Bilateral Subcostal Transversus Abdominis Plane Research Articles

A randomized comparative study of transversus abdominis plane block (tap) with 0.25% bupivacaine and 0.375% ropivacaine in the duration of post-operative analgesia in upper abdominal laparoscopic surgeries

Transversus abdominis plane (TAP) block is a successful postoperative analgesia technique in laparoscopic surgeries. This study compared the analgesic efficacy of 0.25% bupivacaine and 0.375% Ropivacaine in TAP block as post-operative analgesia for upper abdomen laparoscopic surgeries.: This randomized, double-blinded comparative study was conducted at the Dr Jeyasekharan Medical Trust and Nursing Home for 18 months. Seventy-one consenting adult patients undergoing upper abdominal laparoscopic surgeries qualifying the inclusion criteria to undergo Bilateral Subcostal TAP Block were included. The patient was labelled group A or B according to a computer-generated randomization list. TAP block was administered using 30 ml (15 ml on each side) of 0.25% bupivacaine (A) or 0.375% ropivacaine (B). Similar premedication and induction were given to all patients. : Among 71 patients in group A, males were 5 (14.7%), and females were 29 (85.3%). In group B, males were 7 (18.9%), and female was 30 (81.1%). There is no significant difference in gender, age, and BMI between groups. The mean duration of analgesia with 0.375% ropivacaine (10.21±3.36 hrs.) was significantly higher than 0.25% bupivacaine (6.38±2.03 hrs.). In the first 24 hours postoperatively, the mean total tramadol consumption was 147.06±11.94 mg in group A and 117.57±31.11 mg in group B, which is statistically significant.: This study concludes that 0.375% 30ml ropivacaine given as a TAP block under ultrasound guidance significantly prolonged the post-operative analgesia duration compared to 0.25% 30ml bupivacaine.

ANALGESIC EFFICACY OF ULTRASOUND GUIDED BILATERAL SUBCOSTAL TRANSVERSUS ABDOMINIS MUSCLE PLANE BLOCK AND PORT SITE INFILTRATION WITH BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: To evaluate the postoperative analgesic efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane block in comparison to port-site local anesthetic infiltration in patients undergoing elective lapa­roscopic cholecystectomy. Methodology: It was a Quasi experimental study, conducted in Combined Military Hospital Rawalpindi, over 6 months, from 13/4/21 till 13/10/2021. Patients numbering 92 of both genders fulfilling inclusion criteria were incorporated and placed into 2 groups equally. Group O (n=46) underwent ultrasound guided bilateral subcostal transversus abdominis plane block using 0.25% bupivacaine with volume dosage of 0.4ml/kg divided by 2, one part for each side. In Group-P (n=46) total dose of bupivacaine (0.25%, volume dose of 0.4ml/kg) was divided by total number of ports used and one portion was infiltrated at each port-site at the completion stage of surgery. Post-operative pain score, quantity of post-operative analgesia and patient satisfaction scores were calculated. Results: Mean tramadol usage in Group-O was 109.56 ± 15.04 mg compared with 155.21 ± 22.18 mg of Group-P (p value <0.001 for both). Visual Analog pain scores were lesser in Group-O all the times. Patient satis­faction scores were 3.30 ± 0.66 and 2.71 ± 0.98 for Group-O and Group-P respectively. Conclusion: Ultrasound guided subcostal Transversus abdominis plane block is effective in contributing to post-operative analgesia following laparoscopic cholecystectomy and is superior to port site infiltration. It decreas­es pain scores, post-operative analgesia requirement and increments patient satisfaction compared with port-site infiltration.

