Anesthesia and analgesia in surgery for anterior abdominal wall hernia: a review

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Ventral hernias, or anterior abdominal wall hernias, represent a relevant surgical problem. An important aspect of high-quality recovery of the patient after this surgical intervention is the appropriate selection of anesthetic management and effective pain control. A scientific data search was conducted in medical databases including PubMed, Google Scholar, the Cochrane Library, and eLibrary. This review analyzes data from clinical studies and meta-analyses addressing various anesthetic techniques used in surgery for anterior abdominal wall hernia repair. Particular attention is given to regional anesthesia, which is currently considered a highly promising method for providing effective and safe high-quality analgesia. Current studies demonstrate that the use of regional anesthesia reduces the risk of opioid-related complications and shortens hospital length of stay compared with epidural, spinal, and general anesthesia.

The most extensively studied regional anesthesia techniques include the erector spinae plane block and the transversus abdominis plane block. However, the choice of the optimal anesthetic method for ventral hernia repair remains a subject of debate. Further research is required to establish a gold standard in this field.

About the authors

Olga E. Romanova

The First Sechenov Moscow State Medical University

Author for correspondence.
Email: rom.olga21@yandex.ru
ORCID iD: 0000-0003-2898-1528
SPIN-code: 5963-7932
Russian Federation, Moscow

Anton A. Alekseev

The First Sechenov Moscow State Medical University

Email: aalekseev.aa@gmail.com
ORCID iD: 0009-0005-8598-7928
SPIN-code: 2536-1337
Russian Federation, Moscow

Anastasia A. Maksimova

The First Sechenov Moscow State Medical University

Email: am9165577382@yandex.ru
ORCID iD: 0009-0009-5260-6833
SPIN-code: 9576-9598
Russian Federation, Moscow

Andrey G. Yavorovskiy

The First Sechenov Moscow State Medical University

Email: yavorovskiy_a_g@staff.sechenov.ru
ORCID iD: 0000-0001-5103-0304
SPIN-code: 1343-9793

