Comparison of the Effect of Adding Dexmedetomidine Versus Dexamethasone to Bupivacaine in Transverse Abdominis Plane Block on Postoperative Pain Intensity in Patients Undergoing Laparoscopic Cholecystectomy.

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

Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period. Recent randomized trials have demonstrated the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia after abdominal surgery. We hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours, opioid consumption, and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery. In this randomized, double-blind study, 80 patients undergoing laparoscopic cholecystectomy in our day-case surgery unit were allocated to receive either bilateral ultrasound-guided posterior TAP blocks (20 mL 0.5% ropivacaine) or placebo blocks. Postoperative pain treatment consisted of oral acetaminophen 1000 mg × 4, oral ibuprofen 400 mg × 3, IV morphine (0-2 hours postoperatively), and oral ketobemidone (2-24 hours postoperatively). The primary outcome was postoperative pain scores while coughing calculated as area under the curve for the first 24 postoperative hours (AUC/24 h). Secondary outcomes were pain scores at rest (AUC/24 h), opioid consumption, and side effects. Patients were assessed 0, 2, 4, 6, 8, and 24 hours postoperatively. Group-wise comparisons of visual analog scale (VAS) pain (AUC/24 h) were performed with the 2-sample t test. Morphine and ketobemidone consumption were compared with the Mann-Whitney test for unpaired data. Categorical data were analyzed using the χ(2) test. The primary outcome variable, VAS pain scores while coughing (AUC/24 h), was significantly reduced in the TAP versus the placebo group (P = 0.04); group TAP: 26 mm (SD 13) (weighted average level) versus group placebo: 34 (18) (95% confidence interval): 0.5-15 mm). VAS pain scores at rest (AUC/24 h) showed no significant difference between groups. Median morphine consumption (0-2 hours postoperatively) was 7.5 mg (interquartile range: 5-10 mg) in the placebo group compared with 5 mg (interquartile range: 0-5 mg) in the TAP group (P < 0.001). The odds ratio of a random patient in group TAP having less morphine consumption than a random patient in group placebo was P (group TAP < group placebo) = 0.26 (confidence interval: 0.15, 0.37) where 0.5 represents no difference between groups. There were no between-group differences in total ketobemidone consumption, levels of nausea and sedation, number of patients vomiting, or consumption of ondansetron. TAP block after laparoscopic cholecystectomy may have some beneficial effect in reducing pain while coughing and on opioid requirements, but this effect is probably rather small.

The transversus abdominis plane block: Case for optimal tap

Annotation. Acute postoperative pain is still a common unresolved health-care challenge even in highly developed countries. Insufficient postoperative pain control is associated not only with patients’ sufferings but also with increased incidence of complications (cardiovascular, thromboembolic, infectious, etc.), the development of chronic postoperative pain, delayed ambulation and discharge. Perioperative anesthesia is currently one of the main concerns in abdominal surgery. According to literature data, regional analgesia methods are widely used for anesthesia in perioperative period. Transversus abdominis plane (TAP) block proved to be a reliable regional technique of postoperative multimodal analgesia for anterior abdominal wall pain. Nowadays, ultrasound-guided TAP block techniques are considered to be a gold standard in many surgeries on anterolateral abdominal wall, producing consistent analgesia and having good safety profile. However, the quality of analgesia provided by TAP blocks under ultrasound guidance is different being influenced by the approach used. The choice between the variants of TAP block technique depends on the targeted region and the duration of nerve blockage. To date, the analgesic effect of anterior lateral abdominal wall blocks during laparoscopic cholecystectomy has not been sufficiently studied. The article provides the review of the latest advances in TAP block techniques as well as its standardized nomenclature, and suggests directions for future research. The aim was to analyze and substantiate the possibility of using regional anesthesia methods of the anterior abdominal wall by implementing the TAP-block type in the perioperative period during laparoscopic cholecystectomy. We have analyzed the current information and used the PubMed database. We have also analyzed the advantages of interstitial local anesthetic (TAP block), which primarily provides better control of pain in the anterior abdominal wall, and reduces the need for opiate and non-narcotic analgesics, the prescription of which may cause several side effects. There are many methods of the TAP-block, which to some extent depend on the pain localization in the anterior abdominal wall. For laparoscopic cholecystectomy, the most anatomically and theoretically justified is the oblique subcostal Tap-block. The use of regional techniques in laparoscopic cholecystectomy, namely the TAP-block, strategically fits into the concept of the accelerated recovery ERAS protocol, one of the purposes of which serves adequate control over the post-operative pain and early recovery.

Effectiveness of transversus abdominis plane block during robotic-assisted endometrial cancer staging in decreasing immediate postoperative pain (557)

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.

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.

