Discussion
hernia, nerve injuries, pain, decreases pain, somatic innervation
INFILTRATION, CREST, COMPLICATION, PNEUMOTHORAX
To the best of our knowledge, this is the first study to evaluate the effectiveness of TFBP block for postoperative analgesia after varicocelectomy surgery. Our study has shown that when compared to local anesthetic infiltration of the surgical site, TFBP block decreases pain scores, non-steroid analgesic requirement and rescue analgesia consumption.Subinguinal incisions are often preferred in microsurgical varicocelectomy because the spermatic cord is more superficial and the anatomy is simpler. As a result, there is far less dissection, manipulation, and pain. This leads to less discomfort, less need for analgesics and earlier mobilization. As a result, microsurgical varicocelectomy with accelerated recovery after surgery (ERAS) is performed on a regular basis in our clinic. Furthermore, as effective postoperative analgesia is essential for ERAS, TFPB is commonly used in patients undergoing varicocelectomy in our clinic, as part of multimodal analgesia.The somatic innervation of the subinguinal incision used in varicocelectomy surgery is through the subcostal nerve (T12-L1), ilioinguinal nerve (L1) and the iliohypogastric nerve (T12-L1) [When the abdominal muscles are evaluated, the rectus muscles are near the linea alba. Traveling to the lateral part of the abdomen, there are three muscles: superficial to deep, the external oblique, internal oblique, and transversus abdominis muscles. TAP block is performed between the internal oblique and transversus abdominis muscles. This interfascial area is vast compared with the perirenal fat tissue compartment. The transversalis fascia is a thin fibrous membrane structure located behind the transversus abdominis muscle that limits perirenal fat tissue. The TFPB can be used to block the subcostal, ilioinguinal, and iliohypogastric nerves while they are running through the perirenal adipose tissue [TFBP was first reported in inguinal hernia surgery, appendectomy and in bone harvesting from the iliac crest. Thereafter, TFPB applications were reported for similar surgeries where somatic innervation was also from T12 and L1. TFBP application was compared to spinal anesthesia for postoperative analgesia in cesarean section and those undergoing TFBP were found to have lower morphine consumption [Increased success and decreased complication rates, such as unintended vascular access, pneumothorax, nerve injuries, etc., have been observed with peripheral nerve blocks performed under ultrasound guidance. Especially in cases where neurostimulation cannot be used, such as plane blocks, ultrasound can further increase the success of the block.This study has some limitations. Firstly; TFPB block was administered during general anesthesia after the end of surgery. Dermatomal analysis were not evaluated after surgical procedure. Secondly, the VAS scoring system was used to assess the patients' pain levels. Although the evaluation is done by a single author, individual variability in pain reactions in visual evaluation should be considered [To conclude, this study has demonstrated that when compared to surgical site infiltration, which is safer and available, TFPB leads to more effective analgesia in patients undergoing varicocelectomy surgery and may be an important part of multimodal analgesia in these patients.