Comparison of Spinal Morphine and Transversus Abdominis Plane Block on Opioid Requirements After Caesarean Section: An Observational Study.

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Postoperative pain caused by laparoscopic cholecystectomy can be controlled by different methods. The study aimed to observe the efficacy of laparoscopic transversus abdominis plane (TAP) block in laparoscopic cholecystectomy and to analyze the cost-effectiveness of the procedure in comparison to the non-TAP method. In this double-blinded randomized clinical trial, the subjects who had come for cholecystectomy were randomly divided into two groups (n = 43 in each group). Group Areceived laparoscopy-guided subcostal TAP block bilaterally (0.25% bupivacaine, 20 ml each) along with parenteral analgesics (100 mg tramadol injection in 100 ml normal saline IV) SOSas rescue analgesia, and group Breceived parenteral analgesics (injection paracetamol 1 gm IV) eight hourly and injection tramadol 100 mg in 100 ml normal saline IV SOS as rescue analgesia. A bulge was visualized by the surgeon through a laparoscope as a signature view for confirming the placement of local anesthetic in TAP. Based on the Visual Analog Scale (VAS) for assessment of postoperative pain and the Numeric Rating Scale (NRS) for assessment of pain at 30 minutes, four hours, eight hours, 12 hours, and 24 hours postoperatively, patients of both groups were assessed. According to the VAS, the pain assessment was better in the TAP block group at 30 minutes post-surgery than in the non-TAP group. As a primary outcome, 37% of TAP block group cases were recovered without any rescue analgesia. VASscore revealed a significant difference in postoperative nausea and vomiting (PONV) among the TAP block and non-TAP groups. PONV at four hours, eight hours, and 12 hoursshowed significantly lesser incidences in the TAP group as compared to the non-TAP group (p-value: 0.015, 0.028, and 0.055, respectively). The cost-effectiveness of the TAP block method is 20 times lesser than the non-TAP method. Thus, a laparoscopic-guided TAP block could offer better postoperative analgesia at a low cost with a similar advantage to a USG-guided TAP block.

Context Cesarean section is one of the most commonly performed surgical procedures. Intrathecal morphine is a popular and effective option for pain management following cesarean section. It is associated with side effects such as nausea, vomiting, pruritus, urinary retention, reactivation of oral herpes, and, rare but life-threatening, respiratory depression. The interest in transversus abdominis plane (TAP) block as a post-cesarean-delivery analgesic modality has surged in the past few years, and many studies have evaluated and compared its efficacy with intrathecal morphine. Aim The aim of the study was to compare spinal morphine and bilateral TAP block in cesarean section in morbidly obese parturients with respect to their postoperative analgesic efficacy and narcotic consumption. Settings and design This was a prospective randomized, double-blinded study. Materials and methods Parturients, 20 years or older, with BMI greater than 35 kg/m 2 , who were scheduled to undergo elective cesarean section were recruited for the study. They were assigned to receive either intrathecal morphine (the ITM group) 0.1 mg or TAP block (the TAP group) using ropivacaine 0.5% 20 ml on each side. The primary outcome was pain on movement, from supine to sitting position. The secondary outcomes were the presence and severity of nausea and pruritus and the presence of respiratory depression. Results We enrolled 60 patients, of whom 59 were analyzed. The numeric rating scale score for pain was less in the ITM group than in the TAP block group, and this difference was statistically significant. Both pruritus and nausea happened in more patients in the ITM group than in the TAP block group, and this difference was statistically significant in both the 8 and 16 h observations. Conclusion In morbidly obese parturients, intrathecal morphine has superior post-cesarean-delivery analgesic efficacy compared with the TAP block.

Background: Patients after Cesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by cesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nervestimulator. The aim of this study was to evaluate the efficacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Cesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Cesarean Section from February to May, 2015. All patients operated under spinal anesthesia for cesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the first 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the first analgesic request. Result: There was reduction of VAS scores within the first 24 hours after cesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.00(0.00-11.50) vs 39.00(7.75-60.50), p=0.001, at 4 hours 0.00(0.00–12.75) vs 17.50(13.25-24.00), p=0.000, at 6 hours 9.00(1.50- 12.00) vs 22.00(14.75-45.00), p=0.000, at 12hours 13.00(11.00-16.00) vs 42.00(10.00-52.00), p=0.003, at 24 hours 10.00(8.00-12.00) vs 15.50(11.25- 26.00), p=0.013 respectively. The total analgesic Tramadol consumption within 24 hours was reduced in TAP block group, and time for the first analgesic request was significantly prolonged (286.00 vs 76.25, p=0.000) minutes. Conclusion: Bilateral TAP block provides lower postoperative severity of pain, reduced total postoperative Tramadol analgesics consumption and prolonged time for the first analgesic request after cesarean section under spinal anesthesia when it is used as multimodal analgesia. We recommend TAP block should be included as part of multimodal analgesia in the postoperative period for women after Cesarean Section delivery

