İnguinal herni onarımında USG eşliğinde TAP blok, USG eşliğinde yara yeri infiltrasyonu ve intravenöz deksketoprofenin preemptif uygulanmasının postoperatif analjezik etkinliklerinin karşılaştırılması

Abstract

Objective: The ideal postoperative analgesic method in inguinal hernia repairs is still controversial. We aimed in this study to comparison the postoperative analgesic efficacy of different analgesic methods that we performed preemptively in inguinal hernia repairs. Methods: This study was designed prospectively. Patients aged 18-75 years who underwent elective inguinal hernia repair under spinal anesthesia were included in the study. 120 patients were divided into three groups according to the analgesic method performed before surgical incision. Group 1: USG-guided Transversus abdominis plane block (n = 40), Group 2: USG-guided local anesthetic infiltration (n = 40) and Group 3 intravenous dexketoprofen (n = 40). The mean of tramadol consumption and number of patients in requiring rescue analgesics were recorded for 24 hours postoperatively. VAS scores were analyzed at the 30 minute, 1, 2, 4, 8, 12, 16 and 24th hours. Results: The postoperative mean tramadol consumption was statistically similar between the groups [Group 1: 22.5±57.6mg; Group 2: 20±51.6mg; Group 3: 27.5±59.8mg (p=0.833)] in groups. There was no significant difference between the number of patients requiring rescue analgesics (p=0.787). VAS scores at 30. min, 1, 2, 4, 8 and 12 hours were statistically lower in Group 1 than in the other groups (p values 0.003, 007, 0013, 0049, 0015, 0021 respectively). VAS scores at 30. min and 2. h were lower in Group 1 than Group 2 (p values 0.049, 0.037 respectively). İn addition, VAS scores at 30 min, 1, 2, 8 and 12 hours were lower in Group 1 than in Group 3 (p values 0.003, 0.006, 0.021, 0.017, 0.016 respectively). VAS scores at all hours were statistically similar between Group 2 and Group 3. Conclusion: In this study, we demonsrated that preemptive transversus abdominis plane block, local anesthetic infiltration or intravenous dexketoprofen for postoperative analgesia in inguinal hernia repairs had similar effects on postoperative tramadol consumption and number of requiring rescue analgesic patients. However, the transversus abdominis plane block block provides lower VAS scores and excellent analgesia in more patients in the first 24 hours postoperatively.