Bilateral Transversus Abdominis Plane Block Research Articles

Modifying efficacy of transversus abdominis plane block combined with general anesthesia in elderly patients undergoing laparoscopic surgery

Objective To evaluate the modifying efficacy of transversus abdominis plane(TAP) block combined with general anesthesia in elderly patients undergoing laparoscopic surgery. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 65-80 yr, with body mass index of 18.5-24.0 kg/m2, scheduled for elective abdominal laparoscopic surgery, were divided into 2 groups (n=30 each) using a random number table: general anesthesia group (group GA) and TAP block combined with general anesthesia group (group TAP+ GA). In group TAP+ GA, bilateral TAP block was performed using the posterior approach, and 0.25% ropivacaine 20 ml was injected into the two sides.Anesthesia was induced with IV midazolam, etomidate, sufentanil and cisatracurium besylate.Anesthesia was maintained using total intravenous anesthesia.When postoperative visual analog scale score≥4, dezocine 5 mg was intravenously injected for analgesia.At 5 min after admission to the operating room, at 2 min after skin incision and at the end of pneumoperitoneum, venous blood samples were collected for determination of plasma norepinephrine concentrations.The intraoperative consumption of propofol and remifentanil and intraoperative requirement for sufentanil and postoperative requirement for dezocine were recorded.The development of adverse reactions was also recorded. Results Compared with group GA, the plasma norepinephrine concentrations were significantly decreased at 2 min after skin incision and at the end of pneumoperitoneum, the intraoperative consumption of propofol and remifentanil was reduced, the intraoperative requirement for sufentanil and postoperative requirement for dezocine were decreased (P 0.05). Conclusion When TAP block combined with general anesthesia is used in elderly patients undergoing laparoscopic surgery, it is helpful in carrying out anesthetic model of low-consumption opioids and more helpful in inhibiting intraoperative stress responses and postoperative pain responses than general anesthesia alone. Key words: Nerve block; Abdominal muscles; Anesthesia, general; Aged; Pneumoperitoneum, artificial

Surgically-assisted abdominal wall blocks for analgesia after abdominoplasty: A prospective randomized trial.

Background:Abdominoplasty is a common aesthetic procedure. The transversus abdominis plane block (TAPB) and rectus sheath block (RSB) have proven efficacy as analgesic modality for abdominal surgeries. This study demonstrates post-abdominoplasty analgesic duration consequent to the three surgically infiltrated local anesthetic techniques: bilateral TAPB, bilateral RSB, and subcutaneous infiltration (SCI) of 0.25% bupivacaine.Methods:In this prospective randomized study, 48 adult patients scheduled for abdominoplasty were randomized into three groups: TAPB group (n = 16), RSB group (n = 16), and SCI group (n = 16) utilizing 40 mL of 0.25% bupivacaine for each block. In both TAPB and RSB groups, the block was performed bilaterally after plication of anterior abdominal wall, while in SCI group, the surgical incisional area was infiltrated before skin closure. Main outcome measures included visual analogue scale (VAS), at rest and during movement; the analgesic duration; and the total required doses of morphine in the first postoperative day.Results:A statistically significant longer analgesia was recorded in the TABP group compared with both the RSB and SCI groups. Statistically significant higher VAS scores in the SCI group 4 hours postoperatively was recorded, both at rest and during movement, compared with both TABP and RSB groups. Significant higher morphine consumption in the SCI group was compared with the other two groups.Conclusions:Among the surgically infiltrated anesthetic techniques for abdominoplasty, bilateral TAPB was associated with longer postoperatively analgesic duration with lower morphine consumption in the first 24 hours compared with RSB and SCI.

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.

Post-operative bilateral continuous ultrasound-guided transversus abdominis plane block versus continuous local anaesthetic wound infusion in patients undergoing abdominoplasty.