Ultrasound-guided versus laparoscopic-guided subcostal transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; a randomized double-blind controlled trial

Background: The main contributor to the pain experienced after abdominal surgery is pain from the incision made in the abdominal wall. The Transversus Abdominis Plane (TAP) block is a peripheral nerve block to the nerves supplying the anterior abdominal wall (T6 to L1). The aim of this study was to evaluate the effect of dexmedetomidine as an adjuvant in ultrasound guided TAP block on post-operative analgesia and morphine consumption in patients undergoing major abdominal or pelvic surgeries.Methods: Seventy five patients were randomly enrolled in the study; patients were divided into 3 groups: Bupivacaine group (group TAP, n=25) received TAP block with bupivacaine done after skin closure, bupivacaine with dexmedetomidine group (group TAP + Dex, n=25) received TAP block with dexmedetomidine added to the bupivacaine and intravenous dexmedetomidine group (group TAP + IV-Dex) received TAP block with bupivacaine in addition to intravenous dexmedeto-midine. Results: The mean time to the first rescue analgesic requirement was significantly longer in both group TAP + Dex (9.8±2.9) hours and group TAP + IV-Dex (10.0±2.3) hours than in group TAP (5.7±1.6) hours (p<0.001). Total morphine consumption in the first 24 hours post-operatively was significantly higher in group TAP (24.3±3.6) mg than in both group TAP + Dex (11 .8±3.7) mg and group TAP + IV-Dex (11.8±3.6) mg (p<0.001). Post-operative VAS pain score was higher in group TAP than in group TAP + IV-Dex at 6 and 12 hours but all three groups were comparable at 2, 4 and 24 hours. Patient satisfaction score was significantly lower for group TAP in comparison to the other two groups (p< 0.001).Conclusion: Dexmedetomidine whether added to bupi-vacaine in the TAP block or administered intravenously improved postoperative analgesia with lower total morphine consumption in the first 24 hours post-operative as a part of multimodal analgesia in abdominal and pelvic surgeries.

Background and Purpose: Transverse abdominis plane (TAP) block has been suggested to reduce post-operative pain after laparoscopic cholecystectomy (LC). However, the literature is divided on whether ultrasound (USG)-guided TAP block is effective for pain control after LC. The present meta-analysis therefore evaluated the efficacy of USG-guided TAP block vs. controls and port site infiltration for pain control after LC.Methods: A comprehensive literature search of online academic databases was performed for published randomized controlled trials (RCTs) for studies published to January 31, 2021. The primary outcome analyzed was post-operative pain score at 0, 6, 12, and 24 h post-surgery, both during rest and while coughing. Secondary outcomes included morphine consumption and post-operative nausea and vomiting (PONV) incidence.Results: A total of 23 studies with data on 1,450 LC patients were included in our meta-analysis. A reduction in pain intensity at certain post-operative timepoints was observed for USG-guided TAP block patients compared to control group patients. No reduction in pain intensity was observed for patients receiving USG-guided TAP block patients vs. conventional Port site infiltration.Conclusion: This meta-analysis concludes that TAP block is more effective than a conventional pain control, but not significatively different from another local incisional pain control that is port site infiltration. Additional prospective randomized controlled trials are required to further validate our findings.

Background: Post-operative analgesia is of vital importance to prevent various undesirable side effects such as respiratory complications, venous thromboembolism, and increased hospital stay. The transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. Therefore, this randomized, prospective study was conducted to compare the post-operative analgesic efficacy of QL block and TAP block in patients undergoing abdominal hysterectomy.Methods: This study was carried out in the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Patients of ASA status I and II, planned for total abdominal hysterectomy under spinal anaesthesia were selected and randomly allocated into two groups (Group A – TAP Block and Group B – QL Block). Hemodynamic status, time of onset of sensory block, mean duration of postoperative analgesia, the amount of rescue analgesic requirements as well as intensity of post-operative pain were assessed at different point of time. Visual analog scale (VAS) was used to assess the postoperative pain. Total morphine consumption in 24 hours and time required for 1st postoperative analgesic were recorded.Results: A total of 60 patients were included in this study. The onset of sensory block was faster in Group B than A (22.6±6.5 min &amp; 16.3±5.2 min). VAS score was higher among group A at 10th hours and 18th hours. In case of group B, VAS score was more at 14th hour. Post operatively 1st demand of analgesia was earlier in Group-A (10.4±1.5 vs 14.1±1.7) (p&lt; 0.001). Total analgesic requirement was higher in Group- A than Group B (18.7±4.6 vs11.2±3.8) (p&lt; 0.001).Conclusion: Quadratus Lumborum Block produces longer duration of analgesia, provides optimum post-operative pain control and maintain an excellent hemodynamics than TAP block in patients undergoing abdominal hysterectomy.

