Guided Transversus Abdominis Plane Block Research Articles

Comparison of ultrasound guided transversus abdominis plane block versus local wound infiltration for post operative analgesia in patients undergoing gynaecological surgery under general anaesthesia.

Transversus abdominis plane block has been recently developed as a part of multimodal post operative analgesic techniques. We compared the analgesic efficacy of this technique with local bupivacaine infiltration in patients undergoing gynaecological surgeries with pfannenstiel incision and lower midline incision under general anaesthesia. To evaluate the efficacy of ultrasound guided transversus abdominis plane block for postoperative analgesia. Patients were randomly allocated to three groups: control group (n=15), transversus abdominis plane block group (n=15), who received bilateral transversus abdominis plane blockwith 0.25% bupivacaine, and local infiltration group (n=15), who received local wound infiltration with 0.25% bupivacaine at the end of surgery. All patients received intramuscular diclofenac 12 hourly and intravenous tramadol SOS in the postoperative period. Visual analogue scores for pain were assessed at 1,2,4,8,12 and 24 hours postoperatively and these were compared between the three groups. Average tramadol consumption in 24 hours were also compared among the three groups. Data were subjected to univariate ANOVA test and chi-square test. Level of significance was set at 0.05. Visual analogue scores were significantly less in transversus abdominis plane block group and effect lasted up to 12 hours at rest postoperatively and 8 hours during cough and movement. Bilateral Transversus abdominis plane block was effective in reducing postoperative pain scores for 8 to 12 hours postoperatively. This block was also successful in reducing postoperative opioid requirement.

Use of ultra-sound guided transversus abdominis plane block for effective postoperative analgesia among patients undergoing gynecologic surgery

Use of ultra-sound guided transversus abdominis plane block for effective postoperative analgesia among patients undergoing gynecologic surgery

GYNECOLOGICAL SURGERIES

Objectives: To evaluate the use of ultra-sound guided transversus abdominisplane block for effective postoperative analgesia in patients undergoing gynaecological surgeryvia transverse lower abdominal skin incision. Study Design: Randomized Control Trial. Period:Six months from April 2013 to October 2013. Setting: Department of Anesthesiology, HolyFamily hospital, Rawalpindi .Sampling technique: Consecutive non-probability sampling.Material and Methods: 200 female patients undergoing gynecological surgery via transverselower abdominal skin incision were enrolled in the study. They were divided into two groups;both received ultra-sound guided transversus abdominus plane block with either bupivacaine(Group A) or saline (Group B). SPSS version17.0 was used to analyze the data. Results:Two hundred female patients undergoing gynecological surgeries were included. Mean ageof patients was 41 yrs (17-71yrs). There were 100 patients in each group. Both groups werecomparable with respect to baseline features. The US-TAP block significantly reduced painintensity as compared to standard care in the PACU at 4hrs(5.2±3.1vs.8.4±1.3,p=0.003).Therewas insignificant difference between the visual assessment score of pain at 8hrs between thetwo study groups(3.6±2.3vs.2.3±2.4,p=0.4). Conclusions: Ultrasound guided transversusabdominis plane block (TAP) is an effective modality for reducing postoperative pain aftergynaecological surgery via transverse lower abdominal skin incision.

Ultrasound guided TAP block versus ultrasound guided caudal block for pain relief in children undergoing lower abdominal surgeries

ObjectiveUltrasound guided transversus abdominis plane (TAP) nerve block and caudal analgesia are safe and effective methods in children. The aim of the study was to compare the effectiveness and safety of both methods.Methods60 patients were randomly allocated into 3 groups: group A: (n = 20) received ultrasound guided transversus abdominis plane (TAP) block; group B: (n = 20) received ultrasound guided caudal block and group C: (n = 20) received conventional analgesia to be considered as controlled group. Hemodynamics, pain scores of Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) and objective pain score (OPS), postoperative complication, satisfaction of the patients and parents and postoperative analgesic requirements were recorded.ResultsThere was no significant difference between the three groups in mean arterial blood pressure and heart rate. Postoperative analgesia requirements were significantly higher in group B compared to group A, meanwhile it was significantly higher in group C compared to both groups A and group B. There was significant difference between group A and group C in pain scores assessment but no significant difference between group A and group B. Patient and parent satisfaction was markedly observed in groups A & B more than group C (the control group) and more satisfaction in group A than group B.ConclusionTAP block and caudal block under ultrasound guidance proved to be safe with no recorded complications either intra or postoperatively. Patient and parent satisfaction was markedly observed in case of TAP block.