Межфасциальная блокада поперечного пространства живота у пациенток пожилого и старческого возраста в программе ускоренной реабилитации после гинекологических операций

Objective. To study the efficacy of interfascial transversus abdominis plane (TAP) block in elderly and senile patients as an element of complex perioperative anesthesia in a gynecology clinic. Patients and methods. The study enrolled 72 patients aged 61–78 years with benign ovarian tumors classified as anesthesia risk groups 2 and 3 according to the grading system of the American Society of Anesthesiologists (1991). The study group randomly included 35 women and the comparison group included 37 women. In the study group, after induction of anesthesia prior to skin incision, an interfascial injection of 2% ropivacaine solution into the rectus sheath under ultrasound control was performed simultaneously with bilateral subcostal TAP block. A total of 140–180 mg of ropivacaine was used. The abovementioned anesthesia was not administered in the comparison group. Results. Within 2 hours after surgery, the pain score on the visual analogue scale was 1.9 (0.2; 2.7) in the study group and 4.9 (3.3; 5.7) in the comparison group. The situation remained unchanged after 6 hours. In none of the observations in the study group was there an indication for opiates to relieve pain. In the comparison group, 14 patients required opiates once or twice during the first day. Conclusion. The use of interfascial plain block in gynecological practice is a promising element of complex anesthesia in the perioperative period. Key words: interfascial transversus abdominis plane block, enhanced recovery, perioperative anesthesia, Fast Track

General anesthesia with remimazolam for a pediatric patient with MELAS and recurrent epilepsy: a case report

BackgroundMitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a mitochondrial disease. We report here the safe use of remimazolam in a pediatric MELAS patient.Case presentationA 10-year-old girl (118 cm, 16 kg) was scheduled for an open gastrostomy to improve nutrition and epileptic seizure control. We induced and maintained general anesthesia with remimazolam, remifentanil, fentanyl, and rocuronium. We also performed a bilateral subcostal transversus abdominis plane block before the surgery. The surgery finished uneventfully. After we discontinued remimazolam administration, the patient woke up immediately but calmly without flumazenil. Epileptic seizures did not occur during intra- and early post-operative periods.ConclusionRemimazolam enabled us to provide a pediatric MELAS patient with general anesthesia without causing delayed emergence or epileptic seizures.

Addition of dexamethasone to levobupivacaine in the ultrasound-guided bilateral subcostal transversus abdominis plane block improves the quality of postoperative analgesia after laparoscopic cholecystectomy: A prospective randomized clinical study

Background and Aims: Addition of dexamethasone to levobupivacaine in the peripheral nerve block provides improved pain scores, prolonged pain relief, and reduced postoperative opioid requirement. However, the evidence regarding its efficacy in the transversus abdominis plane (TAP) block is limited. Therefore, we conducted this study to evaluate the potential benefits of combining dexamethasone with levobupivacaine in the subcostal TAP block during the first 24 h after laparoscopic cholecystectomy. Materials and Methods: Seventy-six patients were enrolled in the study and divided into two groups to receive 20 ml of 0.25% levobupivacaine with 1 ml NS bilaterally (Group LS) or 20 ml of 0.25% levobupivacaine with 4 mg dexamethasone bilaterally (Group LD). Each patient received a standard multimodal analgesic regimen. Pain scores were recorded at rest and during coughing at 0, 2, 4, 6, 12, and 24 h postoperatively. Total opioid consumption and associated complications were recorded during the first 24 h. Results: Pain scores were lower in the LD group as compared to the LS group at all time points. Reduction in Numeric Rating Scale values was statistically significant at 4, 6, and 12 h both at rest and during coughing. Estimated P values on coughing at these time points were 0.000, 0.001, and 0.017, respectively. Postoperative opioid requirement was also significantly reduced between 2 and 24 h (P = 0.007). We did not record any complications in our study population. Conclusion: The combination of dexamethasone and levobupivacaine in the subcostal TAP block significantly improves the efficacy of multimodal analgesic regimen during the first 24 h after laparoscopic cholecystectomy.

Comparison of Ultrasound Guided Bilateral Subcostal Transversus Abdominis Plane Block versus Local Infiltration of Port Site with Bupivacaine in Patients Undergoing Laparoscopic Cholecystectomy under General Anesthesia

