Approximately 200 patients in the study will be randomized to one of two arms: TAP block
with Exparel or TAP block with bupivacaine. Randomization will be performed using a
permuted block randomization algorithm (Ex. AABBABABABBABBAA, where A=Exparel group and
B=Bupivacaine group). Only the participant will be blinded to the arm assignment as the
knowledge of the assignment for the surgeon and anesthesiologist is needed. The bilateral
TAP block will be performed by the department of anesthesia under ultrasound guidance
using 20cc of local anesthetic per side. Additional local anesthetic will be supplied by
the surgeon at the incision sites. Both of these anesthetics being evaluated and the
dosage are commonly administered as standard of care (SOC). The choice of anesthetic used
is up to the discretion of the surgeon in most instances. The patients will be blinded to
which local anesthetic they receive. Operative technique will be standardized amongst all
participating surgeons.
All patients with ventral hernias will undergo an IPOM+ technique detailed by primary
closure of the defect in addition to circumferential mesh fixation with a running suture.
Three or four trochars will be used ranging from 5-12mm in size. Mesh selection will be
at the discretion of the surgeon with a minimum of 5cm overlap of the original defect in
all directions. Defect size will be measured intraoperatively with a ruler
intra-abdominally.
All patients with an inguinal hernia will undergo a transabdominal preperitoneal hernia
repair with mesh placement. Three or four trochars ranging from 5-12mm will be used. Size
of mesh and fixation of mesh at one or two points will be at the surgeon's discretion.
The length of surgery will be recorded.
The patients will be given a packet of VAS pain assessments to take home with pre-marked
time intervals to fill out at 2h, 6h, and 12h post operatively as well as every 12 hours
thereafter. The patients will also be asked to record how many narcotic medications they
will be consuming on a daily basis. Our team will contact patients daily to collect the
data verbally which will also serve as a reminder to patients to complete this task
faithfully. Each patient will follow up at one week and provide the surgeons with the
packet of VAS assessments as well as bring in any excess narcotics that they did not
consume. Each patient will also be told to take tylenol 500mg every 6 hours for the first
96 hours and to record whether they take any additional alternative pain medications
(NSAIDs, muscle relaxants, gabapentinoids). Upon discharge, patients will be prescribed
15 pills of 5mg hydrocodone-325mg acetaminophen to be taken every 6 hours as needed for
severe pain.
Data collection will include demographics of the patients including age, sex, ASA status,
height/weight, BMI, preoperative pain level and previous abdominal surgeries.
Intraoperative variables will include defect size, ventral vs. inguinal, number of
trochar, mesh size and type, operative time. Postoperative collection will include pain
scores as outlined above and narcotic use. Data analysis will include differences, if
any, in post operative pain scores as well as narcotic use. This will be stratified to
the inguinal hernia group vs. ventral hernias and the ventral hernia group will be
stratified to size of defect and length of surgery.
