Posterior Transversus Abdominis Plane Block Research Articles

Comparative evaluation of pre-emptive analgesic efficacy of Posterior Transversus Abdominis Plane block with Fascia Transversalis Plane Block in adult patients undergoing unilateral inguinal hernia repair: A prospective, randomized, single-blind, two-arm parallel study.

Abdominal wall blocks, in conjunction with multimodal analgesia, have demonstrated efficacy in providing post-operative analgesia, reducing opioid requirements in patients undergoing inguinal hernia repair. The inguinal region is primarily innervated by the ilioinguinal nerve (IIN) and iliohypogastric nerve (IIH). Posterior transverse abdominis plane block (pTAP) and fascia transversalis plane block (TFP) have been observed to reliably block IIN and IIH. We hypothesized that posterior TAP block (pTAP) owing to its potential paravertebral spread will provide better post-operative analgesia than TFP block in patients undergoing unilateral open inguinal hernia repair. This prospective, randomized, single-blind, two-arm parallel study was conducted over a duration of one year for which sixty patients undergoing unilateral open inguinal hernia repair under spinal anesthesia were enrolled. They were equally and randomly assigned to receive either preoperative pTAP block or TFP block. The primary aim of the study was to compare median static and dynamic NRS scores during a 24-hour period, with the secondary aim to compare the number of patients who required rescue analgesics in each group. All enrolled patients completed the study. Results showed no statistically significant difference in median static NRS scores between Group pTAP and Group TFP at the designated time of observation during the 24-hour period [1.2 (0.4-1.60 vs. 1 (0.6-1)]. Group pTAP reported a higher median dynamic NRS scores during the 24-hour period [2.6 (1.2-3) v/s 2 (1.6-2.4); P < 0.035], although this difference was clinically insignificant. The mean time to request for the first rescue analgesia was comparable (11.7 h v/s 12 h; P = 0.99). In all the patients of both groups, loss of pinprick and cold touch sensation was observed at T10, T12, and L1 dermatomal levels. However, sensory assessment at T6 and T8 levels showed variability between the two groups (P > 0.05). In conjunction with background analgesia and the use of dexamethasone as an adjuvant, both blocks (pTAP and TFP) were observed to be equally effective for post-operative pain relief with similar patient satisfaction scores.

Comparison of ultrasound-guided transversalis fascia and posterior transversus abdominis plane block for postoperative analgesia following caesarean delivery: A double-blinded randomised controlled trial.

Posterior-transversus abdominus plane (TAP) block and transversalis fascia plane (TFP) block have been used for postoperative analgesia following caesarean delivery. We compared the analgesic efficacy of the TAP vs TFP plane blocks in patients undergoing elective caesarean delivery. We randomised 90 women undergoing caesarean delivery under spinal anaesthesia to receive either a posterior-TAP (Group-TAP), TFP (Group-TFP) or no block (Group-C) postoperatively. The primary objective was the postoperative analgesic requirements. Secondary objectives were duration of analgesia, pain scores and infra-umbilical sensory loss, which were recorded at specific intervals for 24 h. Statistical analysis was carried out using Statistical Package for Social Sciences version 16.0 software. The patients requiring one, two or nil rescue analgesics were comparable between the interventions and the control (P = 0.32). The duration of analgesia was longer in Group-TAP when compared to Group-C, 4.76 (1.2) vs. 6.89 (2.4); P < 0.001, whereas Group-TFP, 5.64 (2.1) h, was not significantly different from Group-C. The static pain score in Group-TAP was significantly less than that in Group-C at 4 h and beyond 12 h (P < 0.001), whereas Group-TFP was comparable with Group-C at all time points except at 4 h and 24 h (P = 0.002). Only Group-TAP demonstrated midline infraumbilical sensory loss. TAP and TFP blocks did not decrease the rescue analgesic requirement compared with the control group. The posterior-TAP block prolonged the duration of analgesia by 2 h, maintained the median static pain score at 0 beyond 12 h, and demonstrated sensory loss at the infraumbilical dermatomes.

Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial☆

BackgroundDue to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. MethodsASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg−1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. ResultsA total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). ConclusionLateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. Clinical Trials Registry: NCT03969316.