Introduction: Patients undergoing laparoscopic cholecystectomy have moderate post-operative pain in the early post-operative period. There are several modalities to manage pain in the postoperative period. Subcostal transversus abdominis plane block is one of the effective methods for pain management. The objective of our study was to compare the analgesic efficacy of subcostal transversus abdominis block versus local infiltration at the port site with bupivacaine in patients undergoing Laparoscopic cholecystectomy under general anesthesia. Methodology: This is a prospective randomized study of 60 patients of age group 18 – 60 years of either gender, of ASA PS I and II scheduled for laparoscopic cholecystectomy under general anesthesia and were randomly divided into two groups. At the end of the surgery 20ml of 0.25% bupivacaine was administered with ultrasound guided subcostal transversus abdominis plane block bilaterally in group T and local infiltration at the port sites in group L. Visual analogue scale at 0, 2, 6, 12 and 24 hours at rest, time of rescue analgesia and opioids consumption were recorded. Results: Both the groups were comparable with each other to assess pain scores and analgesic requirements. Group T had less pain at rest (<0.001) on visual analogue scales and also less analgesic and opioids consumption compared to group L (<0.001), which were found to be statistically significant. Conclusion: Subcostal transversus abdominis plane block is beneficial, effective and reliable method in providing post-operative analgesia in patients after laparoscopic cholecystectomy compared to local infiltration at port sites.

Effectiveness of Subcostal Transversus Abdominis Plane Block in Subcutaneous Onlay Laparoscopic Approach (SCOLA) Surgery: A Retrospective Observational Study.

Postoperative analgesia in SCOLA (subcutaneous onlay laparoscopic approach) surgery is traditionally based on intravenous opioids. The aim of this retrospective observational study was to evaluate the efficacy of bilateral subcostal transversus abdominis plane (SCTAP) block on postoperative pain relief in the first 48 postoperative hours following SCOLA. From August 2017 to December 2019, 163 patients were eligible for the analysis. Postoperative analgesia was managed either with an intravenous tramadol continuous infusion (opioid group) or a multimodal opioid-sparing strategy based on bilateral SCTAP block (SCTAP group), according to the anesthesiologist's postoperative plan. After data collection, 103 patients were assigned post hoc to the SCTAP group and 60 patients to the opioid group. The primary outcome was the evaluation of postoperative pain, considering both the Numeric Rating Scale score and the percentage of patients with uncontrolled pain at 6, 12, 24, or 48 hours. Secondary outcomes were differences in the administration of ketorolac rescue analgesia and incidence of mild adverse effects. There were no significant differences in median Numeric Rating Scale at 6, 12, 24, and 48 hours and ketorolac rescue dose consumption in both groups. Five patients (4.85% of a total of 103 patients) referred postoperative nausea and vomiting in the SCTAP group versus 10 patients (16.67% of a total of 60 patients) in the opioid group (P=0.02). Analgesia with SCTAP block seems to represent a feasible and efficient strategy for pain management in patients undergoing SCOLA surgery, allowing good quality analgesia, low opioids requirements, and reduced incidence of postoperative nausea and vomiting.

Ultrasound-guided bilateral subcostal transversus abdominis plane block in gastric cancer patients undergoing laparoscopic gastrectomy: a randomised-controlled double-blinded study.

The effectiveness of subcostal transversus abdominis plane block (TAPB) in laparoscopic gastric cancer surgery is unknown. We aimed to investigate its opioid-sparing and pain-relief effects in laparoscopic gastrectomy for gastric cancer. One hundred and twelve patients undergoing elective laparoscopic gastrectomy were randomised to the TAPB or control group. The TAPB group received ultrasound-guided bilateral subcostal TAPB at the end of surgery, while the control group did not. We investigated fentanyl consumption administered via intravenous patient-controlled analgesia and as a rescue analgesic, the numeric rating scale (NRS) pain scores at rest and during coughing, and the opioid-related side effects at 6, 12, 24, and 48h postoperatively. The primary outcome was cumulative fentanyl consumption at 24h postoperatively. The study included 53 patients in each group. The cumulative fentanyl consumption 24h postoperatively was significantly lower in the TAPB group than in the control group (median difference -170 mcg, P = 0.03, 95% CI -360 to -15 mcg). Subcostal TAPB also significantly reduced the resting NRS score at 48h postoperatively (median difference -1, 95% CI -1 to 0, P = 0.01) and coughing NRS score at all time points (all median difference -1, 95% CI -2 to 0, P < 0.01, P =0.02, 0.01, and 0.01, respectively). However, it did not reduce the occurrence of opioid-related side effects, except the use of antiemetics during the first 6h postoperatively (TAPB, 1.9% vs. Control, 15.1%, P = 0.03). Ultrasound-guided bilateral subcostal TAPB provides efficient postoperative analgesia with an opioid-sparing effect after laparoscopic gastrectomy.