Background and Aims:Transversus abdominis plane (TAP) block and continuous local anaesthetic wound infusion are used as part of multimodal analgesia to treat postoperative pain after lower abdominal surgeries. The aim of this randomised controlled study was to assess the efficacy of the two techniques and compare the two in patients undergoing abdominoplasty.Methods:Ninety female patients undergoing abdominoplasty were allocated to receive continuous wound infusion with saline (control group, GC, n = 30), continuous bilateral TAP block with 0.25% levobupivacaine (group GT, n = 30), or continuous wound infusion with 0.25% levobupivacaine (group GW, n = 30). The primary end-point was morphine requirement in the first 48 h. Numerical rating scale (NRS) at rest and during movement, time to first morphine dose and time to first ambulation were recorded.Results:Morphine requirement in the first 48 h was significantly higher in GC than GW and GT (61.9 ± 12.8, 21.5 ± 9.5, and 18.9 ± 8.1 mg, respectively; P = 0.001), but GW and GT were comparable (P = 0.259). NRS was significantly higher in GC during movement in the first 24 h. GW and GT showed significantly longer time to first morphine dose (6.5 ± 1.7 and 8.9 ± 1.4 h, respectively, vs. 1.2 ± 0.3 h in GC) and significantly shorter time to first ambulation (7.8 ± 3.1 and 6.9 ± 3.4 h, respectively, vs. 13.2 ± 4.9 h in GC) (P = 0.001).Conclusion:Continuous bilateral ultrasound-guided TAP block and continuous local anaesthetic wound infusion significantly decreased total morphine consumption in the first 48 h compared to placebo; however, both treatment techniques were comparable.

Comparative analysis of duration of postoperative analgesia between levobupivacaine and levobupivacaine with clonidine after ultrasound-guided transversus abdominis plane block in patients undergoing lower segment cesarean section

Background:Transversus abdominis plane (TAP) block in cesarean section is carried out by local anesthetics such as bupivacaine or ropivacaine with a limited duration of analgesia. The addition of adjuvants such as clonidine and dexmedetomidine has increased the duration of postoperative analgesia.Aims, Settings and Design:The aim of this study was to compare the duration of postoperative analgesia between clonidine and levobupivacaine (0.25%) versus levobupivacaine (0.25%) alone in the bilateral TAP block after lower segment cesarean section (LSCS).Materials and Methods:In this prospective randomized double-blind interventional study, 100 parturients undergoing elective LSCS were included in the study. Patients were randomly divided to receive either 20-ml levobupivacaine 0.25% (Group A; n = 50) or 20-mL levobupivacaine (0.25%) +1-μg/kg clonidine bilaterally (Group B; n = 50) in TAP block in a double-blind fashion. The total duration of analgesia, patient satisfaction score, postoperative visual analog scale score, total requirement of analgesics in the first 24 h, and the side effects of clonidine were observed.Statistical Analysis:Statistical tests were conducted using SPSS. P < 0.05 was considered as statistically significant.Results:A total of 92 patients were analyzed. Duration of analgesia was significantly longer in Group B (17.94 ± 0.76 h) compared to Group A (7.16 ± 0.41 h) (P < 0.001). Mean consumption of tramadol was 197.77 ± 14.90 mg and 8.889 ± 28.77 mg in Groups A and B (P < 0.001), respectively. All patients in Group B were extremely satisfied while those in Group A were satisfied (P < 0.01). None of the patients experienced hypotension or bradycardia.Conclusion:The addition of clonidine 1 μg/kg to 20-ml levobupivacaine 0.25% in TAP block bilaterally for cesarean section significantly increases the duration of postoperative analgesia, decreases postoperative rescue analgesic requirement, and increases maternal comfort compared to 20 ml of levobupivacaine 0.25% alone.

Transversus abdominis plane block for postoperative analgesia after abdominal surgeries in morbidly obese