Efficacy of ultrasound-guided erector spinae plane block &lt;i&gt;versus&lt;/i&gt; transversus abdominis plane block for intraoperative and postoperative pain control in total laparoscopic hysterectomy: results of the ARTEMIDE randomised controlled trial

Laparoscopic hysterectomy (LH), one of the most common surgeries among women, results in moderate-to-severe postoperative pain. The use of the transversus abdominis plane (TAP) block for pain management in LH has been evaluated but with conflicting results. The erector spinae plane (ESP) block has emerged as an effective and safe technique for relieving visceral pain. This study aimed to compare the analgesic efficacy of posterior TAP block versus ESP block following LH. We conducted a prospective, randomised, multicentre study. Seventy-six patients (American Society of Anesthesiologists I–III) scheduled for elective LH were included in the final analysis. The interventions performed were posterior TAP block (TAP group) and ESP block at T8 (ESP group). We adopted numerical rating scale (NRS) scores for pain at different time points, intraoperative remifentanil need, rescue analgesic requirements, incidence of postoperative nausea and vomiting in the first 36 postoperative hours, and days of hospitalisation as criteria of evaluetion. At nearly all time points, NRS scores did not significantly differ between the TAP and ESP groups. The TAP group had higher NRS scores for pain in the immediate postoperative period (p=0.008). The need for intraoperative remifentanil was higher in the TAP group (p=0.0018). When needed, remifentanil was infused at slower maximum infusion rates in the ESP group than in the TAP group (mean±SD: 0.02±0.04 vs. 0.04±0.05, respectively; p=0.006). The total rescue analgesic requirements in the first 36 postoperative hours did not significantly differ between the two groups. We conclude that following LH, the posterior TAP and ESP blocks can achieve similar levels of pain management.

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

Posterior quadratus lumborum block versus posterior transversus abdominis plane block for unilateral inguinal hernia surgery.

Ultrasound-guided truncal nerve blocks are increasingly used for postoperative pain relief after abdominal surgery. The aim of this prospective and randomized study was to compare posterior transversus abdominis plane block (pTAPB) with posterior quadratus lumborum block (pQLB) for postoperative analgesic efficacy in patients undergoing unilateral inguinal hernia surgery under general anesthesia (GA). A total of 90 adult patients were randomized into 3 groups: group pTAPB (n = 30), group pQLB (n = 30), and group Control (n = 30). The patients in groups pQLB and pTAPB received a unilateral block using 20 ml of 0.25% bupivacaine after the induction of GA. Intravenous (IV) tramadol patient control group analgesia (PCA) and paracetamol were used in the postoperative period as a part of the multimodal analgesic regimen in both groups. Postoperative pain was assessed using a visual analog scale (VAS) during postoperative 24 h. Dexketoprofene was used as a rescue analgesic when VAS is >3. The primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesics and the amount of tramadol delivered by PCA. P <0.05 was considered statistically significant. Mean VAS scores were significantly lower in the group pQLB than group pTAPB and group Control at all-time points (pQLB < pTAPB < Control; P < 0.001). Rescue analgesic was not required in group QLB. Rescue analgesic consumption, the number of bolus demand on PCA, and total PCA dose were highest in group Control and lowest in the pQLB group (Control > pTAPB > pQLB; P < 0.001). It is concluded that both pQLB and pTAPB provided effective pain relief after unilateral inguinal hernia surgery. pQLB was superior to pTAPB due to lower pain scores and analgesic consumption.

Analgesic efficacy of postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block for laparoscopic colorectal cancer surgery: a randomized, prospective, controlled study