Efficacy of The Subcostal Transversus Abdominis Plane Block In Laparoscopic Cholecystectomy: A Comparison With Conventional Port- Site Infiltration

Introduction: Pain experienced following laparoscopic cholecystectomy derives significantly from incision made in anterior abdominal wall. Many patients experience moderate to severe pain following laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided bilateral subcostal transversus abdominal plane (TAP) block with port-site infiltration for post-operative analgesia after laparoscopic cholecystectomy.&#x0D; Methods: Sixty patients undergoing laparoscopic cholecystectomy were randomly allocated to two groups to receive port-site infiltration of local anaesthesia or ultrasound guided subcostal TAP block at the end of surgery before extubation. All patients received 1 gm paracetamol intravenously 8 hourly. Post-operative pain was assessed using visual analogue score at 0,1,2,4,8,16 and 24 hours. Time to first analgesic requirement and total opioid consumption over 24 hours were recorded.&#x0D; Results: Ultrasound guided bilateral subcostal transversus abdominis plane block significantly reduced post-operative pain score compared to port site infiltration. We observed statistically significant differences in visual analogue score between two groups at all other time frame. The 24 hours opioid consumption was less in Subcostal TAP (136±66.31μg VS 202±80.58μg, p=0.001). Time for rescue analgesia was prolonged in patient receiving subcostal TAP (3.63±2.09 hrs VS 1.73±1.60 hrs, p=0.0002).&#x0D; Conclusion: Ultrasound guided bilateral subcostal transversus abdominal block provides superior post-operative analgesia and reduced opioid consumption after laparoscopic cholecystectomy compared to port-site infiltration.

Comparison between the ultrasound-guided erector spinae block and the subcostal approach to the transversus abdominis plane block in obese patients undergoing sleeve gastrectomy: a randomized controlled trial.

Pain control in the morbidly obese has presented as an anesthetic challenge. The aim of this study is to assess the analgesic efficacy of ultrasound guided bilateral erector spinae block compared to bilateral subcostal transversus abdominis plane block. A prospective randomized, double-blinded controlled study was conducted at Kasr Alainy Hospital on 66 patients scheduled for laparoscopic sleeve gastrectomy. Patients were randomly allocated into three groups and received general anesthesia: bilateral erector spinae block at the level of T9 or bilateral subcostal transversus abdominis block or opioid analgesia (control group). The primary outcome was pain assessment by Visual Analogue Scale. Visual Analogue Scale was lower in the erector spinae and transversus abdominis groups compared with the control group throughout the first 12 postoperative hours (P≤0.001). Visual Analogue Scale was lower in the erector spinae group in relation to control group at 18 postoperative hours (P=0.034). Visual Analogue Scale in the erector spinae group was significantly lower compared to transversus abdominis at the 12 postoperative hours. Twenty-four-hour postoperative pethidine consumption was higher in the control group (median 150, IQR 100-200) compared to both erector spinae (median 0, IQR 0-50) and transversus abdominis (median 50, IQR 0-100) groups (P<0.001). Erector spinae group showed less pethidine consumption than transversus abdominis group. Ultrasound-guided single-shot T9 erector spinae plane block lowers postoperative pain scores, and reduces intraoperative and postoperative opioid consumption compared with both the subcostal approach transversus abdominis plane block and the control group in obese patients that had undergone sleeve gastrectomy.

Bilateral subcostal transversus abdominis plane block does not improve the postoperative analgesia provided by multimodal analgesia after laparoscopic cholecystectomy: A randomised placebo-controlled trial.