Moderate-to-severe intensity pain is reported on the first day following lower abdominal surgery. No study has compared transversus abdominis plane (TAP) block with retrolaminar block (RLB) in laparoscopic inguinal hernia surgery for postoperative pain relief. In this prospective, randomized trial, 42 male patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, and having a BMI <40 kg/m2 received TAP or RLB following laparoscopic inguinal hernia surgery. A standard general anesthetic technique was performed. Patients were randomized into two groups: single-shot TAP block (group I) (n = 21) or the RLB (group II) (n = 21) with bilateral 20 ml of 0.375% ropivacaine. Postoperatively, IV paracetamol 1 g was administered as rescue analgesia. Postoperative cumulative Visual Analogue Scale (VAS) score 24 hours after surgery was considered as the primary outcome. Postoperative cumulative VAS score at rest at 24 h, represented as mean ± S.D (95% CI), in the TAP block group was 3.54 ± 3.04 (2.16-4.93) and in the RLB group was 6.09 ± 4.83 (3.89-8.29). P value was 0.112 and VAS on movement was 7.95 ± 3.41 (6.39-9.50 [2.5-15.0]) in TAP block group, whereas P value was 0.110 and VAS on movement was 10.83 ± 5.51 (8.32-13.34) in the RLB group. Similar postoperative cumulative pain score on movement at 24 h was present in patients receiving TAP block or RLB. However, VAS score at rest and on movement was reduced in patients receiving TAP block at 18 and 24 h postoperatively.

Transversus abdominis plane (TAP) catheters inserted under direct vision in the donor site following free DIEP and MS-TRAM breast reconstruction: A prospective cohort study of 45 patients

Acute postoperative pain after myomectomy can impair patient function. Like all other postoperative pain, it is a challenge requiring solution, particularly in developing countries. Ultrasound-guided transversus abdominis plane (TAP) block and wound infiltration (WI) are both known to be effective in managing postoperative pain. It is not certain if transversus abdominis plain block would be superior to wound infiltration. Aims: It was hypothesized that the TAP block has similar analgesic effectiveness to wound infiltration. This study was a randomized controlled trial involving, seventy-four (74) patients scheduled for myomectomy at the University of Benin Teaching Hospital Benin City, Nigeria under the subarachnoid block, which were randomized into TAP and WI group preoperatively. The ultrasound-guided bilateral TAP block group and wound infiltration group (subfascial and subcutaneous infiltration) each used 40 mL of 0.25% of plain bupivacaine to achieve postoperative analgesia. The time to first analgesic request, numerical pain rating scale (NRS) score at rest, and movement were assessed. Data were analyzed using SPSS version 16 (Chicago Il, USA). The time to first analgesic request was significantly delayed in the TAP block group compared to the wound infiltration group [240 (131, 375) min vs 170 (128, 187) minutes. P = 0.006]. The proportions of patients with NRS score ≤3 at the time of first analgesic requests were significantly more in the TAP block group (P < 0.001). The analgesic consumed by the TAP block group was significantly low compared to the WI group. There were no incidences of complications due to TAP block or wound infiltration. TAP block provided a longer duration of analgesia and a clinically superior quality of analgesia to wound infiltration.

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption.&#x0D; Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section.&#x0D; Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively.&#x0D; Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.&#x0D; Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

Transversus abdominis plane (TAP) block using a short-acting local anesthetic as part of multimodal analgesia is efficient in various abdominal surgeries, including laparoscopic surgery. However, information regarding its use in laparoscopic colorectal surgery is still limited and sometimes controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether TAP block using a short-acting anesthetic has a positive postoperative analgesic outcome in patients who have undergone laparoscopic colorectal surgery. We searched for studies comparing the postoperative pain outcome after laparoscopic colorectal surgery between patients who received TAP block and a control group (placebo or no treatment). Outcome measures were early pain at rest (numeric rating scale [NRS] score at 0-2h postoperatively), late pain at movement (NRS score at 24h postoperatively), late pain at rest (NRS score at 24h postoperatively), and postoperative opioid consumption (up to 24h postoperatively). We used a random-effects model for the meta-analysis and Egger's regression test to detect publication bias. We included six studies involving 452 patients (224 in the TAP block group, 228 in the control group). Early and late pain scores at movement were significantly different between the TAP block and control groups (standardized mean difference: - 0.695, P < 0.0001 for early pain and - 0.242, P = 0.029 for late pain). There was no significant difference between the TAP block and control groups in early pain at rest (P = 0.475), late pain at rest (P = 0.826), and postoperative opioid consumption (P = 0.257). The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early (0-2h) and late (24h) period at movement. However, it did not have a significant effect on the postoperative pain outcome in the early (0-2h) and late (24h) periods at rest after laparoscopic surgery.

