Endoscopic vs. percutaneous inguinal field block [IFB] for postoperative pain control after total extra-peritoneal [TEP] inguinal hernioplasty

Despite the proven merits of using inguinal field block in open hernia repair, there is little data examining its use in laparoscopic hernioplasty. Interestingly, complete field block can be approached endoscopically with minimal hazards. The objective of this prospective randomized study is to compare the outcome of two different approaches of inguinal field block [IFB] for postoperative pain control following endoscopic total extra-peritoneal laparoscopic [TEP] inguinal hernioplasty. Between January 2001 and December 2003, a total of 77 male patients attending Dhahran Health Center, underwent unilateral endoscopic TEP hernioplasties, were randomized to receive either preoperative percutaneous IFB [group A, n = 38] or intraopertive endoscopic IFB [group B, n = 39]: using 50 mls of levobupivacaine [0.25%]. Postoperative pain was assessed by visual analogue score on a scale from 0 to 6. The intraopertive anesthetic requirements, time from end of surgery till extubation, postoperative narcotic analgesia requirement; length of hospital stay and return to full activity were compared among the two groups. Comparison between the two groups showed that patients in group A had significantly less requirements of intraoperative [Fentanyl, analgesia 65.2 +/- 16.8 [micro g] and shorter recovemy time 7.3 +/- 1.7 [min] than patients in group B [98.4 +/- 27.9 [micro g and 8.4 +/- 2.l [min]]. Postoperative pain scores were slightly higher in group A in the first 4-6 hours [p = NS]. Postoperative IV morphine requirement was significantly higher in the first 12 hours [Day surgery cases] in group A [13.2 +/- 3 mg] than in group B [9.2 +/- 2.5 mg]. This difference was not significant among patients hospitalized within the next 24 hours. Almost one third of the patients were able to go home on same day of surgery [11 in group A and 15 in group B, p= NS] Inguinal field block for TEP hernioplasty provides merits for the patients regarding the postoperative pain control and short hospital stay. However, endoscopic IFB was shown to have better control of postoperative pain than the percutaneous IFB during the first 12 hours