Laparoscopic cholecystectomy might be considered minor surgery, but it may result in severe postoperative pain. Subcostal transversus abdominis plane (TAP) block, which produces long-lasting supra-umbilical parietal analgesia, might improve analgesia after laparoscopic cholecystectomy. We investigated whether subcostal TAP block would reduce opioid consumption and pain after laparoscopic cholecystectomy in patients provided with multimodal analgesia. A randomised, placebo-controlled, double-blind study. The study was conducted at a university teaching hospital from December 2017 to June 2018. Sixty patients scheduled for laparoscopic cholecystectomy were included. Anaesthesia and postoperative analgesia (etoricoxib, paracetamol, ketamine and dexamethasone) were standardised. After induction of anaesthesia, patients were allocated into two groups: ultrasound-guided bilateral subcostal TAP block with 20 ml of levobupivacaine 0.375% and epinephrine 5 μg ml or 0.9% saline with epinephrine 5 μg ml. Opioid consumption in the recovery room and during the first 24 h after surgery were recorded. Postoperative somatic and visceral pain scores, fatigue and nausea were measured. Intra-operative end-tidal concentrations of sevoflurane (FETSEVO) were also recorded. Twenty-four hour postoperative opioid consumption were similar in both groups: 21.2 mg (95% CI 15.3 to 27.1) vs. 25.2 (95% CI 15.1 to 35.5) oral morphine equivalent in the levobupivacaine and 0.9% saline groups, respectively; P = 0.48. No significant between-group differences were observed with regards to parietal (P = 0.56) and visceral (P = 0.50) pain scores, fatigue and nausea. FETSEVO was slightly lower in the levobupivacaine group (P < 0.01). Subcostal TAP block does not improve the analgesia provided by multimodal analgesia after laparoscopic cholecystectomy. It allows for a small reduction in intra-operative sevoflurane requirements. NCT0339153.

Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study.

Background The aim of this study was to compare the effectiveness of ultrasound-guided (USG) subcostal transversus abdominis plane (TAP) block and quadratus lumborum (QL) block as preventive analgesia methods after laparoscopic cholecystectomy. Methods A total of 120 patients, 18–75 years of age, were separated into 2 groups preoperatively. Patients in group TAP (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral subcostal TAP block; patients in group QL (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral QL block. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 h were recorded. Results Fifty-three patients in group TAP and 54 in group QL were ultimately evaluated. No statistically significant difference was found in at rest and dynamic visual analog scale scores between the groups. There was also no statistically significant difference between the groups with regard to total analgesia consumption. Although the duration of anesthesia was significantly longer in group QL, no statistically significant difference was found in the duration of surgery between the groups (p < 0.05). Conclusions Results of this study demonstrated that USG subcostal TAP and QL blocks similarly reduced postoperative pain scores and analgesia consumption, with high patient satisfaction. However, subcostal TAP block could be considered preferable to QL block because it can be applied easily and in a shorter time.

Comparison of Analgesic Efficacy of Ultrasound Guided Subcostal Transversus Abdominis Plane Block with Port Site Infiltration Following Laparoscopic Cholecystectomy

Patients have significant pain following laparoscopic cholecystectomy. Several modalities have been used to manage this pain. Subcostal transversus abdominis plane (TAP) block is one of the components of multimodal analgesia and has been described as an effective technique for postoperative pain management. This study compares the impact of subcostal TAP block with port site local infiltration following laparoscopic cholecystectomy for postoperative pain and opioid consumption. This is a prospective, randomized, interventional study. Sixty patients were enrolled and divided into two groups having 30 patients in each group. Group A received bilateral ultrasound guided subcostal TAP block with 10 mL of 0.25% bupivacaine after the completion of surgery. Group B received similar amount of local anesthetic infiltrated over all the laparoscopic port sites. Pain at rest and on movement was assessed using VAS scale in post-operative period at 0 min, 30 min, 2, 4, 6, 12 and 24 hours. Time of first rescue analgesic requirement and total opioid consumption over 24 hours were recorded. Patients receiving Subcostal TAP block had reduced postoperative pain as compared to port site infiltration and statistically significantly in first two hours after surgery. The 24 hours opioids consumption was significantly less (125mg ±25.42 versus 175mg ±25.42, p <0.001) in Subcostal TAP block group. Time for request of first rescue analgesic was prolonged in patients receiving the Subcostal TAP block (3.20±0.84 hours vs 1.70±0.65 hours, p <0.001). Ultrasound guided bilateral Subcostal TAP block provides effective post-operative analgesia and reduces opioid consumption in patients undergoing laparoscopic cholecystectomy.

