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Ultra Fast-Track en hernioplastia inguinal

Ultra Fast-Track in inguinal hernia repair

INTRODUCTION

Inguinal hernia surgery is a very common surgical procedure in our country, representing about 15% of all surgical procedures performed in the field of general surgery in adults. It is a relatively simple procedure, and with an increasingly frequent trend toward its inclusion in outpatient surgical programmes so the anaesthesia strategy employed becomes very relevant. Thus, regional anaesthesia techniques have been shown to favour fast-track programmes to reduce consumption of opioids for pain control during the immediate postoperative period.

The groin region is supplied mainly by branches of the iliohypogastric and ilioinguinal nerves, so blocking these nerves provides adequate perioperative analgesia after hernia repair at this level. Performing a block by the TAP (Transversus Abdominis Plane) technique allows rapid recovery of the patient with a high degree of postoperative comfort.

CASE DESCRIPTION

We report the case of a man of 44 years, with no history of interest and clinical status ASA I, who was involved on a scheduled basis for the performance of a left hernia repair through the outpatient surgery circuit.

The patient was premedicated with 2mg midazolam and monitored according to SEDAR. Intravenous induction was performed and a Supreme© laryngeal mask was inserted according to protocol. Ultrasound-guided TAP blocking was then performed with a Temena Group hybrid ultrasound needle (EH95-21 21G) by a lateromedial approach with an injection of 0.5% 25ml levobupivacaine and 4mg dexamethasone, which diffuses adequately, dissecting the muscle planes. (transversus abdominis in depth and inferior oblique surface).

 

Aguja híbrida

 

A balanced anaesthesia was performed with sevoflurane and remifentanil, requiring only 150 µg of fentanyl. Intravenous NSAIDS were administered during the intraoperative period and after 45 minutes of surgery; eduction of the patient was performed without incident, exhibiting pain in accordance with the analgesic verbal scale from 0-1.

 

TAP y hernia Temena Group

 

During his stay, the patient did not require any analgesic rescue and presented adequate oral tolerance, so he was discharged 5 hours after admission without exhibiting any event of interest and under optimal conditions for the restoration of basic activities of daily life.

DISCUSSION

The impact of the anaesthetic technique is critical in inguinal hernia surgery for the inclusion of the procedure in outpatient surgery programmes. The primary objective of the use of regional techniques alongside general anaesthesia is to allow early discharge of the patient avoiding unwanted side effects arising from other anaesthesia techniques which are also used in this type of surgery (urinary retention after spinal anaesthetic or hyperalgesia secondary to the consumption of intravenous opioids)

CONCLUSIONS

Blocking the ilioinguinal and iliohypogastric nerves is presented as a quality supplement to general anaesthesia for inguinal hernia surgery. TAP is a simple technique with a low complication rate with obvious benefits for the management of postoperative pain and facilitates the implementation of the fast-track in the field of outpatient surgery for inguinal hernia repair.

BIBLIOGRAPHY

  • Aveline C, Hetet H, Le Roux A, Vautier P. Comparison between ultrasound-guided transverses abdominis plane and conventional ilioinguinal/iliohypogastric nerve blocks for day-case open inguinal hernia repair. British Journal of Anaesthesia. 2011; 106 (3): 3806
  • Salman A, Yetisir F, Yürekli B, Aksoy M. The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospectiverandomized double-blind study. Local and Regional Anesthesia 2013:6 1-7
  • Bergmans E, Jacobs A, Desai R, Masters RD. Pain relief after transversus abdominis plane block for abdominal surgery in children: a service evaluation. Local and Regional Anesthesia 2015:8 1-6

AUTHOR

Carrió Font M, Cerrada Gómez T, Martín Pauls N, Tejada Ortega S, Hernando Sáez, J, Agulló Agulló J. Anaesthesia Service. San Juan de Alicante University Clinic Hospital