The Effect of Ultrasound Guided Transversus Abdominis Plane Block for Cesarean Delivery on Postoperative Analgesic Consumption

Backgraund and aim: In our study we evaluated the postoperative analgesic consumption and analgesic efficacy of ultrasound guided transversus abdominis plane (USG-TAP) block in patients undergoing caesarean section (CS). Methods: Seventy ASA I-II patients undergoing CS following spinal anaesthesia were included in our study. The patients were divided into two groups randomly: Group T (TAP Block group) (n:35) and Group C (Control group) (n:35). At the end of the surgery Group T patients received USG-TAP block using 20 ml of 0.25% levobubivacaine. All participants received standart analgesic regime of tramadol via intravenous patient controlled analgesia (IV-PCA). Patients were assessed at 1, 4, 6, 12, 18 and 24 h after TAP block for hemodynamic parameters, verbal numerical rating pain scores (VNRS) (pain at rest and coughing), total amount of IV-PCA tramadol demand and consumption, time to first rescue analgesia, total amount of rescue analgesic demands, sedation, nausea, vomitting and satisfaction by a blinded investigator. Results: The VRNS scores both at rest and coughing were found significantly lower in TAP block group with levobupivacaine compared to control group at all check points. Total amount of IV-PCA tramadol demand and consumption, number of rescue analgesic demands and consumption were significantly lower in TAP block group. Time to first rescue analgesia was longer in TAP group. Patient satisfaction was significantly higher in TAP group. Conclusions: In our study USG-TAP block provided effective postoperative analgesia and we consider this technique as a safe and effective method for postoperative pain control after Caesarean delivery.

Ultrasound guided Transversus Abdominis Plane block through surgical wound.

Sir, A 47-year-old super obese (body mass index >50 kg/m2) male weighing approximately 295 kg, breathless in the supine position, presented for laparoscopic sleeve resection. As laparoscopic instruments with adequate length to reach the abdominal cavity were unavailable, he was scheduled for panniculectomy with vacuum-assisted closure (VAC) initially. Central venous and arterial lines were inserted under ultrasonic guidance on the day of surgery, but we failed to administer epidural or transversus abdominis plane (TAP) block as thickness of adipose tissue itself was >15 cm and deeper structures could not be visualised. Hence, general anaesthesia was administered following awake fibreoptic intubation in the lateral position. The abdominal wall was lifted up with the help of hooks (run through the anterior abdominal wall) hung from a steel frame making mechanical ventilation possible in the supine position. Through a lower transverse abdominal incision 20 kg adipose tissue was excised and VAC therapy was initiated. At the end of surgery, patient was extubated. On 3rd day, patient had tachypnoea (respiratory rate 30/min) oxygen saturation (SpO2) of 90–94% and oliguria with elevated serum creatinine. Since he was haemodynamically stable, he was posted for closure of surgical wound or reapplication of VAC (if there was infection). In the theatre after removing surgical dressings, high-frequency (13–6 MHz) linear ultrasound probe was directly placed over the wound under aseptic precautions with povidone iodine 10% solution as an acoustic couplant which also reduced chance of infection. 60 ml of 1% lignocaine with 1/100,000 adrenaline was injected in the plane between the internal oblique and transversus abdominis muscles using 23 gauge spinal needle on each side keeping the patient on lateral sides [Figure 1]. Injections were made at a depth of 4 cm from the surface, just anterior to mid-axillary line. Thickness of the tissue probably indicated possible oedema secondary to incision and surgical handling. Analgesia was adequate, debridement with reapplication of VAC was performed. The patient came for repeated procedures thrice in 2 weeks and was managed under TAP block using the same technique. Placing bilateral catheters for subsequent blocks was not considered, as catheter through a wound could potentially be a path for infections. The patient unfortunately succumbed to an acute coronary event 4 weeks after surgery. Figure 1 TAP block being given through the surgical wound Morbid obesity commonly results in derangements in most organ systems and is often associated with increased mortality and morbidity. Transversus abdominis plane block provides reliable analgesia to the anterior and lateral abdominal wall and is volume dependent. It can be performed blindly or using ultrasound. But ultrasound guided block helps in better localisation of the planes resulting in improved accuracy.[1,2] It is easier to perform TAP block in semilateral position in the obese.[3] In super obese patients, low-frequency convex probe is preferable as the deeper tissues are visualised better.[4] Since a major thickness of the anterior abdominal wall was bypassed by placing the ultrasound probe directly over the surgical area, the linear probe proved sufficient in our case.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial.

