Guided Transversus Abdominis Plane Block Research Articles

Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic bariatric surgery: a randomized controlled trial

BackgroundTransversus abdominis plane block (TAPB) guided by laparoscopy and ultrasound showed promise in enhancing the multimodal analgesic approach following several abdominal procedures. This study aimed to compare the efficacy and safety between Laparoscopic (LAP) TAP block (LTAP) and ultrasound-guided TAP block (UTAP) block in patients undergoing LAP bariatric surgery.Patients and methodsThis non-inferiority randomized controlled single-blind study was conducted on 120 patients with obesity scheduled for LAP bariatric surgeries. Patients were allocated into two equal groups: LTAP and UTAP, administered with 20 mL of 0.25% bupivacaine on each side.ResultsThere was no statistically significant difference in the total morphine consumption, Visual Analogue Scale (VAS) score at all times of measurements, and time to the first rescue analgesia (p > .05) between both groups. The duration of anesthesia and duration of block performance were significantly shorter in the LTAP group than in the UTAP group (p < .001). Both groups had comparable post-operative heart rate, mean arterial pressure, adverse effects, and patient satisfaction.ConclusionsIn LAP bariatric surgery, the analgesic effect of LTAP is non-inferior to UTAP, as evidenced by comparable time to first rescue analgesia and total morphine consumption with similar safety blocking through the low incidence of post-operative complications and patient satisfaction.Trial registrationThe study was registered in Pan African Clinical Trials Registry (PACTR) (ID: PACTR202206871825386) on June 29, 2022.

Comparison of USG guided with Anatomical Landmark guided TAP Block following Total Abdominal Hysterectomy

A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.

Genel Anestezi Altında Göbek Altı Ameliyatları Geçiren Çocuklarda Postoperatif Analjezi için Quadratus Lumborum Bloğu ile Transversus Abdominis Plan Bloğunun Karşılaştırılması: Prospektif Randomize Çalışma

Objective: Quadratus lumborum block (QL block) is a new addition to the truncal blocks used for postoperative analgesia of both upper and lower abdominal surgeries. We conducted this study to evaluate and compare the effect of the two truncal blocks QL-II block and transverses abdominis plane block on the of duration of effective analgesia in children undergoing infra umblical surgeries under general anesthesia. Methods: A prospective randomised study in patients between 1-7 years of age undergoing infraumbilical surgeries. 33 patients in each group. Group A received ipsilateral ultrasound guided Quadratus lumborum (QL) block group (0.5 ml kg-1 0.2% bupivacaine) and Group B received ipsilateral ultrasound guided Transversus abdominis plane block (TAP) (0.5 ml kg-1 0.2% bupivacaine). The primary outcome was the duration of effective in the postoperative period and secondary outcomes were the distribution of FLACC scores and Parent Satisfaction score. Results: The duration of effective analgesia was longer in group A (mean of 18.0 hours) when compared to group B (mean of 9.5 hours) in Quadratus lumborum (Type II) block group tends to have lesser pain scores (FLACC scale) and better parent satisfaction levels when compared with TAP block. Conclusion: Quadratus lumborum-II block provides longer duration of effective analgesia in the post–operative period in children aged 1-7 years undergoing infra umbilical surgeries under general anaesthesia. It also tends to achieve lesser pain scores and better parent satisfaction levels when compared with TAP block. Keywords: Bupivacaine, quadratus lumborum, satisfaction, analgesia, children

Effect of dexamethasone as an adjuvant to levobupivacaine in transversus abdominis plane (TAP) block for postoperative analgesia in subjects undergoing lower segment cesarean section

