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Abstract
Purpose. Transversus abdominis plane (TAP) blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10) at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48) mg (median, IQR) within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.
Highlights
Epidural analgesia is commonly used for the treatment of postoperative pain after major abdominal surgery despite the well-known risks and the long list of contraindications [1, 2]
During the last few years, interest has grown concerning the use of transversus abdominis plane (TAP) block as an alternative to epidural analgesia
The duration of a single-shot Transversus abdominis plane (TAP) block is limited by the pharmacokinetics of the local anesthetic used, and the use of TAP catheters has been described in order to prolong the effect of the TAP block through infusion or injection of local anesthetic [6,7,8,9,10]
Summary
Epidural analgesia is commonly used for the treatment of postoperative pain after major abdominal surgery despite the well-known risks and the long list of contraindications [1, 2]. Kadam and Field [11] randomized 40 patients undergoing nonspecified major abdominal surgery to receive either a singleshot TAP block at the end of surgery followed by a 72 hr infusion at 8–10 mL/hr of 0.2% ropivacaine 2 mg/mL and fentanyl patient-controlled analgesia (PCA) (TAP group, n = 20) or fentanyl PCA only (control group, n = 20). Niraj et al [12] randomized 62 patients undergoing major hepatobiliary or renal surgery to receive either intermittent bolus injections of 1 mg/kg bupivacaine 3.75 mg/mL every 8 hr via subcostal TAP catheters placed at the end of surgery (TAP group, n = 29) or an epidural infusion of bupivacaine 1.25 mg/mL and fentanyl 2 μg/mL (epidural group, n = 33)
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