Effect of intraoperative crural block on first-day postoperative pain after laparoscopic hiatal hernia repair: a two-center retrospective study

Hernia. 2026 May 20;30(1):222. doi: 10.1007/s10029-026-03722-7.

ABSTRACT

Hiatal hernia repair is one of the most commonly performed surgical procedures for the treatment of gastroesophageal reflux disease (GERD), yet postoperative pain remains a clinically relevant issue despite the widespread adoption of minimally invasive techniques. Dissection and suturing of the diaphragmatic crura may contribute significantly to early postoperative discomfort, and intraoperative local anesthetic infiltration of the crura under direct visualization has been proposed as a simple pain-modulating strategy. In this retrospective two-center study, 196 patients who underwent laparoscopic hiatal hernia repair between 2023 and 2025 were divided into two groups according to whether intraoperative crural infiltration with bupivacaine was performed. Postoperative pain during the first postoperative day was assessed using a visual analog scale (VAS; 0-10), and postoperative analgesic consumption was compared between groups. Patients who received intraoperative bupivacaine infiltration demonstrated significantly lower postoperative pain scores and reduced analgesic requirements compared with the control group, with statistical analysis performed using SPSS software revealing a significant difference between the groups (p < 0.001). These findings suggest that intraoperative bupivacaine infiltration of the diaphragmatic crura is a safe, simple, and effective adjunct technique for reducing early postoperative pain following laparoscopic hiatal hernia repair.

PMID:42159814 | DOI:10.1007/s10029-026-03722-7