Experience in using a TAP block during TAPP surgery for inguinal hernia in a short-stay hospital setting

Background. Modern surgery strives to minimize invasiveness and reduce hospital stays, which is particularly relevant for laparoscopic procedures, including transabdominal preperitoneal (TAPP) hernioplasty. However, despite the minimally invasive nature of the method, patients often experience significant pain at the trocar insertion sites, which can slow recovery and impair quality of life in the early postoperative period. In this regard, the search for effective analgesia methods to reduce discomfort and accelerate rehabilitation remains an important task. One promising approach is the transverse abdominis plane (TAP) block, which has proven effective in other areas of abdominal surgery but has not yet been widely adopted for TAPP. Objective. To evaluate the clinical efficacy of the TAP block in managing postoperative pain, the need for analgesics, and the quality of life of patients after laparoscopic TAPP in a short-stay hospital setting. Material and methods. The study included patients who underwent TAPP repair for inguinal hernia in the short-stay hospital (SSH) of the S.P. Botkin Moscow Clinical Scientific and Practical Center from 2021 to 2024. The main group (n=47) received an intraoperative interfascial TAP block, while the control group (n=50) received standard analgesia without regional anesthesia. The groups were comparable in age, gender, comorbidities, and the nature of the hernia defect. Assessment criteria included: pain intensity (on the visual analogue scale — VAS) at 2 hours, 1st, 2nd, and 8—9 days postoperatively; the need for opioid analgesics and muscle relaxants in the early postoperative period; quality of life (SF-36 questionnaire) before surgery, on days 8—9, and after 1 month; operative time; and the frequency of intra- and postoperative complications. Results. The use of the TAP block facilitated early mobilization of patients and significantly reduced pain in the first 48 hours in the study groups: group 1 — 3 points, group 2 — 5 points (p<0.05), which makes it possible to reduce the use of opioids to 38.6 and 55 mcg, respectively (p<0.05); and muscle relaxants to 23.000 and 36.000 mcg (p<0.05). Patients in the main group reported a higher quality of life on the 8th–9th day compared to the control group. At the same time, the duration of the operation (66 and 68 minutes; p>0.05) and the incidence of complications did not differ between the groups. Conclusion. The TAP block is an effective and safe method of analgesia for laparoscopic TAPP, providing: reduced postoperative pain at trocar access sites; minimized need for opioids, thereby reducing the risk of side effects; improved early rehabilitation and patient quality of life; and optimized conditions for treatment in an SSH due to shorter recovery times. Thus, integrating the TAP block into the anesthesia protocol for TAPP can be recommended for widespread adoption in clinical practice, especially in short-stay hospital settings.