Ultrasound Guided Oblique Subcostal Tranversus Abdominis Plane Block (TAP) versus both Subcostal and Posterior TAP Block as Postoperative Analgesia in Hepatectomy

Abstract

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Aim of the Work The aim of this study is to determine the postoperative analgesic effect of ultrasound guided TAP block via oblique subcostal and posterior approaches in hepatectomy. Patients and Methods The study was conducted on 40 randomly chosen patients aged 40 to 60 years old, American Society of Anesthesiologists (ASA) class II and III scheduled for hepatectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 20 patients each: Subcostal TAP block Group: received general anesthesia and 30 ml (10 ml bupivacaine 0.25%, 10 ml lidocaine, 1 gm magnesium and 4 mg dexamethasone) by oblique subcostal approach under ultrasound guidance. Subcostal- posterior TAP block Group: received general anesthesia and with injection of same solution as in the first group in both approaches divided equally between them “ without exceeding the toxic dose “ with total volume 60 ml. Results The results of the study revealed that the Patients who received only subcostal TAP block had significantly lower pain scores for 24 h after operation and decreased total need of analgesic in first 24 h post operative compared with patients who received combination of subcostal and posterior TAP. Conclusion Combination of Oblique Subcostal TAP block with posterior TAP block was more effective in reducing postoperative pain and analgesic consumption after hepatectomy under general anesthesia, compared to subcostal TAP block only.