract

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.

https://doi.org/10.1097/AAP.0b013e3181fa69e9

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    Footnotes

    • Funding for this project was provided by National Institutes of Health grant GM077026 (principal investigator Dr. Ilfeld) from the National Institute of General Medical Sciences (Bethesda, MD) and the Department of Anesthesiology, University of California, San Diego Medical Center (San Diego, CA). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of these entities.

    • Drs. Loland, Ilfeld, and Mariano have received funding for other research investigations from Arrow International (Reading, PA) and Stryker Instruments (Kalamazoo, MI). These companies had absolutely no input into any aspect of the present study conceptualization, design, and implementation; data collection, analysis, and interpretation; or manuscript preparation. Drs. Loland and Mariano conduct continuous peripheral nerve block workshops for Stryker Instruments. None of the other authors has any personal financial interest in this research.