Background: Inadequate pain relief after caesarean section is a common problem in every part of the world. Transversus abdominis plane (TAP) block provides adequate post-operative pain relief following abdominal surgeries. TAP block duration is limited to effect of administered local anesthetics. Hence, adjuvant medications are added to local anaesthetic (LA) to prolong the effect of TAP block. The primay objective of this study was to analyse the analgesic effect of dexamethasone added to levobupivacaine in comparison with analgesic effect of levobupivacaine alone in TAP block. The secondary objectives are to analyse the number of supplemental analgesic requirements in the first 24 hrs after surgery and to analyse the duration of postoperative analgesia which is time to first analgesic request from the time of TAP block. Methods: 116 women scheduled for lower segment cesarean section (LSCS), belonging to ASA physical status 2 or 3, aged between 18 and 35 years, under SAB were recruited. Ultrasonogram (USG) guided TAP block was performed on each side after the completion of the surgery. Subjects in group L (n = 58) received TAP block on each side with 20 ml of 0.375% levobupivacaine and group LD (n = 58) with 19 ml of 0.375% levobupivacaine + 1ml (4mg) of dexamethasone. They were evaluated for pain at 10min, 30min, 45min, 1hour, 2hrs, 4hrs, 8hrs, 12hrs and 24hrs after the block using visual analog scale (VAS) score. Duration of postoperative analgesia and requirement of rescue analgesia were also analysed. Results: The post-operative visual analogue scale (VAS) scores were lower in group LD at 8, 12 and 24 hrs (p &lt; 0.05). Mean duration of analgesia was significantly prolonged in group LD with lesser requirement of rescue analgesics (p &lt; 0.05) up to 24 hrs. Conclusion: Dexamethasone (4 mg) as an adjuvant to levobupivacaine in USG guided TAP block reduces post-operative pain scores prolongs the duration of analgesia and decreases demands for rescue analgesics.

Effect of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Congenital Inguinal Hernia Repair

Abstract Background Inguinal hernia is the most common lower abdominal surgery of childhood. It results from a small sac that comes through the inguinal ring that is normally open during fetal life and closes around the time of birth. For reasons we don't understand, it does not close in some infants. This sac then makes a pathway for abdominal organs to come through the inguinal ring into the groin. Analgesic techniques in pediatric patients having surgery are often delayed by the inherent difficulties of conducting a large randomized clinical trial in those patients. TAP block and caudal epidural block are two anesthetic techniques that are commonly used in pediatric age group for lower abdominal surgeries. Aim of the Work Compares the efficacy of Dexmedetomidine as an adjuvant to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block versus Caudal Block for postoperative analgesia in children undergoing congenital inguinal hernia repair especially to provide prolonged post-operative analgesia and decrease opioid consumption. Patients and Methods We conducted a prospective, randomized, controlled and comparative study in Ain shams university hospitals in a period of 6 months including 50 patients divided on 2 groups; group A 25 of them received ultrasound guided transversus abdominis plane block with 0.3 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 2.5-8 years and they were 6 females (24%) and 19 were males (76.0%) and group B 25 patients received caudal epidural block with 0.6 ml/kg of 0.25% Bupivacaine with 1 µg/kg dexmedetomidine with age ranged from 3 – 9 years and they were also 4 females (16%) and 21 were males (84.0%). Results In the present study there was statistically significant increase in pain at 1 hr, 2 hrs and 4 hrs in caudal block group and increase in pain score at 12 hrs in tap block group but there was no statistically significant difference found between them at 6 hrs, 18 hrs and 24 hrs. There was statistically significant increase in rescue analgesia in caudal block group at 4 hr with p-value &amp;lt;0.001; also there was statistically significant increase in rescue analgesia in tap block than caudal block at 12 hr with p-value = 0.009 while no statistically significant difference found between both groups at the other times of follow up. Conclusion TAP block was superior to caudal epidural anesthesia in terms of early postoperative pain, less need for rescue analgesia and need for less potent analgesia e.g. Paracetamol and NSAID. Addition of dexmedetomidine to conventional regional anesthetic protocol showed significant reduction of postoperative pain and the need for rescue analgesia.

Comparative Study of Post-Operative Analgesic Effect between Wound Site Infiltration and Bilateral U/S Guided Transversus Abdominis Plane Block with 0.25% Bupivacaine after Cesarean Section

Abstract Background The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. Objectives This study assessed the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to local wound infiltration after cesarean section regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). Patients and Methods The study was conducted on 90 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for cesarean section surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 45 patients each: TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Local wound infiltration: received general anesthesia and with 0.25% bupivacaine 30 ml at surgical site. Results The results of the study revealed that the Patients who received TAP block had significantly lower pain scores for 12 h after operation and decreased total need of analgesic in first 12 h post-operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores for 12 hours and lower total 12 hours postoperative pethidine consumption after cesarean section under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Intravenous Patient Controlled Analgesia for Post Operative Analgesia in Parturients Undergoing Cesarean Delivery under General Anesthesia