Background and Aims:The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial.Materials and Methods:Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant.Results:There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A.Conclusion:Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery.

Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial

BackgroundThe transversus abdominis plane block (TAP) has been described for pain management following abdominal surgery in adults, but there are only few reports on its use in pediatrics. The aim of this study was to evaluate the analgesic effect of ultrasound guided TAP block in patients scheduled for open appendectomy versus an active comparator (wound infiltration).MethodsForty-four children aged 4–16 years (ASA 1–2) were enrolled. Patients were randomized into two groups (22 in each). Patients in group (T) were assigned to receive ultrasound guided TAP block using 0.4 ml/kg of bupivacaine 0.25%, and those in group (L) were assigned to receive local infiltration by the surgeon. Maximum pain scores, the time to the first analgesic requirement and the number of analgesic requirements were recorded over 48 h.ResultsThe ultrasound guided TAP block increased the mean time to the first analgesic requirement (10.4 ± 1.5 h) in comparison with the local infiltration group (5.4 ± 1.5). The cumulative number of doses of analgesic was significantly lower in TAP group than in local infiltration group (3.7 ± 1.1 versus 5.3 ± 2.1) and the Pain Scale score was significantly lower in the TAP group over the study period. Besides, there were no complications attributable to the ultrasound guided TAP block.ConclusionUltrasound-guided TAP block with (0.4 ml/kg) 0.25% bupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after appendectomy in children.

Preemptive Analgesia of Ultrasound - Guided Transversus Abdominis Plane Block Compared with Deep Wound Infiltration in Patients Undergoing Urological Surgery

Preemptive Analgesia of Ultrasound - Guided Transversus Abdominis Plane Block Compared with Deep Wound Infiltration in Patients Undergoing Urological Surgery

Ultrasound-guided Transversus Abdominis plane block versus continuous wound infusion for post-caesarean analgesia: a randomized trial.

ObjectiveTo compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane (TAP) block versus Continuous Wound Infusion (CWI) with levobupivacaine after caesarean delivery.MethodsWe recruited parturients undergoing elective caesareans for this multicenter study. Following written informed consent, they received a spinal anaesthetic without intrathecal morphine for their caesarean section. The postoperative analgesia was randomized to either a bilateral ultrasound guided TAP block (levobupivicaine = 150 mg) or a CWI through an elastomeric pump for 48 hours (levobupivacaine = 150 mg the first day and 12.5 mg/h thereafter). Every woman received regular analgesics along with oral morphine if required. The primary outcome was comparison of the 48-hour area under the curve (AUC) pain scores. Secondary outcomes included morphine consumption, adverse events, and persistent pain one month postoperatively.ResultsRecruitment of 120 women was planned but the study was prematurely terminated due to the occurrence of generalized seizures in one patient of the TAP group. By then, 36 patients with TAP and 29 with CWI had completed the study. AUC of pain at rest and during mobilization were not significantly different: 50 [22.5–80] in TAP versus 50 [27.5–130] in CWI (P = 0.4) and 190 [130–240] versus 160 [112.5–247.5] (P = 0.5), respectively. Morphine consumption (0 [0–20] mg in the TAP group and 10 [0–32.5] mg in the CWI group (P = 0.09)) and persistent pain at one month were similar in both groups (respectively 29.6% and 26.6% (P = 0.73)).ConclusionIn cases of morphine-free spinal anesthesia for cesarean delivery, no difference between TAP block and CWI for postoperative analgesia was suggested. TAP block may induce seizures in this specific context. Consequently, such a technique after a caesarean section cannot be recommended.Trial RegistrationClinicalTrials.gov NCT01151943

Situs Inversus Totalisi Olan Bir Hastada Laparoskopik Kolesistektomide Uygulanan Transversus Abdominis Plan Bloğu

Transversus abdominis plane (TAP) block has been used for postoperative analgesia in patients undergoing abdominal surgery. In this case we report an ultrasound guided TAP block which was performed for laparoscopic cholecystectomy with situs inversus totalis.