Ultrasound-guided bilateral subcostal TAP block for epigastric hernia repair: A case series.

The transversus abdominis plane (TAP) block is a field block and it involves myocutaneous nerves supplying the anterior abdominal wall (T6 to L1). It can be performed through the classical posterior or subcostal approaches.[1] It is commonly used as an adjunct to perioperative analgesia in a wide variety of surgeries, but reports on its role as a sole anaesthetic technique are scarce.[2,3,4] We present a case series of epigastric hernia repair where subcostal TAP block was used as a sole anaesthetic technique.

Comparison of ultrasound-guided bilateral subcostal transversus abdominis plane block and port-site infiltration with bupivacaine in laparoscopic cholecystectomy.

Background and Aims:Many patients experience moderate-to-severe pain after laparoscopic cholecystectomy. We aimed to compare the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block with port-site infiltration for post-operative analgesia after laparoscopic cholecystectomy.Methods:Patients undergoing elective laparoscopic cholecystectomy under general anaesthesia were divided into two groups of 40 each to receive ultrasound-guided bilateral subcostal TAP block (T) with 0.25% bupivacaine 20 ml each side or port-site infiltration with 0.5% bupivacaine 5 ml each at 4 ports (I) at the end of the surgery before extubation. All patients received paracetamol 1 g intravenous 8th hourly. Tramadol 1 mg/kg intravenous bolus and diclofenac 1 mg/kg intravenous infusion were used as the first- and second-line rescue analgesics when Numerical Rating Scale (NRS) ≥4, or when the patient complained of pain. NRS at 1, 2, 3, 6, 12 and 24 h after surgery, time to first analgesic request and total dose of analgesics in 24 h were recorded. Chi-square test and independent t-test were used to compare qualitative and quantitative data, respectively.Results:Time to first analgesic (mean±SD) in Group I and Group T was 292.7 ± 67.03 and 510.3 ± 154.55 min and mean tramadol required was141.8 ± 60.01 mg and 48.69 ± 36.14 mg, respectively (P = 0.001 for both). Mean NRS at 2, 3, 6, 12 and 24 h was significantly lower in Group T.Conclusion:Ultrasound-guided bilateral subcostal TAP block provides superior post-operative analgesia after laparoscopic cholecystectomy compared to port-site infiltration.

Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy.

Objectives:To investigate the analgesic effect of a subcostal-posterior transversus abdominis plane (TAP) block combination following laparoscopic sleeve gastrectomy.Methods:This study was conducted at Fatih Sultan Mehmet Educational and Research Hospital, Istanbul, Turkey, between March 2014 and June 2015. A total of 40 patients with a body mass index of 40-60 kg/m2 scheduled for laparoscopic sleeve gastrectomy were randomly allocated into 2 groups. Patients in Group I (n=20) received a bilateral subcostal TAP block, and patients in Group II (n=20) received a bilateral subcostal and posterior TAP block. Pain intensity was assessed at rest and during coughing using the visual analog scale (VAS) prior to and at various time points after TAP block (0 min, 30 min, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours). Morphine consumption over 24 hours and time to first morphine requirement were recorded.Results:There was no difference in VAS scores between groups. Morphine consumption was 6.78±5.95 mg in Group I, and 7.28±5.95 mg in Group II (p=0.795). Time to first morphine requirement was 267.22±303.84 min for Group I, and 207.80±209.81 min for Group II (p=0.154).ConclusionsSubcostal-posterior TAP block provided equivalent analgesia to subcostal TAP block alone following laparoscopic sleeve gastrectomy.