Abstract Background Cesarean delivery rates are rising, and efficient postoperative pain management is a key priority of women undergoing cesarean delivery. Inadequate pain management in the acute postoperative period is associated with persistent pain, greater opioid use, delayed functional recovery, and increased postpartum depression. In addition to pain relief, optimal management of patients after cesarean delivery should address the goals of unrestricted maternal mobility, minimal maternal and neonatal side effects, rapid recovery to baseline functionality, and early discharge home. Aim of the Work The Primary aim is to compare the efficacy of TAP block versus PCA with IV morphine to Provide Prolonged Post-operative analgesia. Secondary objective is to identify the side effects of both techniques as post operative analgesia. Patients and Methods 74 patients were randomly allocated to one of 2 groups (n=37; each); group A received general anesthesia followed by US-guided TAB block at the end of the operation before extubation using 20 ml bupivacaine 0.25% bilaterally. Group B: received general anesthesia followed by PCA at the end of operation after extubation via dedicated 20 G canula woth disposable PCA pump of 100 ml volume, through continuous infusion of 2 ml/hr &amp; bolus application of 1 ml with 15 min lock time using 50 mg morphine, 60 mg ketorolac, 2 mg granisetrone &amp; filled with 0.9% normal saline. Conclusion when TAP block is given in the volume of 20 mL bilaterally, it is as effective as intravenous Morphine PCA in pain treatment. Compared with intravenous PCA, TAP block can be considered as a more preferable method because it can avoid the systemic actions of morphine used for PCA, and its analgesic effect begins earlier.

Randomized single blind trial to compare the short term post-operative outcome and cost analysis of laparoscopic versus ultrasound guided transversus abdominis plane block in patients undergoing bariatric surgery.

Laparoscopic Bariatric surgery despite being minimally invasive can cause moderate to severe pain in the immediate postoperative period. Adequate pain management remains a major challenge. Transversus Abdominis Plane (TAP) block is a regional anesthesia technique which blocks the sensory nerve supply of anterior-lateral abdominal wall. Primary: evaluate Laparoscopic versus ultrasound (USG)-guided TAP block on immediate post-operative analgesia after undergoing laparoscopic bariatric surgery. Secondary: compare cost effectiveness of Laparoscopic versus ultrasound-guided TAP block after undergoing bariatric surgery. Randomized Single blind study undertaken after sample size was calculated by (N) = 2(Zα + Z1-β)2σ2/δ2 which proposed 60 patients in each group. Block randomization was done after excluding redo/revision surgeries and patients were alloted Group I: Laparoscopic-guided TAP block & Group II: USG-guided TAP block. In both groups, Bilaterally, 20ml (0.25%) bupivacaine was injected immediately after completion of bariatric surgery. SPSS v23 (IBM Corp.) was used for analysis. Group I (N = 61 53F/8M) & Group II (N = 60 42F/18M) were demographically comparable. Group I (3.58 ± 0.67) had significantly lower procedure time compared to Group II (12.47 ± 1.61) (p-Value < 0.001). First rescue analgesia was administered at 7.07 ± 2.61h in Group I vs 7.21 ± 2.39h in Group II (p-Value 0.659). In first 24h rescue analgesic dose requirement in Group I was 1.29 ± 0.53 vs 1.39 ± 0.50 in Group II (p-Value 0.487). VAS scores during rest and movement till 24h post-operative were statistically similar. Procedural cost was more in group II. Laparoscopic-guided TAP block is a safe and cost-effective approach for postoperative pain management after bariatric surgery and provides similar comparable analgesic effect as the USG-TAP block. Laparoscopic TAP is a surgeon delivered, easy to administer and significantly less time-consuming procedure which is feasible even when an ultrasound machine is not available.