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

References

  1. Zatevahin II, Kirienko AI, Kubyshkin VA, editors. Abdominal Surgery. National Guidelines, Concise Edition. Moscow: GEOTAR-Media; 2016. (In Russ.) EDN: VYRYXP
  2. Kirienko AI, Nikishkov AS, Seliverstov EI, Andriyashkin AV. Epidemiology of abdominal wall hernias. Endosk Khirurgiya. 2016;22(4):55. doi: 10.17116/endoskop201622455-60 EDN: YGGJDL
  3. Elhadidi A, Shetiwy M, Al-Katary M. Comparative analysis of laparoscopic, retro-muscular, and open mesh repair techniques for ventral and incisional hernias: a comprehensive review and meta-analysis. Updat Surg. 2025;77(1):217–229. doi: 10.1007/s13304-024-02049-1 EDN: UBCGIW
  4. Holihan JL, Alawadi ZM, Harris JW, et al. Ventral hernia: Patient selection, treatment, and management. Curr Probl Surg. 2016;53(7):307–354. doi: 10.1067/j.cpsurg.2016.06.003
  5. Zhu S, Yang B, Wang Y. Visceral obesity is associated with incisional hernia in patients undergoing single-port laparoscopic gynecologic surgery. Asian J Surg. 2023;46(8):3203–3204. doi: 10.1016/j.asjsur.2023.02.118 EDN: AXBCBE
  6. Zhang Y, Zhou H, Chai Y, et al. Laparoscopic versus open incisional and ventral hernia repair: a systematic review and meta-analysis. World J Surg. 2014;38(9):2233–2240. doi: 10.1007/s00268-014-2578-z EDN: WOTQQJ
  7. Katawazai A, Wallin G, Sandblom G. Long-term reoperation rate following primary ventral hernia repair: a register-based study. Hernia. 2022;26(6):1551–1559. doi: 10.1007/s10029-022-02645-3 EDN: UWJXEU
  8. Bhardwaj P, Huayllani MT, Olson MA, Janis JE. Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors. JAMA Surg. 2024;159(6):651–658. doi: 10.1001/jamasurg.2024.0233 EDN: DPCTEL
  9. Nardi M, Millo P, Brachet Contul R, et al. Laparoscopic ventral hernia repair with composite mesh: Analysis of risk factors for recurrence in 185 patients with 5 years follow-up. Int J Surg Lond Engl. 2017;40:38–44. doi: 10.1016/j.ijsu.2017.02.016
  10. Fadhel MA. Laparoscopic ventral hernia repair: A surgeon’s insights into defect closure. Surg Pract Sci. 2025;21:100280. doi: 10.1016/j.sipas.2025.100280 EDN: ONHOVY
  11. LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg Laparosc Endosc. 1993;3(1):39–41.
  12. Almiron da R Soares G, de Oliveira Filho JR, Bregion PB, et al. Robotic vs Laparoscopic vs Open Ventral Hernia Repair: Insights from a Network Meta-Analysis of Randomized Clinical Trials. J Am Coll Surg. 2025;241(4):550–563. doi: 10.1097/XCS.0000000000001455 EDN: DNXNOU
  13. Sajid MS, Bokhari SA, Mallick AS, Cheek E, Baig MK. Laparoscopic versus open repair of incisional/ventral hernia: a meta-analysis. Am J Surg. 2009;197(1):64–72. doi: 10.1016/j.amjsurg.2007.12.051
  14. Lomanto D, Iyer SG, Shabbir A, Cheah WK. Laparoscopic versus open ventral hernia mesh repair: a prospective study. Surg Endosc. 2006;20(7):1030–1035. doi: 10.1007/s00464-005-0554-2 EDN: TOGBKI
  15. Rasador ACD, Balthazar da Silveira CA, Pereira NP, et al. Transversus abdominis plane (TAP) block for postoperative pain management after ventral hernia repair: an updated systematic review and meta-analysis. Hernia J Hernias Abdom Wall Surg. 2025;29(1):113. doi: 10.1007/s10029-025-03305-y EDN: TMEGRR
  16. Ovechkin AM, Efremenko IV. Postoperative analgesia: the role of drugs affecting the NMDA-receptor complex. Russian Journal of Pain. 2011;(1(30)):31–37. EDN: NTRBZJ
  17. Ali F, Wallin G, Wahlin RR, et al. Surgery for primary ventral hernias and risk of postoperative pain, nausea: a population-based register study. Hernia J Hernias Abdom Wall Surg. 2025;29(1):68. doi: 10.1007/s10029-025-03256-4 EDN: VCGEQX
  18. Ahn H, Chae YJ, Kang S, Yi IK. Postoperative nausea and vomiting and recovery of heart rate variability following general anesthesia with propofol or sevoflurane: a randomized, double-blind preliminary study. Front Med. 2025;12:1575865. doi: 10.3389/fmed.2025.1575865 EDN: CQPTGQ