Ultrasound guided transversus abdominis plane block in pediatric patients undergoing laparoscopic surgery

ObjectiveTo assess safety and effectiveness of ultrasound-guided TAP block in children undergoing laparoscopic surgery for undescended testis.Subjects and methodsThis randomized controlled trial involved 108 children, 3–7 years old, randomly allocated into one of two equal groups; TAP Group and Control Group. All children received general anesthesia using propofol 1.5–2.5 mg/kg, atracurium 0.5 mg/kg and fentanyl 2 μg/kg. TAP Group received 0.5 ml/kg of ropivacaine 0.375% bilaterally under ultrasound guidance and control group received regular analgesics. Quality of analgesia was assessed using Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) and Objective behavioral pain score (OPS). The primary outcome measures were hemodynamic parameters and degree of pain. Secondary outcome measures were intraoperative fentanyl requirement, postoperative rescue analgesia (time and dose), complications, hospital stay and degree of satisfaction of patients and their parents.ResultsTAP block group had significantly lower intraoperative fentanyl dose (p < 0.001), significantly longer time to first postoperative request of analgesic (p < 0.001), lower analgesic dose during the first postoperative 24 h (p < 0.001) and lower pain scores along the whole 24 postoperative hours. Mean arterial pressure and heart rate were within the clinically accepted range in the two groups. Parents’ satisfaction was significantly higher (p < 0.001) in the TAP block group.ConclusionTAP block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing laparoscopic surgery for undescended testis.

Transversus abdominis plane block in inguinal hernia repair

Transversus abdominis plane block in inguinal hernia repair

Ultrasound Guided Transversus Abdominis Plane vs Surgeon Administered Intraoperative Regional Field Infiltration with Bupivacaine for Early Postoperative Pain Control in Children Undergoing Open Pyeloplasty

Regional analgesic techniques are commonly used in pediatric urology. Ultrasound guided transversus abdominis plane block has recently gained popularity. However, there is a paucity of information supporting a benefit over regional field infiltration. We present a parallel group, randomized, controlled trial evaluating ultrasound guided transversus abdominis plane block superiority over surgeon delivered regional field infiltration for children undergoing open pyeloplasty at a tertiary referral center. Following ethics board approval and registration, children 0 to 6 years old were recruited and randomized to undergo perioperative transversus abdominis plane block or regional field infiltration for early post-pyeloplasty pain control. General anesthetic delivery, surgical technique and postoperative analgesics were standardized. A blinded assessor regularly captured pain scores in the recovery room using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. The primary outcome was the need for rescue morphine administration based on a FLACC score of 3 or higher. Two pediatric urologists performed 57 pyeloplasties during a 2.5-year period, enrolling 32 children (16 in each group, balanced for age and weight). There were statistically significant differences in the number of children requiring rescue morphine administration (13 of 16 receiving transversus abdominis plane block and 6 of 16 receiving regional field infiltration, p = 0.011), mean ± SD total morphine consumption (0.066 ± 0.051 vs 0.028 ± 0.040 mg/kg, p = 0.021) and mean ± SD pain scores (5 ± 5 vs 2 ± 3, p = 0.043) in the recovery room, in favor of surgeon administered regional field infiltration. No local anesthetic specific adverse events were noted. Ultrasound guided transversus abdominis plane block is not superior to regional field infiltration with bupivacaine as a strategy to minimize early opioid requirements following open pyeloplasty in children. Instead, our data suggest that surgeon delivered regional field infiltration provides better pain control.

Pilot Study of Ambulatory Inguinal Hernia Repair under Ultrasound-guided Transversus Abdominis Plane Block Anesthesia Plus Conscious Sedation

Aim: Transversus abdominis plane (TAP) block is mainly used as part of multimodal postoperative analgesia regimens in a wide variety of abdominal operations. Our purpose was to evaluate feasibility and safety of TAP block as anesthesia method for inguinal hernia repair. Methodology: Twenty patients scheduled to undergo ambulatory inguinal hernia repair were selected and consented to ultrasound -guided TAP block anesthesia plus conscious sedation. Twenty to 25 ml of ropivacaine 0.5% were administered into the TAP and sensory blockade ofT11-L1 dermatomes was examined 30 minutes later. Data on

Treatment of acute flares of chronic pancreatitis pain with ultrasound guided transversus abdominis plane block: a novel application of a pain management technique in the acute care setting.