V10-09 SURGEON ADMINISTERED LAPAROSCOPIC GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023V10-09 SURGEON ADMINISTERED LAPAROSCOPIC GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Pushan Prabhakar, Hariharan Ganapathi, Ahmed Eldefrawy, Jorge Caso, and Murugesan Manoharan Pushan PrabhakarPushan Prabhakar More articles by this author , Hariharan GanapathiHariharan Ganapathi More articles by this author , Ahmed EldefrawyAhmed Eldefrawy More articles by this author , Jorge CasoJorge Caso More articles by this author , and Murugesan ManoharanMurugesan Manoharan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe the technique of a surgeon-administered laparoscopic guided transversus abdominis plane block and evaluate the safety and efficacy of the block in patients underwent robot-assisted laparoscopic prostatectomy (RALP). METHODS: A consecutive series of patients who underwent RALP were administered laparoscopic guided transversus abdominis plane block by the surgeon. A validated numeric pain rating scale was used to record their pain during their postoperative hospital stay. Also, the morphine milligram equivalents (MME) for pain medications were calculated. RESULTS: A total of 61 patients were included in the analysis, 57 patients were discharged within 24 hours and 4 patients were discharged the following day. The mean pain score prior to discharge (24 hr) was 3.64 ± 1.81 (range 1-8). The MME for postoperative day 1 was 13.7 ± 11.03 (range 0-49) and 10.91 ± 8.77 (range 0-25) for postoperative day 2. There were no block related complications. CONCLUSIONS: The surgeon administered laparoscopic TAP block is a safe pain management tool. Studies compared laparoscopic guided TAP block with ultrasound-guided TAP block and reported no discernible differences in the efficacy of pain management following general surgical procedures. Direct visualization of the administration site minimizes complications such as iatrogenic visceral injury by the needle or administration of the local anesthetic in the wrong plane. In addition, the surgeon-administered block also potentially reduces the additional time taken to set up an ultrasound guided TAP block which requires an anesthesiologist and an ultrasound machine. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e928 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pushan Prabhakar More articles by this author Hariharan Ganapathi More articles by this author Ahmed Eldefrawy More articles by this author Jorge Caso More articles by this author Murugesan Manoharan More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparative Study between Caudal Epidural Block and Ultrasound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia in Children Undergoing Infraumblical Surgeries

Comparative Study between Caudal Epidural Block and Ultrasound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia in Children Undergoing Infraumblical Surgeries

Study of Dexmedetomidine versus Fentanyl as Adjuvants to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block for Postoperative Analgesia after Cesarean Delivery

Study of Dexmedetomidine versus Fentanyl as Adjuvants to Bupivacaine in Ultrasound Guided Transversus Abdominis Plane Block for Postoperative Analgesia after Cesarean Delivery

THE ANALGESIC EFFICACY OF TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK VERSUS EPIDURAL ANALGESIA IN LAPAROSCOPIC LOWER ABDOMINAL SURGERIES IN ADULTS: A CASE STUDY

Background: The aim of the study was to compare the analgesic efcacy of epidural analgesia and transversus abdominis plane (TAP) block in laparoscopic lower abdominal surgeries for postoperative pain management. Over time, TAP block has gained popularity, however its superiority versus epidural analgesia is still debatable. Methods: 120 patients undergoing lower abdominal surgeries under general anaesthesia were randomly allocated into two groups, to postoperatively receive lumbar epidural analgesia (Group E) or USG guided TAP block (Group T). Group E received 0.125% bupivacaine (20ml) as a single shot postoperative analgesic via lumbar epidural catheter Group T received 0.125% bupivacaine (20ml) as a single shot postoperative analgesic via USG guided TAP block Pain at rest, Numeric Rating Scale (NRS) and rst request for rescue analgesia (Inj. Paracetamol 20mg/kg IV) were recorded

Transversus Abdominis Plane (TAP) Steroid Block for Chronic Abdominal Pain Caused by Chronic Postoperative Pain

Introduction: Various factors including surgical, psychological, amount of acute pain relief have been proposed as risk factors for developing CPSP. Different treatment modalities like nerve and plane blocks, psychiatric counselling have been described to counter this pain.&#x0D; Case: The patient was a 30-year-old female with complaints of severe pain in the right lower quadrant of the abdomen and found a surgical scar with hyperalgesia and a history of open appendicectomy surgery, two times section caesarean section surgery. The patient experienced pain after section caesarean section surgery 6 months ago. Because the pain was also felt in the right hypochondrium, the patient was unable to move his body, unable to sit and stand. The patient was diagnosed as a case of chronic post surgical pain syndrome (CPSP). We performed transversus abdominis plane block (TAP) with ultrasound guidance and lidocaine 15 ml combined with 40mg methylprednisolone. VAS scores showed significant improvement from 8/10 and 2/10 during the 10-day follow-up. We conclude that ultrasound-guided TAP block can be a treatment option for CPSP cases.&#x0D; Conclusion: Chronic post surgical pain (CPSP) is a definite clinical entity after laparatomy. We report a successful management of such a case with ultrasound guided transversus abdominis plane block. The patient had very significant pain relief after procedure follow up continue until today without any side effects.

