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.