The use of transversus abdominis plane (TAP) block to provide either analgesia or anesthesia to the anterior abdominal wall is well described. The technique yields high analgesic effectiveness and is opioid sparing and potentially of long duration with reported analgesia lasting up to 36 hours. When compared to neuraxial analgesia, TAP blocks are associated with a lower incidence of hypotension and motor blockade. TAP blocks are typically described as providing somatic analgesia only without any effect on visceral pain. There may be, however, certain conditions in which TAP blocks can provide effective analgesia in pain of visceral or mixed somatic and visceral origin. We describe two cases in which TAP blockade provided complete control of pain considered to be of visceral origin.

Surgeon-administered, intra-operative transversus abdominis plane block in autologous breast reconstruction: A UK hospital experience

Perioperative Transversus abdominis plane (TAP) block has been well described in the literature as part of the multi-modal approach for management of postoperative pain in gynaecological and general surgery. The senior author started performing ultrasound-guided TAP block perioperatively in DIEP patients in January 2011. The role of surgeon-administered, intra-operative TAP block in abdominal based breast reconstruction surgery was investigated in terms of its efficacy, safety, ease of administration and impact on opioid-related usage and side effects profile. Retrospective analysis of a single surgeon's experience of patients undergoing autologous breast reconstruction using abdominally-based free flaps who received intra-operative, surgeon-delivered TAP block (n=12) compared with a similar patient set not receiving TAP block (n=15). Data was analysed using Student's t-test and assessed for significance of results using p<0.05 as the threshold of significance. Patient's receiving TAP block had a significantly shorter length of stay (4.75 vs 7.00 days, p=0.002), lower usage of morphine (15.4 vs 71.4 mg, p=0.005), and fewer episodes of peri-operative nausea and vomiting (1 vs 6, p=0.03). Perioperative ultrasound guided TAP Block is an effective, cost effective and safe technique for postoperative pain management in abdominal based breast reconstruction.

Effects of ultrasound guided transversus abdominis plane block in gynecological laparoscopic surgery

Effects of ultrasound guided transversus abdominis plane block in gynecological laparoscopic surgery

The analgesic efficacy of ultrasound-guided transversus abdominis plane block for retroperitoneoscopic donor nephrectomy: A randomized controlled study

Background:Transversus abdominis plane (TAP) block is suitable for lower abdominal surgeries. Blind TAP block has many complications and uncertainty of its effects. Use of ultrasonography increases the safety and efficacy. This study was conducted to evaluate the analgesic efficacy of ultrasound (USG)-guided TAP block for retroperitoneoscopic donor nephrectomy (RDN).Methods:In a prospective randomized double-blind study, 60 patients undergoing laparoscopic donor nephrectomy were randomly divided into two groups by closed envelope method. At the end of surgery, USG-guided TAP block was given to the patients of both the groups. Study group (group S) received inj. Bupivacaine (0.375%), whereas control group (group C) received normal saline. Inj. Tramadol (1 mg/kg) was given as rescue analgesic at visual analog scale (VAS) more than 3 in any group at rest or on movement. The analgesic efficacy was judged by VAS both at rest and on movement, time tofirst dose of rescue analgesic, cumulative dose of tramadol, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively. Total tramadol consumption at 24 h was also assessed.Results:Patients in group S had significantly lower VAS score, longer time tofirst dose of rescue analgesic (547.13±266.96 min vs. 49.17±24.95 min) and lower tramadol consumption (103.8±32.18 mg vs. 235.8±47.5 mg) in 24 h.Conclusion:The USG-guided TAP block is easy to perform and effective as a postoperative analgesic regimen in RDN, with opioids-sparing effect and without any complications.

Ultrasound Guided TAP Block For The Treatment of Postoperative Prolonged Pain - An Alternative Approach

Transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique in which T7-12 intercostal nerves, ilioinguinal and iliohypogastric nerves, and cutaneous branches of L1-3 nerves are blocked between the internal oblique and transversus abdominis muscles. This technique is mostly used for the treatment of acute postoperative pain following abdominal surgery. In this case report, we evaluate the usage of TAP block in prolonged pain following upper abdominal surgery.