Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach.

INTRODUCTION: A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure. MATERIAL AND SURGICAL TECHNIQUE: An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications. DISCUSSION: This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required.

[Postoperative palsies of the common peroneal nerve and the tibial nerve associated with lateral position].

A 36-year-old woman with systemic lupus erythematous secondary to diabetes underwent right total hip arthroplasty in the left lateral position. An epidural catheter was inserted at the L1-2 interspace and placed cephalad prior to induction of general anesthesia. After the operation, she complained of numbness on the dorsum and plantar of the left foot and was unable to dorsiflex and plantarflex the ankle. The symptoms persisted after discontinuation of the epidural infusion of a local anesthetic, and they became exacerbated after the second operation in the left lateral position. Electromyography and nerve conduction study revealed palsies of the left common peroneal nerve and the tibial nerve due to local compression and also showed mononeuritis multiplex. Fortunately, the symptoms disappeared completely eight months post-operation. It should be noted that lateral positioning may be at a substantial risk of perioperative peripheral neuropathy in patients with diseases causing neural disorder.