Tension-free inguinal hernia repair with transversus abdominis plane (TAP) block in elderly high-risk patients

Inguinal hernia repair is still being studied today because it is one of the most commonly performed surgical procedures in the world and is used in people of all ages. Although many centers use spinal anesthetic to treat inguinal hernias, complications such as hypotension from peripheral vasodilation, delayed mobilization from paralysis, urine retention and post-spinal headache might occur. Regional blocks are a significant component of multimodal anaesthesia that promotes postoperative recovery. Transversus abdominis plane (TAP) block is a regional anesthetic block technique that is effective on the parietal peritoneum, skin, and anterior abdominal wall.

This study aimed to show that TAP block administration may be done safely without the use of an extra anesthetic treatment, especially in older patients who may experience complications from general or spinal anesthesia. Without either general, spinal or epidural anesthetic, we conducted a tension-free - Lichtenstein - inguinal hernia repair operation with only TAP block application. This retrospective case-control study received ethics committee approval (decision number 21-5T/108). Between September and December 2019, patients who underwent elective Lichtenstein hernia repair in our clinic were evaluated retrospectively.

We think that inguinal hernia repair can be safely performed with only TAP block and that TAP block application has fewer anaesthesia-related complications such as postspinal headache and urinary retention compared with spinal anaesthesia, and that it can be used as an alternative to spinal anaesthesia in patients who cannot tolerate general anaesthesia.

Even hernia surgery can be very challenging in patients with advanced age and comorbidities. We wanted to show the feasibility of the TAP block method as an alternative to anaesthesia in such patients.