Introduction: The surgical transversus abdominis plane (TAP) block is a novel approach for postoperative analgesia after abdominal surgeries. The block was given intraperitoneally during the intraoperative period. We evaluated its analgesic efficacy in patients during the first 48 h of the postoperative period after abdominal surgery, in a randomized, controlled, double-blind clinical trial. Materials and Methods: Thirty adult patients undergoing surgery requiring midline abdominal incision were randomized and divided into two groups. Group-T received TAP block with 20 ml of 0.5% bupivacaine intraperitoneally, and Group-P received TAP block with normal saline (placebo). Each patient was evaluated by a blinded investigator in the postanesthesia care unit and at 1, 2, 4, 6, 12, 24, 36, and 48 h. Results: Diclofenac consumption was almost reduced by 50% in TAP group in comparison to placebo group (mean diclofenac requirement of the TAP group vs. placebo group was 110 ± 25 mg and 225 ± 28 mg, respectively; P < 0.0001). Mean time to first request of analgesic was significantly prolonged in TAP block (210 min) as compared to placebo (90 min). Postoperative verbal analog scores at rest and at movement were significantly reduced in TAP block group from 4 to 24 h postoperatively as compared to placebo group. All TAP block patients were quite satisfied with the postoperative analgesic regimen. Conclusion: Postoperative analgesic consumption of diclofenac was almost reduced to half in TAP block group as compared to placebo group, and also, time to first request of analgesic was significantly prolonged in TAP block group. The surgical TAP block is a novel approach for providing postoperative analgesia which is easy to perform, safe and has no adverse effects.

Simple SummaryThe transversus abdominis plane (TAP) block is an anesthetic technique that involves the injection of a local anesthetic to block the branches of the thoracolumbar spinal nerves innervating the abdominal wall and peritoneum. TAP has gained popularity in abdominal procedures, such as ovariectomy, but its use in veterinary laparoscopy remains poorly described. Among the different approaches described for TAP performance, the two-injection-point TAP results in a larger blocked area; however, clinical data on its efficacy are lacking. Our hypothesis is that a two-injection-point TAP could reduce the dose of intraoperative inhalational anesthetic and postoperative pain in dogs undergoing laparoscopic ovariectomy (LapOV). A total of 52 bitches were enrolled and divided into two groups: 26 were assigned to inhalational anesthesia, and 26 were assigned to inhalational anesthesia combined with TAP block. The end-tidal concentration of isoflurane and postoperative pain were assessed at different time points. The combination of the TAP block with inhalational anesthesia for the LapOV significantly reduced the requirements of isoflurane during the ovarian resection. Bitches that received TAP showed lower postoperative pain and required less analgesia intra- and postoperatively. The two-injection-point TAP block is an easy and effective anesthetic technique to provide postoperative analgesia to dogs undergoing LapOV.The transversus abdominis plane (TAP) block causes desensitization of the abdominal wall and peritoneum. Of all the approaches proposed to perform it, the two-injection-point TAP showed the best results in terms of the area reached by the anesthetic solution. However, to date, no clinical data exist. The aim of this study was to evaluate the intra- and postoperative analgesic efficacy of a two-injection-point TAP block in dogs undergoing laparoscopic ovariectomy. A total of 26 animals were assigned to receive general inhalation anesthesia (control group), and 26 dogs were assigned to general inhalation anesthesia combined with TAP block (TAP group). The ultrasound-guided TAP block was carried out with a subcostal and cranial-to-ilium injection per hemiabdomen. The end-tidal concentration of isoflurane (EtISO) was recorded at different moments during the surgery. Postoperative pain was assessed at different time points during the first 24 h after surgery. The control group required significantly higher EtISO concentration during the ovarian resection and showed higher postoperative pain scores than the TAP group. Fewer dogs in the TAP group required intra- or postoperative rescue analgesia. TAP block can be implemented to improve postoperative pain management after laparoscopy, reducing the dosage of the systemic drugs used and, hence, their possible side effects.