Background Pain is a significant problem for many patients after major surgery. The transversus abdominis plane (TAP) block is a new technique that provides analgesia following abdominal surgery. TAP block can be done blindly or by using ultrasound that include posterior and subcostal approach. Aim The primary aim was to study the clinical utility of TAP block as analgesia after lower abdominal surgeries in morbidly obese. The secondary aim was to assess the advantages and disadvantages of the same. Patients and methods A total of 60 patients fulfilling inclusion criteria who were undergoing elective lower abdominal surgeries were divided into two equal groups. Group T (TAP group), which received bilateral ultrasound-guided subcostal TAP block at the end of the surgery before emergence, and group C (control group) that received general anesthesia, with no further narcotic administration. Postoperative mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough, PaCO2, time to first request of analgesia, average frequency of analgesia, average total analgesics consumption, average total local anesthetic (bupivacaine) consumption, postoperative complications, and frequency of antiemetic were recorded. Bromage score was assessed at 20 min postoperatively. Results There were significant decrease in mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough in group T than group C at 10, 20 min. There wasa high significant decrease in peak expiratory flow rate and significant increase in PaCO2 in group C than group T at 2, 6 h postoperatively. There was a high significant increase in the time to first request of analgesia, and a high significant decrease of both frequency of analgesia and average total consumption of analgesia. A high significant increase was observed in local anesthetic consumption in the first 24 h postoperatively in group T than group C. There were significant differences in nausea, vomiting, and frequency of antiemetic, whereas they did not occur in group T. There were no significant differences in the grade of motor block between two groups at 20 min or any other time. Conclusion TAP block was safe, and easy to perform, and more effective in the early postoperative period with significant reductions in opioid requirement, pain score, and complications, and did not produce motor block.

A Comparative Study between Ultrasound Guided Quadratus Lumborum Block versus Ultrasound Guided Transversus Abdominis Plane Block in Laporoscopic Bariatric Surgery

Background: ultrasound-guided quadratus Lumborumblock is performed as one of the perioperative pain management procedures for patients undergoing abdominal surgeries. Objective: the aim of this study was to compare the analgesic efficacy of ultrasound-guided trans-muscular quadratus lumborum block with transversus abdominis plane (TAP) block and intravenous opioid drugs during laparoscopic bariatric surgery and in the early postoperative period regarding pain relief, provision of comfort, early mobilization and improved respiratory functions. Patients and Methods: Setting and design: pilot exploratory study was conducted on 60 patients scheduled for elective laparoscopic bariatric surgeries. All patients received general anesthesia using IV fentanyl (1-2 μg/kg LBW). Group QLB (20 patients): received bilateral ultrasound-guided quadratus lumborum block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%. Group TAP (20 patients): received bilateral ultrasound-guided TAP block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%. Group GA (20 patients): received general anesthesia and then IV Morphine (0.1 mg/Kg LBW). Results: there was statistically significant difference between the three groups as regardsthe first call for rescue analgesia (morphine), total morphine consumption and pain scores; indicating that tansversus abdominis plane block was more effective than intravenous opioid drug analgesia, while quadratus lumborum block was more effective than tansversus abdominis plane block. Conclusion: this study concluded that quadratus lumborum block was the most effective technique in providing analgesia after laparoscopic bariatric surgery without associated hemodynamic instability in comparison to transversus abdominis plane block and intravenous opioid drugs.

A comparison of transversus abdominis plane block guided with ultrasonography and local anesthetic infiltration in laparoscopic cholecystectomy operations

The aim of this study was to compare a transversus abdominis plane (TAP) block guided with ultrasound (USG) and local anesthetic infiltration (LAI) in terms of the intraoperative and postoperative analgesia efficiency, intraoperative opioid need, and side effects in cases of laparoscopic cholecystectomy. A total of 75 patients classified as American Society of Anesthesiologists class I or II were included in this randomized, controlled, prospective study and divided into 3 groups. 20 mL of levobupivacaine 0.5% was applied around the trocar entrance site before the operation to group L (n=25), and 30 mL 0.25% levobupivacaine was applied with a USG-guided TAP block to group T (n=25). No TAP block or LAI was applied to the control group (n=25), group K. In the first 24 hours after surgery, an infusion of tramadol was administered with a controlled analgesia device. The intraoperative fentanyl use was recorded, and a visual analogue scale was administered to assess pain while resting (VASrest) and upon coughing (VAScough) at 1, 2, 4, 8, 12, 16, and 24 hours postoperative. An evaluation of shoulder pain and the consumption of analgesia in 24 hours were also recorded. The VASrest and VAScough values, the dose of fentanyl used intraoperatively, and the total analgesia dose administered in 24 hours were compared between groups and there was no statistically significant difference detected (p>0.05). In group T, the vomiting rate 1 and 2 hours postoperative (20% and 12%, respectively) was significantly lower than in group K (64% and 44%, respectively). The efficiency of the analgesia provided after a laparoscopic cholecystectomy with a bilateral TAP block guided with USG and LAI was determined to be similar.

