Efficacy of ultrasound-guided TAP block for postoperative pain relief in abdominal surgeries: A prospective, randomized controlled trial

Abstract

: Transversus abdominis plane (TAP) block has emerged as a safe, reliable, and efficient technique to provide post-operative analgesia for a range of abdominal procedures and has been shown to minimize the usage of opioids in the perioperative period. This paper compares the overall efficacy and safety of TAP block for postoperative analgesia in abdominal surgeries, by two techniques (blind v/s USG). Eighty patients, ASA grade I-II, 18-60 years age group, posted for abdominal surgery like appendicectomy, appendicular perforation, umbilical, paraumbilical, incisional and ventral hernia repair, hysterectomy and exploratory laparotomy under GA. They were divided into two groups to undergo blind or USG-guided TAP block. At the end of the procedure, before the reversal, both groups received a TAP block with Inj. Bupivacaine 0.25% 20cc on each side in supine position. Patients were followed up for 24 hours, and pain scores were measured using a visual analogue scale. Inj. Diclofenac was given as rescue analgesic and Inj. Tramadol was used for breakthrough pain. Total analgesic requirement for 24 hours and complications if any, were noted.: VAS score was found to be significantly lower in USG- guided group at various time intervals till 12 hours (2.05 ± 0.75 vs 2.98 ± 1.03) in the USG-guided group as compared to the blind group (p<0.05). Time to first rescue analgesic was significantly prolonged in USG- the guided group being 19.68 ± 4.90 hours than the blind technique of 13.48 ± 6.86 hours (p <0.001). The number of rescue analgesics required in the USG-guided group was significantly lower than the blind technique (p<0.05).: USG-guided group had significantly less pain scores postoperatively and a reduced number of analgesic requirements. This resulted in fewer opioid-mediated side effects. TAP block can serve as a part of multimodal analgesia with enhanced recovery after abdominal surgery. The USG-guided approach helped in achieving near perfect block which is evident by pain scores and reduced analgesics required.