  19. Jones MR, Brovman EY, Wagenaar AE, et al. Epidural Analgesia in Ventral Hernia Repair: An Analysis of 30-day Outcomes. Psychopharmacol Bull. 2020;50(4 Suppl 1):33–47. doi: 10.64719/pb.4380
  20. Shui M, Zhao D, Xue Z, Wu A. Impact of Spinal/Epidural Anesthesia Versus General Anesthesia on Perioperative Outcomes in Patients Undergoing Lumbar Spine Surgery: An Updated Systematic Review and Meta-analysis. Clin Spine Surg. 2023;36(6):227–236. doi: 10.1097/BSD.0000000000001374 EDN: DPKMCS
  21. Karamanos E, Dream S, Falvo A, Schmoekel N, Siddiqui A. Use of Epidural Analgesia as an Adjunct in Elective Abdominal Wall Reconstruction: A Review of 4983 Cases. Perm J. 2017;21:16–115. doi: 10.7812/TPP/16-115
  22. Morera Ocon FJ, Carcel I. Feasibility of spinal anesthesia in laparoscopic ventral hernia repair: is it worth it? Am J Surg. 2009;198(2):299–300. doi: 10.1016/j.amjsurg.2008.09.024
  23. Bejarano González-Serna D, Utrera A, Gallego JI, et al. Laparoscopic treatment of ventral hernia under spinal anesthesia. Cirugia Espanola. 2006;80(3):168–170. doi: 10.1016/s0009-739x(06)70946-0
  24. Symeonidis D, Baloyiannis I, Georgopoulou S, et al. Laparoscopic ventral hernia repair in obese patients under spinal anesthesia. Int J Surg Lond Engl. 2013;11(9):926–929. doi: 10.1016/j.ijsu.2013.07.002
  25. Germanò P, Siboni S, Milito P, et al. Ventral hernia repair under neuraxial anesthesia. Eur Surg ACA Acta Chir Austriaca. 2022;54(1):54–58. doi: 10.1007/s10353-021-00731-x EDN: XGEECW
  26. Janež J, Preskar J, Avguštin M, Štor Z. Surgical repair of a large ventral hernia under spinal anaesthesia: A case report. Ann Med Surg. 2019;40:31–33. doi: 10.1016/j.amsu.2019.03.005
  27. Makino Y, Miyake K, Roche D, et al. Ultrasound guidance versus anatomical landmarks for neuraxial anaesthesia in adults. Cochrane Database Syst Rev. 2025;5(5):CD014964. doi: 10.1002/14651858.CD014964.pub2
  28. Alekseev AA, Yavorovsky AG, Ovechkin AM, Useinov AV, Maksimova AA. The effectiveness of combined anesthesia compared to general anesthesia in thyroid and parathyroid surgery: a single-center prospective randomized study. Reg Anesth Acute Pain Manag. 2024;18(3):261–271. doi: 10.17816/RA633219 EDN: RZEFVL
  29. Ferguson S, Thomas V, Lewis I. The rectus sheath block in paediatric anaesthesia: new indications for an old technique? Paediatr Anaesth. 1996;6(6):463–466. doi: 10.1046/j.1460-9592.1996.d01-24.x
  30. Willschke H, Bösenberg A, Marhofer P, et al. Ultrasonography-guided rectus sheath block in paediatric anaesthesia-a new approach to an old technique. Br J Anaesth. 2006;97(2):244–249. doi: 10.1093/bja/ael143 EDN: IMMKJD
  31. Kartalov A, Jankulovski N, Kuzmanovska B, et al. The Effect of Rectus Sheath Block as a Supplement of General Anesthesia on Postoperative Analgesia in Adult Patient Undergoing Umbilical Hernia Repair. Pril Makedon Akad Na Nauk Umet Oddelenie Za Med Nauki. 2017;38(3):135–142. doi: 10.2478/prilozi-2018-0014
  32. Litz CN, Farach SM, Fernandez AM, et al. Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial. J Pediatr Surg. 2017;52(6):901–906. doi: 10.1016/j.jpedsurg.2017.03.007
  33. Wang Y, Li M, Wang Z, Liu W. Use of Bilateral Rectus Sheath Blocks in Open Umbilical Hernia Repair. Pain Physician. 2024;27(2):E239–E244. doi: 10.36076/ppj.2024.27.e239 EDN: KHLAZN
  34. Siddiqui N, Krishnan S, Dua A, Cascella M. Erector Spinae Plane Block [Internet]. Bethesda: StatPearls Publishing; 2025 [cited 2025 Jun 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK545305
  35. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia. 2017;72(4):452–460. doi: 10.1111/anae.13814
  36. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth. 2017;118(3):474–475. doi: 10.1093/bja/aex013
