Comparison the Analgesic Efficacy of Ultrasonographic Bilateral TAP and Anesthetic Infiltration Into the Surgery Field for Laparoscopic Unilateral TEP Herniorrhaphy

In laparoscopic hernia repairs, patients are positioned supine, and the surgical area is cleansed with povidone iodine and covered with sterile green drapes. A 1-centimeter incision will be made 1 centimeter below the umbilical border. A 10-mm trocar will be inserted into the preperitoneal space. The operation was filmed from the front with a 30-degree camera. After observing the preperitoneal space, two five-mm working trocars will be placed midline, two and six centimeters inferior to the symphysis pubis. Next, the cord structures and Cooper ligament will be exposed and the hernia sac freed from surrounding anatomical structures.Prolene mesh will be spread over the preperitoneal area to cover all hernia defects and secured to the Cooper ligament and abdominal wall with an absorbable fixation device. Group 1 patients undergo desufflation via 50 mg of bupivacaine into the preperitoneal space, followed by 10 mg of bupivacaine into each trocar incision and skin closure with sutures.

After the surgery, the anesthesiologist will use a TAP block under ultrasound guidance. Before the patient wakes up, the Hitachi ultrasound probe will be sterilized and positioned between the iliac wing and the costae. An ultrasound shows the skin, fat beneath it, the six abdominal muscle layers, and a support muscle.A thin needle goes through the skin from one side to the other to reach the muscle layers. The location of the block is confirmed by injecting 1-2 ml of 0.09% NaCl followed by negative aspiration. Patients receive 15-20 ml (40-50 mg per quadrant) of bupivacaine 0.5% concentration in a controlled manner with negative aspiration every 5 ml. The block is performed bilaterally.