COMPARISON OF POSTOPERATIVE ANALGESIC EFFECT OF US-GUIDED TRANSVERSES ABDOMINIS PLANE BLOCK WITH PARAVERTEBRAL BLOCK FOR UNILATERAL INGUINAL HERNIA REPAIR IN ADULT PATIENTS UNDER GENERAL ANAESTHESIA

Abstract

Girish Sharma1, Beauty Chowdahry2, Shweta Mahajan3

BACKGROUND
Both Transvers
e Abdominis Plane (TAP) block and Paravertebral Block (PVB) can be used to provide postoperative analgesia in
inguinal hernia surgeries. Present study was done to evaluate the postoperative analgesic effect of USG guided TAP block with
USG guided PVB for unilateral inguinal hernia repair under general anaesthesia.
MATERIALS AND METHODS
Sixty, American
Society of Anesthesiologist (ASA) grade 1 and 2 adult patients undergoing inguinal hernia repair under general
anaesthesia were randomly allocated to TAP (Gp I ) and PVB (Gp II ) group of 30 In Gp I patients received local anaesthetic
mixture of 0.5% bupivacaine (15 mL ) and Xylocaine with adrenaline (15 mL ) in TAP plane under real time USG. In Gp II
the same anaesthetic mixture was injected 1 cm deep to superior surface of transverse process of T 10,12 and L 2 vertebra under
ultrasound guidance The postoperative pain using the Visual Analogue Scale (VAS), the number of analgesic doses and total
drug requirement in the first 24 hours of postoperative period was noted.
Statistical Analysis Used
SPSS version 14.0 (SPSS Inc .., Chicago, IL), Chi squar e test, S tudent’s t test. P ? 0.05 was taken as
statistically significant.
RESULTS
VAS scores were statistically significantly lower in Gp
II as compared to Gp1 at 1, 2, 4 and 6 hours postoperative time interval
(p value 0.05). The difference in VAS scores became insignificant at 12 and 24 hours of postoperative period. Mean time to
first analgesic in post operative period in Gp I was 5:06 hrs. (range 2 10 hrs.) and in Gp II was 7.7 hrs (range 5 10 hrs.) (p
value ? 0.001)0.001). Twenty two patients in Gp I and ten patients in Gp I I required analgesic in post operative period (p ?0.001).
Total number of diclofenac doses required in post operative period was significantly lower in Gp II than in Gp I (10 v/s Total
dose of diclof enac consumed in first 24 h rs. was significantly lower in Gp II (750 mg) than in Gp I (1875 mg) (p value ?0.001).
CONCLUSION
PVB is better than TAP block regarding
post operative analgesia in unilateral inguinal hernia repair. Unilateral ultrasound-guided paravertebral block is better than unilateral ultrasound-guided transverses abdominis plane block for postoperative pain control in unilateral inguinal hernia surgeries. The time to first analgesic dose, total number of analgesic doses and total drug requirements in first 24 hours of postoperative period were significantly better in paravertebral group. Both blocks showed haemodynamic stability, no motor weakness, no urinary retention or vomiting in postoperative period. Performing the block under ultrasound guidance also prevented complications associated with these blocks.
KEYWORDS
Para
v ertebral Block, Transverses Abdominis Plane Block, Inguinal Hernia , USG USG.

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