Efficacy of Fentanyl Patches versus Ultrasound Guided Transversus Abdominis Plane Block in Post Cesarean Section Pain Relief: A Randomized Clinical Study

Efficacy of Fentanyl Patches versus Ultrasound Guided Transversus Abdominis Plane Block in Post Cesarean Section Pain Relief: A Randomized Clinical Study

Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block versus Epidural Block for Postoperative Analgesia Following Lower Abdominal Cancer SurgeriesA Randomised Clinical Study

Introduction: Effective post-operative analgesia improves patient’s outcome and satisfaction. Many methods are available to provide best analgesia after major abdominal surgery. Epidural anaesthesia is “gold standard” but it is associated with its own drawbacks. Transversus Abdominis Plane (TAP) block is a comparable technique to epidural to provide reliable analgesia in lower abdominal surgeries. Aim: To compare the efficacy of Ultrasonography (USG) guided TAP block and the epidural block for the post-operative pain management in lower abdominal cancer surgery. Materials and Methods: This randomised clinical double-blinded study, conducted in 60 female patients undergoing lower abdominal cancer surgery under General Anaesthesia (GA) from July 2022 to September 2022. Patients were randomised to Group-E and Group-T. Group-E (Epidural) received injection (inj.) 0.2% Ropivacaine (10 ml) plus inj. Morphine 2 mg via epidural. Group-T (TAP) received inj. 0.2% Ropivacaine (20 ml) plus inj. Morphine 2 mg on each side via USG guided TAP block postoperatively. The Visual Analog Scale (VAS) Score, first rescue analgesia, total analgesic consumption and any side-effects in 24 hours were recorded. The Statistical Package for Social Sciences(SPSS) version 22.0 International Business Management (IBM) Corporation (NY) was used for statistical analysis. Unpaired t test, Chi-square test and Fisher’s-exact test and one-way Analysis of Variance (ANOVA) test were used as and when appropriate. Results: Data of total 60 female patients , 30 patients in each group(Group E mean age: 47.33±9.614 years and Group T mean age: 47.77±12.370 years) was collected and analysed. Both the groups were comparable with respect to age, height, weight, American Society of Anaesthesiologists (ASA) grade, mean duration of surgery and duration of anaesthesia (p&gt;0.05). More patients in group-E had moderate pain at rest and coughing (VAS-4 to 6) at six hours and 12 hours which is statistically significant (p&lt;0.05). None of the patient in both groups had severe pain. Time for need of first rescue analgesic was lower in Group-E (399.6±25.32 min) and in Group-T it was higher (462.6±26.94 min) which is also statistically highly significant (p&lt;0.001). Conclusion: TAP has advantage over epidural in terms of effective postoperative analgesia, time of need and quantity of postoperative analgesics.

Transversus Abdominis Plane Block with or without Intravenous Diclofenac Sodium as a Component of Multimodal Postoperative Analgesia Following Laparoscopic Cholecystectomy: A Randomised Clinical Study

Introduction: Multimodal analgesia is the recommended approach for treating post-operative pain after laparoscopic cholecystectomy. The Transversus Abdominis Plane (TAP) block is a recently introduced technique showing promising results. To control visceral and somatic pain adequately and to avoid use of opioids intra-operative diclofenac sodium, combined with TAP block as part of a multimodal approach, may be beneficial. Aim: To evaluate the efficacy of TAP block with or without intraoperative diclofenac sodium aqueous injection for controlling post-operative pain following laparoscopic cholecystectomy. Materials and Methods: A randomised, double-blinded study was conducted from February 2022 to October 2022 at Nil Ratan Sircar Medical College, Kolkata, West Bengal, India. Forty American Society of Anaesthesiology (ASA) physical status-I and II patients aged 20-50 years scheduled for elective laparoscopic cholecystectomy were divided into two groups of 20 patients each. Group A patients received bilateral Ultrasonography (USG) guided TAP block using 20 mL of 0.125% Bupivacaine on each side of the abdomen at the end of surgery. Group B patients received intravenous injection of diclofenac sodium aqueous 75 mg intravenous, intraoperatively, along with bilateral USG guided TAP block using 0.125% Bupivacaine. The primary outcome was the duration of post-operative analgesia (measured by the first request for rescue analgesia after the end of the operation at a VAS score of 4). Secondary outcomes included the total post-operative analgesic requirement (diclofenac sodium), pain score (VAS) over 24 hours in the post-operative period, and the incidence of complications such as nausea, vomiting, hypotension, and bradycardia. Patient Satisfaction Score (PSS) was recorded for each patient before discharge. Statistical analysis was performed using Statistical Package for Social Sciences(SPSS) version 24.0 software. Continuous variables were expressed as mean and standard deviation, and categorical variables were expressed as percentages. Independent t-tests and chi-square tests were used for between-group comparisons, with a p-value ≤0.05 considered statistically significant. Results: Amongst total 40 patients included, divided into group A(mean age: 32.95±8.74 years, 6 males and 14 females) and group B(31.90±9.16 years, 5 males and 15 females) with 20 patients each, the demographic characteristics such as age, gender, height, and weight were similar in both groups. The duration of post-operative analgesia was longer in Group B (16.32±1.29 hours) than in Group A (7.85±1.04 hours). The total post-operative analgesic requirement was lower in Group B (32.95±20.9 mg) compared to Group A (58.33±17.14 mg). Visual Analogue Scale (VAS) scores were lower in Group B than in Group A. PSS was significantly higher in Group B patients (8.14±1.06) than in Group A patients (6.16±1.38). Conclusion: TAP block, along with intra-operative intravenous diclofenac sodium aqueous, as part of a multimodal regimen, provides superior post-operative analgesia compared to TAP block alone. It is also associated with improved patient satisfaction.

