Dear Editor,
I read with immense interest the research article comparing the posterior transversus abdominis plane (pTAP) block versus the fascia transversalis plane block (TFP) in inguinal hernia repair.[1] I would like to congratulate the authors on their novel study and add a few points.
I agree that this study is the first to compare these two techniques in inguinal hernia repair procedures; however, it merits further discussion. Notably, a few studies compared pTAP with ilioinguinal nerve (IIN) and iliohypogastric nerve (IIH) blocks,[2,3] similar to this study.[1] The only difference is that these studies did not apply TFP block wherein the IIN and IIH nerves can be blocked proximally like in the current study,[1] instead, the IIN and IIH blocks were performed slightly distally.[2,3] Nevertheless, the blocks were performed under ultrasound guidance ensuring the identification of each nerve, and after assessing the sensory coverage of the blocks, patients with failed blocks were excluded in both of these studies.[2,3] Conversely, it is perplexing that the current study concluded that “both blocks were equally effective”, despite the dynamic pain scores, breakthrough pain incidence, and fentanyl consumption were significantly higher in the pTAP group.[1]
Additionally, in one of those studies, the genital branch of the genitofemoral nerve was also blocked in all patients intraoperatively.[2] This is also important as this nerve contributes to significant pain in this population.
Lastly, standardized general anesthesia is usually administered whenever the efficacy of regional techniques is compared to make the conclusions more accurate. The studies I have mentioned here also applied general anesthesia to all patients.[2,3] Otherwise, they are compared as a sole technique of surgical anesthesia in adult patients. Although it is also correct if a standardized regional technique is applied, the other regional techniques that are compared should preferably be applied at the end of the surgical procedure. However, in this study, the blocks were provided before the administration of spinal anesthesia. Moreover, the duration of spinal anesthesia of each patient using a standard dermatomal regression was not assessed in this study.[1] Considering the various factors that contribute to a significant variation in the duration of spinal anesthesia between the patients despite the same dose, this should have been taken into account.
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References
- 1.Priya V, Shamim R, Singh B, Singh S, Bais PS, Prasad G. Comparative evaluation of pre-emptive analgesic efficacy of posterior transversus abdominis plane block with fascia transversalis plane block in adult patients undergoing unilateral inguinal hernia repair: A prospective, randomized, single-blind, two-arm parallel study. Saudi J Anesth. 2024;18:211–7. doi: 10.4103/sja.sja_893_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 3.Elwany AF, Mohamed SA, EL-Fatah AMA, El-sayed NE, Samir GM. A comparative study between ultrasound-guided ilioingunial/iliohypogastric nerve block versus transverse abdominis plane block in patients undergoing oblique inguinal hernia repair. Ain-Shams J Anesthesiol. 2022;14:28. [Google Scholar]