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Effect of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block for post-operative pain relief in cesarean section

Introduction: Peripheral nerve blocks after cesarean section (C-section) reduce post-operative use of analgesic agents. Transversus abdominis plane (TAP) block is an effective way to provide postoperative analgesia. TAP block with ropivacaine alone has not consistently been proven to be useful after C-section, and dexmedetomidine has not been studied as an adjuvant to ropivacaine for TAP blocks after C-section. Objective: To compare the combination of dexmedetomidine and ropivacaine to ropivacaine alone for TAP block after C-section for time to onset of pain and time to rescue analgesia. Materials and Methods: Forty American Society of Anesthesiology grade I or II patients undergoing C-section were enrolled in this randomized, controlled, double-blind study. Twenty patients each were allocated to two groups receiving bilateral TAP block. Test group received TAP block with 3 mg/kg of ropivacaine with 50 μg of dexmedetomidine. Control group received TAP block with 3 mg/kg of ropivacaine. Patient demographics, time to initial reporting of pain, time to first rescue analgesia, quality of block, and side effects were recorded. Results: Time to initial onset of pain (6.6 vs. 5.03 h; P = 0.01) and time to first rescue analgesia (7.8 vs. 6.47 h; P = 0.03) were significantly longer in the test group compared with control group. The two groups were similar in demographics and quality of block. No significant difference in side effects was noted between the two groups. Conclusion: Addition of dexmedetomidine to ropivacaine for TAP block in patients undergoing C-section prolonged the time to initial onset of pain and time to first rescue analgesia.

Efficacy of preoperative transversus abdominis plane block with different volumes of ropivacaine for improving postoperative analgesia in patients undergoing laparoscopic radical resection of ovarian cancer

Objective To evaluate the efficacy of preoperative transversus abdominis plane(TAP)block with different volumes of ropivacaine for improving postoperative analgesia in patients undergoing laparoscopic radical resection of ovarian cancer. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 30-60 yr, with body mass index of 18-24 kg/m2, scheduled for elective laparoscopic radical resection of ovarian cancer under general anesthesia, were divided into 3 groups(n=20 each)using a random number table: 0.375% ropivacaine 20 ml group(group R1), 0.375% ropivacaine 12 ml group(group R2)and control group(group C). In R1 and R2 groups, ultrasound-guided bilateral TAP block was performed before induction of anesthesia, and 0.375% ropivacaine 20 and 12 ml were injected, respectively.Both groups received patient-controlled intravenous analgesia(PCIA)with sufentanil after operation, and the PCIA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of 2 ml to maintain the visual analogue scale score ≤3.When the visual analogue scale score >3, tramadol 100 mg was intravenously injected as rescue analgesic.The consumption of sufentanil during PCIA, effective pressing times of PCIA, requirement for rescue analgesic and occurrence of adverse reactions were recorded within 24 h after operation.At 10 min before induction of anesthesia and 4, 8, 12 and 24 h after operation, venous blood samples were collected for measurement of the plasma concentrations of interleukin-6(IL-6)and IL-10 by enzyme-linked immunosorbent assay. Results Compared with group C, the consumption of sufentanil, effective pressing times of PCIA, requirement for rescue analgesic and incidence of nausea and vomiting and pruritus were significantly decreased, and the concentration of plasma IL-6 was decreased and the concentration of IL-10 in plasma was increased at each time point after operation in R1 and R2 groups(P<0.05). The consumption of sufentanil, effective pressing times of PCIA, requirement for rescue analgesic and incidence of nausea and vomiting and pruritus were significantly lower, and the concentration of plasma IL-6 was lower and the concentration of IL-10 in plasma was higher at each time point after operation in group R1 than in group R2(P<0.05). Hematoma and infection at the puncture site were not found in R1 and R2 groups. Conclusion Preoperative TAP block can enhance the postoperative analgesic efficacy, reduce the occurrence of adverse reactions, and 0.375% ropivacaine 20 ml provides better efficacy in patients undergoing laparoscopic radical resection of ovarian cancer. Key words: Amides; Abdominal muscles; Nerve block; Pain, postoperative; Laparoscopy

Transversus Abdominis Plane Block Improves Perioperative Outcome After Esophagectomy Versus Epidural