Laparoscopic-assisted Transversus Abdominis Plane (TAP) Block in Patient Undergoing Laparoscopic Gynecologic Surgery: Randomized Controlled Trial

It is reported that following abdominal surgery, transversus abdominis plane (TAP) block can reduce postoperative pain. The primary outcome of this study was the evaluation of the efficacy of TAP block on pain intensity following cesarean delivery with Pfannenstiel incision. Fifty pregnant women were randomized blindly to receive either a TAP block with 15ml 0.25% bupivacaine in both sides (group T, n=25) or no blockade (group C, n=25) at the end of the surgery, which was performed with a Pfannenstiel incision under general anesthesia. The pain intensity in the patients was assessed by a blinded investigator at the time of discharge from recovery and at 6, 12, and 24h postoperatively, with a visual analogue scale (VAS) for pain. The women in the TAP block group had significantly lower VAS pain scores at rest and during coughing and consumed significantly less tramadol than the women in group C [50mg (0-150) vs. 250mg (0-400), P=0.001]. There was a significantly longer time to the first request for analgesic in the TAP block group [210min (0-300) vs. 30min (10-180) in group C, P=0.0001]. Two-sided TAP block with 0.25% bupivacaine in parturients who undergo cesarean section with a Pfannenstiel incision under general anesthesia can decrease postoperative pain and analgesic consumption. The time to the first analgesic rescue was longer in the parturients who received the TAP block.

Introduction:Transversus abdominis plane (TAP) block is a new regional analgesic technique for postoperative pain in abdominal surgery. Its efficacy is not clear, and thus it needs to be explored for its regular utilisation on prolonged period. The objective was to study the continuous local anaesthetic infusion effect on postoperative analgesia. Continuous use of TAP block as an analgesic technique has not been evaluated prospectively in clinical trials. This study evaluates the efficacy of ultrasound-guided TAP block in comparison with PCA fentanyl in major abdominal surgery.Materials and Methods:There were 20 patients in the study, allocated to TAP and control groups. The parameters measured were pain scores on a numerical rating scale (NRS) of 0-10 at various time intervals and the amount of fentanyl used as rescue analgesia. Patient satisfaction scores were recorded in the TAP block group and along with any complications related to the block.Results:The postoperative median pain scores on coughing on day one were 6.0 for control group and 2.0 for the TAP group (P = 0.02); on day two, the equivalent scores were 7.0 and 2.0 (P = 0.01). The fentanyl requirement at one hour was 203 μ for the control group and 78 μg for the TAP group (P = 0.03); at day one, the control and TAP requirements were 1237 μg and 664 μg respectively (P = 0.01). Three TAP patients rated their satisfaction as ‘excellent’, four as ‘satisfied, and two as ‘poor’.Conclusion:TAP block is a promising technique for postoperative analgesia in major abdominal surgeries. Our study demonstrated lower pain scores in the TAP group with reduced fentanyl requirement. Further, a large scale study is needed to establish the efficacy of TAP block in this setting.

The gold standard treatment for pain after cesarean delivery is subarachnoid morphine (SAM). Use of morphine, however, is associated with a number of adverse effects and with medical contraindications and logistic issues that limit its use. An effective alternative is ultrasound-guided transversus abdominis plane (TAP) block. This treatment method provides real-time imaging of the needle trajectory and injectate spread, and may improve both safety and nerve block effectiveness. SAM not only has a longer duration of effective pain relief as compared with TAP block, but also relieves abdominal wall-derived pain, and unlike TAP block, relieves visceral pain from the uterus. This prospective, randomized, double-blind study tested the hypothesis that SAM provides more prolonged and superior analgesia as compared with a TAP plane block in patients undergoing elective cesarean delivery. Patients were randomly assigned to receive treatment with SAM (n = 28) or TAP block (n = 29). Spinal anesthesia was initiated in SAM patients with bupivacaine combined with 0.2 mg morphine; TAP block patients received saline. At the end of surgery, bilateral TAP block was performed in SAM patients using 20 mL of saline or in TAP block patients using bupivacaine plus epinephrine with saline on each side. For the first 24 hours, postoperative analgesia was provided by rectal diclofenac and intravenous (IV) paracetamol; breakthrough pain was managed with IV tramadol. In the second 24 hours, patients received rectal diclofenac; oral paracetamol and IV tramadol were given upon patient request. Postoperatively, patients were evaluated in the postanesthesia care unit at 0 hours and at 2, 4, 6, 12, 24, 36, and 48 hours. The time to first analgesic request was longer in the SAM group compared with the TAP group (median [range] for SAM was 8 [2-36] hours vs. 4 [0.5 to 29] for TAP block; P = 0.005). Patents in the SAM group received a lower median number of tramadol doses between 0 and 12 hours (median [range] for SAM was 0 [0―1] vs. 0 [0-2] for the TAP block group; P = 0.03). In the first the 4 hours after surgery, visceral pain scores at rest and on movement were lower in the SAM group compared with the TAP group, but were not different at all other time points. Moderate to severe nausea occurred more frequently in the SAM group than in the TAP group (13/28 [46%] vs. 5/29 [17%], respectively; P = 0.02) and the frequency of pruritus requiring treatment was higher (SAM: 11/28 (39%) vs. TAP: none (0%) (P< 0.001). The investigators conclude from these findings that SAM as part of multimodal analgesia after cesarean delivery achieves superior pain relief than TAP block but is also associated with more adverse effects.