Transversus Abdominis Plane Block Vs. Paravertebral Block for Post-Operative Analgesia Following Inguinal Herniorrhaphy - A Cross-Sectional North Indian Sub-Population Study

Author(s): Trilok Chand1, Amrita Gupta2, Avanish Kumar Saxena3, Pulkit Agarwal4, Shanu Maheshwari5

Inguinal hernia is a frequently encountered surgical problem. General anaesthesia
carries the risk of possible airway complications. Regional blocks improve acute
post-operative pain, decrease post-operative visual analogue scale (VAS) score
and patient can mobilise early. The purpose of this study was to compare the
effectiveness of transversus abdominis plane (TAP) block vs. paravertebral (PVB)
block for post-operative analgeia in inguinal hernia surgeries.
We conducted a research on 64 patients of age > 18 years with American society
of Anaesthesiologists (ASA I – III) to undergo unilateral inguinal herniorrhaphy.
Patients were randomized into two groups. Group T received TAP block in which
20 ml of 0.25 % bupivacaine was injected and Group P underwent PVB in which 5
ml of bupivacaine (0.25 %) at each segment from T10-L1 was injected slowly
(total dose of 20 ml). Post-operative VAS score, time for first rescue analgesia,
total diclofenac requirement, total anti-emetic requirement and complications if
any was noted.
The demographic data of both the groups were comparable. Also, pre and postoperative
heart rate, blood pressure, IV fluids, ephedrine use, operative time and
complications were statistically insignificant. As compared to group T, group P had
lower VAS score from 2nd – 12th hour which was statistically significant (P < 0.05).
Although more time is required to perform paravertebral block but the time for
request of first rescue analgesia was quite prolonged in paravertebral block. Time
of ambulation in group P was significantly lower than group T.
PVB requires more time to perform due to multiple site of injection, the comparison
of both techniques in the present study revealed that PVB showed relatively higher
efficacy in the management of post-operative pain, early ambulation and had
significant reduction in dose requirement of additional analgesia (diclofenac) and
antiemetics (ondansetron) over tap block.