Pain control is challenging during esophagectomy. An epidural is commonly used, but the sympathetic blockade can have unintended consequences such as hypotension or delayed return of bowel function. A transversus abdominis plane (TAP) block has the potential to control upper abdominal pain without these adverse consequences. We aimed to compare bilateral TAP blocks with patient-controlled analgesia (PCA) for immediate management after esophagectomy with a cohort using a thoracic (T5 to T8) epidural. This was a retrospective review of patients undergoing esophagectomy between 2012 and 2016. Primary outcomes were pain scores (0 to 10) assessed at 24, 48, and 72 hours for adequacy of pain control. Secondary outcomes were volume resuscitation at 72 hours, hypotension (systolic blood pressure <90 mm Hg), length of stay (LOS), return of bowel function, and complications. Sixty-one patients underwent esophagectomy using bilateral TAP block and PCA (n= 32) or thoracic (T5 to T8) epidural (n= 29). Overall pain scores were not statistically different between the TAP group and the epidural group averaged over 72 hours (4.98 versus 4.39, p= 0.09). During the initial 72 hours after operation, hypotension was less prevalent in the TAP group (25% versus 76%, p < 0.05) with lower crystalloid resuscitation needs. The LOS in the intensive care unit (3.2 days versus 4.6 days, p < 0.05) and return of bowel function (5 days versus 6.7 days, p < 0.05) were considerably shorter in the TAP group. Pulmonary complications were similar. TAP blocks with a PCA is an alternative option for pain control in patients undergoing esophagectomy and may reduce hypotension and need for volume resuscitation with similar pulmonary complications.

Sensory Assessment and Regression Rate of Bilateral Oblique Subcostal Transversus Abdominis Plane Block in Volunteers.

The analgesic effect and duration of a transversus abdominis plane (TAP) block remain controversial. Transversus abdominis plane blocks are effective for somatic/incisional pain but do not provide analgesia for visceral pain from intra-abdominal procedures. The purpose of this study was to assess the area and extent of cutaneous sensory blockade and the regression of dermatomal anesthesia after bilateral oblique subcostal TAP block. This observational, prospective clinical study consisted of 12 healthy volunteers. All volunteers received a bilateral oblique subcostal TAP block under real-time ultrasound guidance with 20 mL of 0.375% ropivacaine. The anterior abdominal cutaneous area was divided into 3 parts (midabdomen, left-lateral abdomen, right-lateral abdomen) using 2 lines drawn in a parasagittal fashion 5 cm lateral to the midline. The area of cutaneous sensory blockade involving the anterior abdomen was assessed 30 minutes after institution of the block using a cold stimulus. This was followed by repeated measurements using a cold stimulus applied along parasagittal lines drawn 3 cm lateral to the midline at 0.5, 6, 10, 14, 18, 22, and 26 hours after blockade. The area of cutaneous sensory blockade of the abdomen was 332 (SD, 73) cm; that of the midabdomen was 253 (SD, 29) cm, which represented an average of 90% of the area of the midabdomen; and that of the lateral abdominal wall (combination of left-lateral abdomen and right-lateral abdomen) was 79 (SD, 62) cm, which represented an average of 26% of total lateral abdominal area. Dermatomes T7-T12 of the midabdomen were successfully blocked in all volunteers after using the bilateral oblique subcostal technique. However, T6 and L1 were only variably blocked. The area of cutaneous sensory block of the anterior abdomen regressed over the ensuing 22 hours in the following manner: 90%, 87%, 73%, 50%, 22%, 3%, and 0% at 0.5, 6, 10, 14, 18, 22, and 26 hours, respectively. Bilateral oblique subcostal TAP block produces a widespread cutaneous sensory blockade with a consistent dermatomal distribution in the midabdomen for a considerable effective duration.

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.

The ultrasound-guided nerve blocks of abdominal wall contributed to anesthetic management of cholecystectomy in a patient with Becker muscular dystrophy without using muscle relaxants

Becker muscular dystrophy (BMD) is a progressive neuromuscular disorder caused by mutations in the dystrophin gene. The sensitivity to non-depolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than that in normal individuals, and the duration of the effect is known to be prolonged. In this report, we present the case of a 58-year-old man with BMD who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis under total intravenous anesthesia without the use of muscle-relaxant drugs and supplemented with regional anesthesia. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl; ultrasound-guided bilateral rectus sheath block (RSB) and right-sided subcostal transversus abdominis plane block (TAP) were performed. The procedure required conversion to open surgery because of hard conglutination; intraoperative and postoperative periods were uneventful. Adequate analgesia was maintained after extubation because of the effect of RSB and TAP.