Background Minimal access cholecystectomy is a common procedure undertaken worldwide. These are usually performed on an ambulatory basis and given the short timeline, strategies to optimize pain control and reduce nausea or vomiting are key factors to facilitate early hospital discharge. There has been studies showing that both TAP block and wound infiltration deliver superior pain relief after laparoscopic cholecystectomy, but TAP blocks are not used routinely after cholecystectomy in the U.K. This study aims to assess the efficacy of post-operative subcostal TAP block in laparoscopic and robot-assisted cholecystectomy in reducing post-operative opioid requirements and facilitating same day discharge. Method A retrospective cohort analysis was performed at a single centre (January 2022 – July 2023). Patients undergoing laparoscopic or robot assisted cholecystectomy under a single surgeon who performs cholecystectomy with additional use of postoperative TAP block were included. The primary outcome of post-operative opioid requirements was assessed. Secondary outcomes included length of post-operative stay and individual morphine/fentanyl requirements. Results Among 87 patients, 22(25.3%) underwent TAP block and 65(74.7%) had local anaesthetic infiltration of the port sites. Of the two cohorts, there were no significant differences in the age, M:F ratio or ASA grade. There were more obese patients (BMI &amp;gt; 30kg/m2) in the TAP block cohort (63.6% vs 47.7%; p= 0.012). Of the patients in the TAP block, 88.2% were discharged the same day. 95.5% of these patients had no post-operative morphine or fentanyl requirements.The difference in outcomes were not statistically significant. There were no post-procedural complications from use of the TAP block in any patient. Conclusion These results demonstrate that use of TAP block can provide a safe alternative approach for post-operative analgesia, with low post-operative opioid requirements and facilitation of same-day discharge.

Simple SummaryIn humans and small animals, the advantages of loco-regional anesthesia include lower peri-operative opioid consumption and less related side effects. Regional techniques which can be used to desensitize the entire abdominal wall in dogs are the transversus abdominis plane (TAP) block, combined with caudal intercostal blocks. The aim of this study was to evaluate whether TAP and intercostal blocks provide analgesia in bitches undergoing a laparoscopic ovariectomy. Twenty client-owned bitches were enrolled in this double-blinded randomized controlled trial, in which the use of the aforementioned techniques was compared with systemic analgesia. Bitches receiving loco-regional anesthesia showed less signs of intra-operative nociception and post-operative pain, with a lower peri-operative opioid requirement. The use of TAP and intercostal blocks seems to be an effective analgesic protocol for bitches undergoing laparoscopic ovariectomy.In humans and dogs, loco-regional anesthesia is associated with lower peri-operative opioid consumption and less related side effects. The combination of transversus abdominis plane (TAP) and intercostal blocks can be used to desensitize the entire abdominal wall in dogs. The aim of this study was to evaluate the effectiveness of TAP and intercostal blocks in bitches undergoing laparoscopic ovariectomy. Twenty client-owned bitches were enrolled in this double-blinded randomized controlled trial. After premedication with dexmedetomidine, methadone and ketamine, the animals were randomized into two groups. Dogs in the TAP group received intercostal blocks from T8 to T10 and a TAP block with ropivacaine. Dogs in the FEN group received a fentanyl bolus and a constant rate infusion for the entire duration of the procedure. Intra-operative cardiovascular stability, post-operative pain scores, rescue opioid requirement, dysphoria during recovery, time to attain sternal recumbency and interest in food at 6 h post-extubation were compared. Bitches in the TAP group received a statistically significant lower amount of rescue fentanyl intra-operatively and methadone post-operatively. Pain scores were lower in the TAP group until 6 h post-extubation. No difference was found for dysphoric recoveries, time to attain sternal recumbency and appetite at 6 h post-extubation. No adverse event was recorded for any of the dogs. The combination of TAP and intercostal blocks can be part of an effective multi-modal analgesic strategy in bitches undergoing laparoscopic ovariectomy.

Clinical effectiveness of ultrasound-guided dual transversus abdominis plane block for postoperative analgesia in open abdominal aortic surgery patients: The randomised, double-blind ETAP trial.

Background and Aims:Postoperative pain for day surgery laparoscopic cholecystectomy has traditionally been managed with the surgeon infiltrating the wound with local anesthetic (LA). However, transversus abdominis plane (TAP) block has recently been used, although its superiority over LA remains uncertain. The primary aim was to compare LA and TAP block pain scores and analgesia used. The secondary aim was to assess satisfaction score and cost.Material and Methods:This retrospective study was commenced after ethics committee approval and ANZ clinical trial registry (ACTRN: 12612000737831). The data were collected from the theatre database and medical records of patients presenting for day case laparoscopic cholecystectomy. The sample included patients who received either bilateral port site LA infiltration with 20 ml of 0.25% Bupivacaine or bilateral TAP block with 20 ml of 0.5% ropivacaine and fentanyl postoperative pain protocol. The patients with incomplete medical records were excluded as were those admitted to an inpatient ward. Demographics and clinical characteristics were obtained from the hospital record along with pain score and postsurgery analgesia use. Postoperative pain satisfaction scores were collected by telephonic interview 30-180 days postsurgery.Results:Of 51 patients analyzed, 19 were in TAP group 29 in LA group. There were no significant differences between the LA and TAP groups with respect to postoperative pain scores (P = 0.31) or patient satisfaction scores (1 and 2+) (P = 0.36). However, fentanyl consumption in the recovery room was significantly lower in TAP group (P = 0.0079.). The consumables cost were >3 times higher in the TAP when compared to LA group.Conclusion:The performance of the TAP block with respect to pain management was comparable to LA. However, LA remains more cost effective.