  37. Capuano P, Alongi A, Burgio G, Martucci G, Arcadipane A, Cortegiani A. Erector spinae plane block for cancer pain relief: a systematic review. J Anesth Analg Crit Care. 2024;4:76. doi: 10.1186/s44158-024-00213-y EDN: QCMJHO
  38. Marija T, Aleksandar D. Erector spinae plane block in various abdominal surgeries: A case series. Saudi J Anaesth. 2020;14(4):528–530. doi: 10.4103/sja.SJA_31_20 EDN: IVTMRU
  39. Sørenstua M, Ræder J, Vamnes JS, Leonardsen ACL. Evaluation of the Erector spinae plane block for postoperative analgesia in laparoscopic ventral hernia repair: a randomized placebo controlled trial. BMC Anesthesiol. 2024;24(1):192. doi: 10.1186/s12871-024-02566-x EDN: YEKTOA
  40. Belfar AL, Deng Y, Yu RC, Sabbagh A. Successful Use of Continuous Erector Spinae Plane Blocks in a Patient With Variant Angina After Large Ventral Hernia Repair. Tex Heart Inst J. 2022;49(6):e217624. doi: 10.14503/THIJ-21-7624 EDN: UBFHYE
  41. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Gümüş Demirbilek S. Erector Spinae Plane Block for anesthesia of open ventral hernia repair in severe Ankylosing Spondylitis. Agri Agri Algoloji Derneginin Yayin Organidir J Turk Soc Algol. 2021;33(3):194–196. doi: 10.14744/agri.2019.41033
  42. Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95(3):771–780. doi: 10.1097/00000542-200109000-00033
  43. Fang Y, Lu H, Yang J, He H, Rao S. Systematic Review and Meta-Analysis of Application of Ultrasound-Guided Thoracic Paravertebral Block in Clinical Surgical Treatment. Ann Ital Chir. 2024;95(6):1026–1047. doi: 10.62713/aic.3495
  44. Ben Aziz M, Mukhdomi J. Thoracic Paravertebral Block [Internet]. Bethesda: StatPearls Publishing; 2025 [cited 2025 Jun 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK570560
  45. Lekhak B, Bartley C, Conacher ID, Nouraei SM. Total spinal anaesthesia in association with insertion of a paravertebral catheter. Br J Anaesth. 2001;86(2):280–282. doi: 10.1093/bja/86.2.280 EDN: IMLGTN
  46. Renes SH, van Geffen GJ, Snoeren MM, Gielen MJ, Groen GJ. Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block. Reg Anesth Pain Med. 2011;36(2):198–201. doi: 10.1097/AAP.0b013e31820d424c
  47. Burlacu CL, Buggy DJ. Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia. Br J Anaesth. 2005;95(6):822–824. doi: 10.1093/bja/aei258 EDN: IMCDUJ
  48. Crawley SM. Coexisting harlequin and Horner syndromes after high thoracic paravertebral block. Br J Anaesth. 2006;96(4):537–538. doi: 10.1093/bja/ael039
  49. Ivanishcheva YuA, Zaytsev AYu, Kavochkin AA, et al. Modern approaches to choosing the method of regional anesthesia during video-assisted thoracoscopic surgery. Messenger of anesthesiology and resuscitation. 2024;21(4):32–42. doi: 10.24884/2078-5658-2024-21-4-32-42 EDN: EDUGPY
  50. Abou Zeid HA, Al-Ghamdi AMA, Abdel-Hadi MSA, et al. Bilateral paravertebral block in advanced schistosomal liver disease: a prospective study. Saudi J Gastroenterol Off J Saudi Gastroenterol Assoc. 2004;10(2):67–77.
  51. Naja Z, Ziade MF, Lönnqvist PA. Bilateral paravertebral somatic nerve block for ventral hernia repair. Eur J Anaesthesiol. 2002;19(3):197–202. doi: 10.1017/s0265021502000352
  52. Rafi AN. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia. 2001;56(10):1024–1026. doi: 10.1046/j.1365-2044.2001.02279-40.x EDN: BAWVIR
  53. O’Donnell BD, McDonnell JG, McShane AJ. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med. 2006;31(1):91. doi: 10.1016/j.rapm.2005.10.006
  54. Hebbard P, Fujiwara Y, Shibata Y, Royse C. Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care. 2007;35(4):616–617.
  55. Lee THW, Barrington MJ, Tran TMN, Wong D, Hebbard PD. Comparison of extent of sensory block following posterior and subcostal approaches to ultrasound-guided transversus abdominis plane block. Anaesth Intensive Care. 2010;38(3):452–460. doi: 10.1177/0310057X1003800307