Subcostal Transversus Abdominis Plane (STAP) Block with Depot Steroids in the Management of Upper Abdominal Myofascial Pain Syndrome (AMPS)q

Background: Abdominal myofascial pain syndrome is a poorly recognised cause of chronic abdominal wall pain. Diagnosis is confirmed by a positive response to trigger point injection. In the presence of extensive myofascial pain, trigger point treatment can result in patient discomfort and distress. Recently, posterior transversus abdominis plane blocks have been reported in the diagnosis and treatment of chronic abdominal wall pain. Subcostal transversus abdominis plane block is an abdominal wall block that is effective for pain arising from the upper abdomen. The report describes the role of the ultrasound guided subcostal transversus abdominis plane block in the management of abdominal myofascial pain syndrome.Methods: Adult patients with myofascial pain syndrome localised in the upper abdomen under the care of a single physician at a tertiary pain medicine unit were offered bilateral ultrasound guided subcostal transversus abdominis plane block with a mixture of local anaesthetic and depot methylprednisolone instead of multiple trigger point injections as a part of an on-going prospective longitudinal audit into the management of abdominal myofascial pain syndrome. Patients completed brief pain inventory questionnaire at baseline and at 12 weeks post procedure.Results: Twenty patients underwent bilateral subcostal transversus abdominis plane blocks with depot steroids. All patients reported complete absence of pain within 15 minutes of the block. Clinically significant benefit at 12 weeks was reported by 60 % (12/20) of patients.Conclusion: Subcostal transversus abdominis plane block with depot steroids could play a role in the management of myofascial pain of the upper abdomen.

Management of a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia with subcostal transversus abdominis plane block.

The anesthetic management of centenarians is challenging, since they have loss of functional reserve in all organs. The mortality rate of 25 % is reported in patients over 100 years old who underwent emergency surgery. The transversus abdominis plane block has been shown to provide effective analgesia in laparoscopic cholecystectomy. A 101-year-old woman was diagnosed with grade I (mild) acute cholecystitis with gallstones. An emergency laparoscopic cholecystectomy was scheduled. The patient had a history of hypertension. The patient’s laboratory data showed that she had mild coagulopathy, anemia, thrombocytopenia, and decreased renal function. After induction of general anesthesia, an ultrasound-guided, bilateral subcostal transversus abdominis plane block was performed. Her postoperative course was uneventful. Using the preoperative subcostal transversus abdominis plane block, we were able to avoid hemodynamic instability and to reduce opioid dosage in a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia.

Efficiency of Bilateral Subcostal Transversus Abdominis Plane Block to Complement General Anaesthesia in Laparoscopic Cholecystectomy

Introduction: Laparoscopic Cholecystectomy is presently a commonly performed surgical procedure. It is needed in both the young and the old; healthy as well as the severely co-morbid. During the surgery, pain is generated at the port site and also from the viscera. Bilateral Subcostal (Upper Quadrant) Transversus Abdominis Plain Block can block the pain from the parietal port sites. This study is to assess the efficiency of Bilateral Subcostal Transversus Abdominis Plane Block as a mode of multi-modal analgesia in the General Anaesthesia administered for Laparoscopic Cholecystectomy. Material and Methods: One hundred patients of ASA 1 or 2 categories in the age group 20 to 60 years from both sex posted for elective Laparoscopic Cholecystectomy was included in the study. Fifty patients each was randomly assigned to two groups ‘A’ and ‘B’. Group A was the control group and did not receive any blocks. The surgery was done solely under General Anaesthesia. In the group ‘B’, Bilateral Subcostal TAP block with 30 ml of 0.25% Ropivacaine was administered from the Block Room. General Anaesthesia in a standardised protocol for the study was administered by a different Anaesthetist who was blinded about the blocks. The extra amount of Fentanyl required per hour to maintain adequate anaesthesia was noted in every patient. Minimum concentration of Sevoflurane demanded by individual patients is also noted. Systolic BP value range of ‘Control BP to an additional 15mm of Hg’ is targeted as adequate anaesthetic depth in this study. Post Operative Analgesia also had a standard protocol for all the patients. The additional dose Inj. Tramadol to control the pain in the 8 post operative hours is also noted. Results: The study demonstrated a statistically significant decrease in the intra operative inhalational anaesthetic and narcotic analgesic demand, in the Group B in which Bilateral Subcostal TAP Block was administered. The decrease in the 8 hour post operative analgesic demand in the Group B was found to be statistically significant.

The transversus abdominis plane block: Case for optimal tap.

The transversus abdominis plane block: Case for optimal tap.