Postoperative analgesic efficiency of transversus abdominis plane block after ventral hernia repair: a prospective, randomized, controlled clinical trial.

Effective postoperative analgesia is a key element in reducing postoperative morbidity, accelerating recovery and avoiding chronic postoperative pain. The aim of this study was to evaluate the effectiveness of ultrasound-guided Transversus Abdominis Plane (TAP) block, performed before surgical incision, in providing postoperative analgesia for patients undergoing open ventral hernia repair under general anaesthesia. Seventy elective patients scheduled for open ventral hernia repair surgery under general anaesthesia were divided randomly into two equal groups: Group I received bilateral TAP block performed before surgical incision (n = 35); Group II received systemic postoperative analgesia with parenteral opioid (morphine) alone (n = 35). Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded. Postoperative pain scores at rest and mobilization/cough were significantly higher in patients without TAP block (p < 0.05). Mean intraoperative fentanyl consumption was comparable between the two groups: 0.75 ± 0.31 mg in group I (TAP) and 0.86 ± 0.29 mg in group II (MO), p = 0.1299. Patients undergoing preincisional TAP block had reduced morphine requirements during the first 24 hours after surgery, compared to patients from group II, without TAP block (p = 0.0001). There was no difference in the incidence of opioid related side effects (nausea, vomiting) in the both groups during the first 24 postoperative hours. The use of preincisional ultrasound guided TAP block reduced the pain scores at rest and with movement/cough, opioid consumption and opioid-related side effects after ventral hernia repair when compared with opioid-only analgesia.

Transversus abdominis plane block after Caesarean section in an area with limited resources

Background: The primary objective of this study was to assess whether transversus abdominis plane (TAP) block is effective as part of multimodal pain management following Caesarean section in an area with limited resources. The study also looked at the advantage of this block in reducing the consumption of morphine and diclofenac postoperatively.Methods: After approval by the institutional ethics committee and informed consent of participants, 108 ASA I and II patients for Caesarean section under spinal anaesthesia were randomly allocated to either the TAP block group or the control. The TAP block group received a landmark-orientated, bilateral TAP block in the triangle of Petit. Postoperative pain treatment followed the same protocol for both groups. Visual analogue scale (VAS) pain scores were measured at 2, 4, 6, 8, 12, 18 and 24 h postoperatively. At the same time, consumption of diclofenac and morphine was measured and compared.Results: No adverse effects of the TAP block were detected. VAS pain scores were significantly lower in the TAP block group at rest, deep breathing, intentional coughing, and mobilisation in all cases (p < 0. 05). Morphine and diclofenac consumption was significantly higher in the control group (p < 0. 001).Conclusion: TAP block reduced the VAS pain scores significantly both at rest and during stressors. As a result, morphine and diclofenac consumption was significantly reduced in the TAP block group. Therefore, it is feasible to implement TAP block as part of a multimodal analgesia regimen after Caesarean section in a tertiary health care centre in a developing nation.

Continuous transversus abdominis plane block vs intermittent bolus for analgesia after abdominal surgery: a randomized trial