  56. Bespalov EK, Novikov DI, Zaitsev AYu, Svetlov VA, Evstropova AA. Factors influencing the spread of local anesthetic during the transverse abdominal plane block (study on unfixed corpses). Messenger of anesthesiology and resuscitation. 2023;20(6):6–11. doi: 10.24884/2078-5658-2023-20-6-6-11 EDN: WJMGFQ
  57. Mavarez AC, Hendrix JM, Ahmed AA. Transabdominal Plane Block [Internet]. Betthesda: StatPearls Publishing; 2025 [cited 2025 Jun 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560527
  58. Tsai HC, Yoshida T, Chuang TY, et al. Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques. BioMed Res Int. 2017;2017:8284363. doi: 10.1155/2017/8284363
  59. Fields AC, Gonzalez DO, Chin EH, et al. Laparoscopic-Assisted Transversus Abdominis Plane Block for Postoperative Pain Control in Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial. J Am Coll Surg. 2015;221(2):462–469. doi: 10.1016/j.jamcollsurg.2015.04.007
  60. Nalankilli VP, Christopher PJ, Motati H, et al. A randomized controlled trial on the effectiveness of laparoscopic-guided transversus abdominis plane block in patients undergoing laparoscopic IPOM plus. Hernia J Hernias Abdom Wall Surg. 2024;28(4):1257–1263. doi: 10.1007/s10029-024-03016-w EDN: PPFBHD
  61. Skoczek AC, Ruane PW, Rasarmos AP, Fernandez DL. Effects of Novel Multimodal Transversus Abdominis Plane Block on Postoperative Opioid Usage and Hospital Length of Stay Following Elective Ventral Hernia Repair. Cureus. 2023;15(5):e38603. doi: 10.7759/cureus.38603 EDN: ZPFKEK
  62. Shao JM, Deerenberg EB, Prasad T, et al. Adoption of enhanced recovery after surgery and intraoperative transverse abdominis plane block decreases opioid use and length of stay in very large open ventral hernia repairs. Am J Surg. 2021;222(4):806–812. doi: 10.1016/j.amjsurg.2021.02.025 EDN: JTGZFA
  63. Warren JA, Carbonell AM, Jones LK, et al. Length of Stay and Opioid Dose Requirement with Transversus Abdominis Plane Block vs Epidural Analgesia for Ventral Hernia Repair. J Am Coll Surg. 2019;228(4):680–686. doi: 10.1016/j.jamcollsurg.2018.12.017 EDN: FKOOIN
  64. Petcka NL, Alter-Troilo K, Hetzel E, et al. Transversus abdominis plane blocks for complex abdominal wall reconstruction decrease hospital length of stay compared to epidurals. Surg Endosc. 2022;36(10):7722–7730. doi: 10.1007/s00464-022-09095-z EDN: CNXWNH
  65. Morrell DJ, Doble JA, Hendriksen BS, et al. Comparative effectiveness of surgeon-performed transversus abdominis plane blocks and epidural catheters following open hernia repair with transversus abdominis release. Hernia J Hernias Abdom Wall Surg. 2021;25(6):1611–1620. doi: 10.1007/s10029-021-02454-0 EDN: FHJJNW
  66. Licari L, Viola S, Salamone G. TAP Block Prior to Open Ventral Hernia Repair Improves Surgical Outcome. World J Surg. 2022;46(6):1383–1388. doi: 10.1007/s00268-022-06508-x EDN: QAEQEU
  67. Hebbard PD. Transversalis fascia plane block, a novel ultrasound-guided abdominal wall nerve block. Can J Anaesth J Can Anesth. 2009;56(8):618–620. doi: 10.1007/s12630-009-9110-1 EDN: UYJPNZ
  68. İrban H, Aksu C. Comparison of the effectiveness of transversalis fascia plane block and transversus abdominis plane block for postoperative analgesia in pediatric lower abdominal surgeries: prospective, single blinded study. BMC Anesthesiol. 2025;25(1):154. doi: 10.1186/s12871-025-03023-z EDN: DNUFJY
  69. Ueshima H, Otake H, Lin JA. Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques. BioMed Res Int. 2017;2017:2752876. doi: 10.1155/2017/2752876
  70. Tesarz J, Hoheisel U, Wiedenhöfer B, Mense S. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience. 2011;194:302–308. doi: 10.1016/j.neuroscience.2011.07.066

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2025 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).