Preperitoneal bupivacaine instillation in addition to TAP block for pain control in laparoscopic inguinal hernia repair: a randomised controlled trial.

Abstract

<h4>Purpose</h4>Enhanced Recovery After Surgery (ERAS) protocols highlight the importance of effective perioperative pain management to facilitate early ambulation and discharge following laparoscopic inguinal hernia repair. While transversus abdominis plane (TAP) block provides effective analgesia, its duration is typically limited to 24 h. This study aimed to evaluate whether adding preperitoneal instillation of bupivacaine to TAP block improves early postoperative pain control.<h4>Methods</h4>This triple-blinded, randomised controlled trial included adult patients undergoing elective laparoscopic inguinal hernia repair at Vajira Hospital. All patients received a TAP block with 0.25% bupivacaine. After mesh placement, patients were randomised to receive either preperitoneal instillation of 10 mL normal saline (control group) or 10 mL of 0.25% bupivacaine (intervention group). Primary outcome was pain intensity (VAS score) at 6 and 24 h postoperatively. Secondary outcomes included operative time, estimated blood loss, postoperative complications, and length of hospital stay.<h4>Results</h4>Sixty patients were randomised (30 per group). The groups were comparable in baseline characteristics and surgical variables. The intervention group also had significantly lower VAS scores at 48 h (1.03 ± 1.12 vs 2.10 ± 1.36; p = 0.002). Functional recovery parameters and satisfaction scores were similar between groups. There were no significant differences in operative time, blood loss, or postoperative complications.<h4>Conclusion</h4>The addition of preperitoneal bupivacaine instillation to TAP block significantly improves early postoperative pain control after laparoscopic inguinal hernia repair without increasing complication rates. This simple and safe technique complements multimodal analgesia strategies and supports ERAS objectives in minimally invasive hernia surgery.