Abstract
Background: The transversus abdominis plane block (TAP block) in the petit triangle is being used since 2001 for analgesia by blocking the T6 to T12 nerves, which is devoid of the sympathetic blockade and has opioid-sparing effect during and after abdominal operations. The appropriateness and efficacy of using double pop blind transversus abdominis plane block were studied in abdominal surgeries using bupivacaine with butorphanol as additive. Subjects and Methods: A total of 78 adult patients of ASA I and II were included, who were to undergo laparoscopic cholecystectomy under general anesthesia. The control group patients received tramadol, diclofenac, and paracetamol in the perioperative period. The study group patients received TAP block by double pop blind technique after induction of anesthesia but before surgical incision as preemptive analgesia. The p-value, the mean and the confidence interval were calculated by using Student t-test with the use of online software by graphpad.com. Results: Each of the two groups had 39 patients, and none met the exclusion criteria. Patients of the study (TAP) group remained pain-free for a longer time by 439 (416 – 463) minutes more than the control (IV, Intravenous) group. Rescue analgesia in the study group was required 640 minutes after the end of the surgery, but in the control group, rescue analgesia was required earlier at 200 minutes only after the surgery. Conclusion: Double pop blind technique for TAP block is appropriate and without complications if done with carefulness as to avoid penetration of the blunted green needle beyond the fascia between the internal oblique and the transversus abdominis muscle.
Highlights
The transversus abdominis plane block (TAP block) which was described by Rafi et al in 2001, is a regional anesthesia technique that requires administration of local anesthetic solution below the fascia between the transversus abdominis muscle and internal oblique muscle of the anterior abdominal wall. [1,2,3,4] The benefits of TAP block are analgesia without sympathetic blockade and the consequent hypotension or bradycardia, unlike in neuraxial block; opioid-induced pruritus, nausea, and vomiting are generally not observed with TAP block. [5,6,7] The technical difficulty with ultrasoundguided TAP block and a dearth of time, discourage to perform the block; we designed this study to ascertain the efficacy of double pop blind TAP block, which can be delivered even in a resource-poor hospital set up
Laparoscopic cholecystectomy was performed in 39 patients in control Group 1 (IV, intravenous group) and 39 patients in study Group 2 (TAP, transversus abdominis plane block)
This study was undertaken to determine the efficacy of the double pop blind technique of transversus abdominis plane block by administering on each side 20 ml of 0.25% bupivacaine with 1.0 mg butorphanol compared to the control group managed by intravenously administered analgesics, which included paracetamol, diclofenac and tramadol.[11,12]
Summary
The transversus abdominis plane block (TAP block) which was described by Rafi et al in 2001, is a regional anesthesia technique that requires administration of local anesthetic solution below the fascia between the transversus abdominis muscle and internal oblique muscle of the anterior abdominal wall. [1,2,3,4] The benefits of TAP block are analgesia without sympathetic blockade and the consequent hypotension or bradycardia, unlike in neuraxial block; opioid-induced pruritus, nausea, and vomiting are generally not observed with TAP block. [5,6,7] The technical difficulty with ultrasoundguided TAP block and a dearth of time, discourage to perform the block; we designed this study to ascertain the efficacy of double pop blind TAP block, which can be delivered even in a resource-poor hospital set up. The transversus abdominis plane block (TAP block) in the petit triangle is being used since 2001 for analgesia by blocking the T6 to T12 nerves, which is devoid of the sympathetic blockade and has opioid-sparing effect during and after abdominal operations. The appropriateness and efficacy of using double pop blind transversus abdominis plane block were studied in abdominal surgeries using bupivacaine with butorphanol as additive. The study group patients received TAP block by double pop blind technique after induction of anesthesia but before surgical incision as preemptive analgesia. Conclusion: Double pop blind technique for TAP block is appropriate and without complications if done with carefulness as to avoid penetration of the blunted green needle beyond the fascia between the internal oblique and the transversus abdominis muscle
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