Analgesic efficacy of ultrasound-guided bilateral transversus abdominis plane block in children: retrospective analysis of 97 cases.

Transversus abdominis plane (TAP) block is a method for postoperative pain management. Studies on children are gradually increasing. The aim of this retrospective study was to evaluate effectiveness of TAP block on pain control, its side effects, and parental satisfaction levels in children. Study included patients operated between January 2019 and December 2020 in Gazi University Faculty of Medicine. Total of 97 patients (35 girls, 62 boys) between 5 and 18 years who had an ultrasound guided TAP block for lower abdominal or inguinal surgery were examined retrospectively. TAP block application time, hemodynamic variables, postoperative pain scores, postoperative analgesic requirement, sex, surgical history and satisfaction levels were evaluated. : The average application time of TAP block was 9.48 ± 3.4 and the time between TAP block and surgical incision was 12.06 ± 6.1 min. Pain scores in postanesthesia care unit (PACU) and at the postoperative first hour decreased as the time between TAP block and surgical incision increased (p < 0.05). Girls have higher pain scores at PACU than boys (p < 0.05). Previous surgical history increased postoperative 1st hour pain scores (OR: 13.8; 95% CI 1.7-113.3; p = 0.01). There was a significant negative correlation between pain scores at PACU, postoperative 1st, 2nd, 4th, 6th, 12th and satisfaction levels (r = -0.45, r = -0.56, r = -0.60, r = -0.54, r = -0.52, r = -0,43, respectively, p < 0.05). Ultrasound-guided TAP blocks can be performed safely in children in lower abdominal surgeries. However, the efficacy of TAP block on late term postoperative pain scores is limited. Time interval between the TAP block and the incision, sex, and pain memory, as well as other factors that may improve the quality of TAP block should be considered.

Comparison Between The Effectiveness of Lateral and Posterior Transversus Abdominis Plane Block by Using Bupivacaine After Total Abdominal Hysterectomy.

Background: Transversus Abdominis Plane (TAP) block is a regional anaesthetic technique used for postoperative pain management following abdominal surgery. Local anesthetics like bupivacaine can be used in this block and it can be performed in various approaches. Among them ultrasound-guided lateral and posterior approaches are popular. Objective: Aim of this study is to compare the effectiveness of lateral and posterior approaches of ultrasound-guided TAP block using bupivacaine in the management of post-operative pain after total abdominal hysterectomy under subarachnoid anesthesia. Materials and Methods: This randomized clinical trial was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka. Total 90 patients were scheduled for elective total abdominal hysterectomy and assigned into two equal groups, group A and group B received ultrasound guided TAP block in lateral approach and in posterior approach respectively. Then patients were observed for pain intensity at rest and during deep breath by visual analog scale (VAS), after 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours of TAP block. The time of first analgesic demand was noted. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: The mean pain intensity at rest and during deep breath was statistically significant (p&lt;0.05) at 4, 6, 12 and 24 hours after TAP between two groups. The mean duration of first analgesic demand was 5.04±0.54 hours in group A and 6.59±0.69 hours in group B was statistically significant (p&lt;0.05) between two groups. Conclusion: TAP block in posterior approach provided considerably effective postoperative analgesia in first 24 hours than lateral approach after total abdominal hysterectomy. KYAMC Journal Vol. 13, No. 02, July 2022: 66-71