BackgroundContinuous and intermittent bolus techniques of transversus abdominis plane (TAP) blocks have been used for analgesia after abdominal surgery. Although both are effective, there are no studies comparing them. The aim of this study is to compare analgesia and cost-effectiveness between these groups.MethodsAfter obtaining ethical approval, 20 American Society of Anesthesiologists ASA grade I to III patients undergoing elective abdominal surgery were recruited with 10 patients allocated to each arm. Bilateral ultrasound-guided TAP blocks were performed with an initial bolus of 0.5% ropivacaine 20 mL per side, followed by catheter insertion. After surgery, the continuous infusion group received 0.2% ropivacaine 8 mL/hour on each side and the intermittent bolus group received doses of 0.2% ropivacaine 20 mL per side every 8 hours for 48 hours. Both groups received intravenous fentanyl patient-controlled analgesia and regular oral paracetamol. Parameters recorded included numerical rating scores for pain and post-operative analgesic consumption at baseline (time 0) and at 1 hour, 1 day and 2 days post-operatively. The duration of catheter insertion, complications, patient satisfaction and information regarding costs were also recorded. Patient satisfaction was assessed utilizing a 4-point “Likert” scale on day 2 and on day 30. Pain and Likert scores were analysed by non-parametric sum rank test and all two-sampled t-tests assumed unequal variances.ResultsThere was no difference between duration of TAP block, anesthetic and surgical technique and length of stay (p=0.23). Primary outcomes: pain scores at rest and cough were not significantly different (p=0.20) between the groups. Satisfaction scores were similar at day 2 and 30 (p=0.77). However, the bolus group was more cost-effective (AU$347.98 vs AU$429.43).ConclusionContinuous or bolus TAP blocks are effective analgesic techniques in abdominal surgery, with bolus technique being more economical.

Laparoscopic approach for the treatment of chronic groin pain after inguinal hernia repair : Laparoscopic approach for inguinodynia.

Traditional methods of clinical research may not be adequate to improve the value of care for patients with complex medical problems such as chronic pain after inguinal hernia repair. This problem is very complex with many potential factors contributing to the development of this complication. We have implemented a clinical quality improvement (CQI) effort in an attempt to better measure and improve outcomes for patients suffering with chronic groin pain (inguinodynia) after inguinal hernia repair. Between April 2011 and June 2016, there were 93 patients who underwent 94 operations in an attempt to relieve pain (1 patient had two separate unilateral procedures). Patients who had prior laparoscopic inguinal hernia repair (26) had their procedure completed laparoscopically. Patients who had open inguinal hernia repair (68) had a combination of a laparoscopic and open procedure in an attempt to relieve pain. Initiatives to attempt to improve measurement and outcomes during this period included the administration of pre-operative bilateral transversus abdominis plane and intra-operative inguinal nerve blocks using long-acting local anesthetic as a part of a multimodal regimen, the introduction of a low pressure pneumoperitoneum system, and the expansion of a pre-operative questionnaire to assess emotional health pre-operatively. The results included the assessment of how much improvement was achieved after recovery from the operation. Forty-five patients (48%) reported significant improvement, 39 patients (41%) reported moderate improvement, and 10 patients (11%) reported little or no improvement. There were 3 (3%) complications, 13 (11%) hernia recurrences, and 15 patients (13%) developed a new pain in the inguinal region after the initial pain had resolved. The principles of CQI can be applied to a group of patients suffering from chronic pain after inguinal hernia repair. Based on these results additional process improvement ideas will be implemented in an attempt to improve outcomes.

Efficacy of US-guided transversus abdominis plane block and rectus sheath block with ropivacaine and dexmedetomidine in elderly high-risk patients.

This study was designed to evaluate the effectiveness and safety of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks with ropivacaine and dexmedetomidine in elderly, high-risk patients undergoing emergency abdominal surgery. Sixty elderly patients undergoing emergency abdominal surgery receiving both bilateral ultrasound-guided TAP and RS blocks were randomly divided into two groups: R+D (10 mL of 0.25% ropivacaine+0.5μg/kg dexmedetomidine) and R (10 mL of 0.25% ropivacaine). Pain scores (at rest and with movement) and overall analgesia satisfaction were assessed. The total amount of sufentanil administered postoperatively during the first 24 h, duration of sensory blockade, first time and total number of patient-controlled intravenous analgesia (PCIA) pump activations on the first postoperative day were recorded. The duration of sensory blockade and the first time to PCIA pump activation in the R+D group were longer than that of the R group (P<0.05). The total number of PCIA pump activations on the first postoperative day as well as the total amount of sufentanil administered during the first 24 h in R+D group were less than in the R group (P<0.05). VAS scores at rest and during activity in the R+D group were lower than those in the R group at 2, 6, and 12 h after surgery (P<0.05). Ultrasound-guided TAP and RS blocks with ropivacaine and dexmedetomidine are more effective in promoting block effect, prolonging the duration of analgesia, reducing postoperative pain in elderly high-risk patients undergoing emergency abdominal surgery.