Transversalis fascia plane block effective analgesic option for patients after varicocelectomy surgery

"Our findings showed that TFBP block decreases the non-steroid analgesic requirement, pain score and rescue analgesia consumption compared to local anaesthetic infiltration of the surgical site," the researchers wrote in their study. According to the authors, the study is the first to evaluate the TFBP block's effectiveness for postoperative analgesia after varicocelectomy surgery.

Varicocele occurs due to dilating the pampiniform plexus in the spermatic veins and is seen in 15–20% of post-pubertal men. It is one of the most frequent causes of primary infertility. Still, its presence is also a significant finding of other pathologies, including renal cell carcinoma that causes renal vein thrombosis, inferior vena cava (IVC) thrombus, and obstruction of the IVC. Most patients with a varicocele do not need surgery, although a sizable percentage do.

Against the above background, Erkan Cem Celik from Ataturk University School of Medicine in Erzurum, Turkey, and colleagues aimed to evaluate the effect of Transversalis Fascia Plane Block on pain scores during the postoperative period in patients undergoing varicocelectomy surgery. Their secondary aim was to assess the impact of TFPB on analgesic consumption.

For this purpose, the researchers initiated the study following approval from the local ethics committee. It included sixty ASA (American Society of Anesthesiology) class I-II patients > 18y scheduled to undergo varicocelectomy and who consented to participation. Before the procedure, the patients were randomly allocated to Group TFPB or the surgical incision site infiltration group (Group I).

All surgeries were done under general anaesthesia and microsurgery using the subinguinal approach. TFPB and local infiltration blocks were applied following surgical suturing before anaesthesia termination. For each block, the researchers utilized 20 mL of 0.25% bupivacaine. Patient data were recorded; passive and active VAS ratings after surgery, demographic information, use of non-steroidal anti-inflammatory medications, and the need for rescue analgesia.

The authors reported the following findings:

· The researchers included a total of 60 patients in the study. Concerning demographic data, no difference was seen between the groups.

· There was a statistically significant decrease at all hours in favour of Group TFPB regarding non-steroidal anti-inflammatory analgesic use, active and passive VAS scores, and tramadol requirement.

"Our findings revealed that TFPB leads to more effective analgesia versus surgical site infiltration, which is safer and available in patients undergoing varicocelectomy surgery and may be an important component of multimodal analgesia in these patients," the authors conclude.

Reference:

Celik, E.C., Ozbey, I., Aydin, M.E. et al. Efficacy of transversalis fascia plane block as a novel ındication for varicocelectomy surgery: prospective randomized controlled study. BMC Anesthesiol 23, 48 (2023). https://doi.org/10.1186/s12871-023-02009-z