Optimising Postoperative Pain in Laparoscopic Incisional Hernia Repair: Analgesic Insights from the TACKoMesh Randomised Trial

Postoperative pain remains a significant challenge following laparoscopic intraperitoneal onlay mesh with primary fascial closure (IPOM+) repair, with important implications for early mobilisation, functional recovery, and patient satisfaction. The TACKoMesh randomised controlled trial compared absorbable and non-absorbable tack fixation under a rigorously standardised multimodal analgesic protocol incorporating routine laparoscopic transversus abdominis plane (TAP) blocks. Although no difference was observed in pain on activity at 30 days between fixation methods, the trial provides valuable insight into early postoperative pain trajectories when anaesthetic variability is controlled. Procedure-specific evidence supports the role of TAP block in reducing early postoperative pain after laparoscopic ventral and incisional hernia repair, with effects that appear time-limited and converge as recovery progresses. This narrative review summarises the analgesic insights arising from TACKoMesh, examines the contribution of intra-operative regional analgesia to postoperative pain modulation in IPOM+ repair, and considers the implications for optimising perioperative pain management and the design of future pain-focused surgical trials.