A comparative study between the use of dexmedetomidine vs. dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries

Background &amp; objective: Transversus abdominis plane (TAP) block using local anesthetics is associated with relatively shorter duration of action, and thus additional analgesic drugs are required in the postoperative period. We compared the efficacy and duration of postoperative analgesia achieved with using dexmedetomidine or dexamethasone as adjuvants to bupivacaine in TAP block for lower abdominal surgeries.&#x0D; Methodology: We enrolled 45 adult patients aged from 20-60 y, and randomly divided them into three equal groups. Group A received ultrasound guided TAP block with 0.25% bupivacaine 20 ml plus 4 mg dexamethasone on each side. Group B received 0.25% bupivacaine 20 ml plus dexmedetomidine 0.5 µg/kg on each side, and Group C (control group) patients received only 0.25% bupivacaine 20 ml on each side. Postoperative pain was assessed with VAS on arrival in post-anesthesia care unit (PACU), at 2 h, 6 h, 12 h, 18 h, and at 24 h postoperatively. Duration of analgesia was the time from drug injection to the time of first rescue of analgesia was recorded.&#x0D; Results: Mean duration to first dose of rescue analgesia among patients of dexmedetomidine group (Group B) was significantly prolonged as compared to dexamethasone group and bupivacaine only group. Regarding postoperative pain scores there were no statistically significant difference between the three groups; except at 6 h between the A and B groups and the control group. Both dexamethasone group and dexmedetomidine group showed better pain control than bupivacaine only at 6 h interval.&#x0D; Conclusion: Dexmedetomidine added to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries prolongs the time to initial postoperative pain presented by time to first rescue analgesic demand than dexamethasone added to bupivacaine; the shortest time to first rescue analgesic was observed in bupivacaine alone group.&#x0D; Abbreviations: TAP: Transversus abdominis plane block; LA: Local anesthetic; PACU: Post anesthesia care unit; VAS: Visual Analogue Scale; ASA: American Society of Anesthesiologists; SD: Standard deviation; IQR: Inter quartile range.&#x0D; Citation: Sobhy YS, Gadalla RR, Nofal WH, Saleh MAE, Abdou KM. A comparative study between the use of dexmedetomidine .vs dexamethasone as adjuvants to bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative pain relief in patients undergoing lower abdominal surgeries. Anaesth. pain intensive care 2022;26(5):681–688; DOI: 10.35975/apic.v26i5.2031

Laparoscopic guided liposomal bupivacaine injection compared to transversus abdominus plane block for postoperative pain after robotic gynecologic oncology surgery

ObjectiveThe purpose of this study was to determine if laparoscopically guided transversus abdominis plane block (Lap-Tap) with liposomal bupivacaine provides superior postoperative pain control when compared to ultrasound-guided block (US-Tap) with liposomal bupivacaine at the time of robotic surgery for gynecology oncology patients. MethodsThis was a prospective randomized controlled trial assigning patients to one of two cohorts: Cohort 1 consisted of US-Tap administered before the procedure using liposomal bupivacaine, Cohort 2 consisted of Lap-Tap administration with laparoscopic visualization using the medication above. Primary outcomes were pain scores and total opioid use in Oral Morphine Equivalents (OME) during the first 72 h after surgery. Secondary outcomes were postoperative pain satisfaction and oral narcotic requirements. ResultsThere was a significant increase in oral narcotic use in the first 24 h in the US-Tap cohort compared to the Lap-Tap cohort: Lap-Tap mean = 6.73 ± 8.22 OME versus US-Tap mean = 12.69 ± 12.94 p = 0.018 OME. The increase was equivalent to one additional Hydrocodone-Acetaminophen 7.5 mg/325 mg in the first 24 h after surgery. However, total oral narcotic use over the first 72 h was not significantly different between the two cohorts: Lap-Tap mean = 21.73 ± 19.83 OME, US-Tap mean = 32.50 ± 29.47, p = 0.062 OME. In addition, there was no significant difference in satisfaction or pain scores between the US-Tap and Lap-Tap groups at 24, 48, or 72-hours. ConclusionsLap-Taps are comparable to US-Tap for postoperative analgesia during the first 72-h after surgery when performing robotic-assisted gynecologic oncology surgery.