BackgroundWe assessed whether a postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane (TAP) block could reduce 24 h rescue tramadol requirement compared with placebo in patients undergoing elective laparoscopic colorectal cancer surgery.MethodsPatients scheduled to undergo elective laparoscopic surgery following the diagnosis of colorectal cancer were included in this study and randomized into Group and Group Control. The patients received a postoperative bilateral, ultrasound-guided, posterior TAP block in either 20 mL of 0.5% ropivacaine (Group TAP) per side or an equivalent volume of normal saline (Group Control). The primary outcome was the cumulative consumption of rescue tramadol within 24 h after the surgery. Secondary endpoints included (1) resting and movement numerical rating scale (NRS) pain scores at 2, 4, 6, 12, 24, 48, and 72 h; (2) incidences of related side effects; (3) time to the first request for rescue tramadol; (4) patient satisfaction regarding postoperative analgesia; (5) time to restoration of intestinal function; (6) time to mobilization; and (7) the length of hospital stay.ResultsIn total, 92 patients were randomized, and 82 patients completed the analysis. The total rescue tramadol requirement (median [interquartile range]) within the first 24 h was lower in Group TAP (0 [0, 87.5] mg) than in Group Control (100 [100, 200] mg), P < 0.001. The posterior TAP block reduced resting and movement NRS pain scores at 2, 4, 6, 12, and 24 h after surgery (all P < 0.001) but showed similar scores at 48 h or 72 h. A higher level of satisfaction with postoperative analgesia was observed in Group TAP on day 1 (P = 0.002), which was similar on days 2 (P = 0.702) and 3 (P = 0.551), compared with the Group Control. A few incidences of opioid-related side effects (P < 0.001) and a lower percentage of patients requiring rescue tramadol analgesia within 24 h (P < 0.001) were observed in Group TAP. The time to the first request for rescue analgesia was prolonged, and the time to mobilization and flatus was reduced with a shorter hospital stay in Group TAP as compared with Group Control.ConclusionsA postoperative bilateral, ultrasound-guided, posterior TAP block resulted in better pain management and a faster recovery in patients undergoing laparoscopic colorectal cancer surgery, without adverse effects.Trial registrationThe study was registered at http://www.chictr.org.cn (ChiCTR-IPR-17012650; Sep 12, 2017).

Effect of ultrasound-guided transversus abdominis plane block with rectus sheath block on patients undergoing laparoscopy-assisted radical resection of rectal cancer: a randomized, double-blind, placebo-controlled trial

BackgroundMany patients complain of pain following laparoscopic surgery. Clinicians have used ultrasound-guided posterior transversus abdominis plane block (TAPB) and rectus sheath block (RSB) for multimodal analgesia after surgery. We investigated the analgesic effects of US-guided posterior TAPB with RSB on postoperative pain following laparoscopy-assisted radical resection of early-stage rectal cancer.MethodsSeventy-eight adults scheduled for laparoscopy-assisted radical resection of rectal cancer were enrolled in this double-blind placebo-controlled trial. Patients were randomized into 3 groups: the TR Group underwent US-guided bilateral posterior TAPB (40 mL 0.33% ropivacaine) with RSB (20 mL 0.33% ropivacaine); the T Group underwent US-guided bilateral posterior TAPB alone; and the Control Group received saline alone. All patients also had access to patient-controlled intravenous analgesia (PCIA) with sufentanil. The primary outcome was postoperative sufentanil consumption at 0–24, 24–48, and 48–72 h. The secondary outcomes were postoperative pain intensity and functional activity score at rest and while coughing for the same three time periods, intraoperative medication dosage, use of rescue analgesia, recovery parameters, and adverse effects.ResultsThe three groups had no significant differences in baseline demographic and perioperative data, use of intraoperative medications, recovery parameters, and adverse effects. The TR group had significantly lower postoperative use of PCIA and rescue analgesic than in the other two groups (P < 0.05), but the Control Group and T Group had no significant differences in these outcomes.ConclusionsPostoperative US-guided posterior TAPB with RSB reduced postoperative opioid use in patients following laparoscopy-assisted radical resection of rectal cancer.Trial registrationThe trial was registered with chictr.org (ChiCTR2000029326) on January 25, 2020.

Combined Subcostal and Posterior Transversus Abdominis Plane Block for Postoperative Pain Relief after Abdominoplasty: A Randomized Clinical Trial

Combined Subcostal and Posterior Transversus Abdominis Plane Block for Postoperative Pain Relief after Abdominoplasty: A Randomized Clinical Trial

Efficient techniques for postoperative analgesia in laparoscopic cholecystectomy

Today, in a generation of technological improvements, Laparoscopic cholecystectomy (L.C.) is the selection for the treatment of symptomatic illnesses of gallbladder like cholecystitis and cholelithiasis. Legitimate pain control is essential for advancing scientific outcomes and previous ambulation after surgery. Results aren't suitable for daycare surgeries. It is minimally invasive with much less postoperative ache, rapid recuperation, lesser health facility live and return to everyday interest on the earliest1. Though laparoscopic cholecystectomy is a slightly invasive surgical procedure with more secondary perioperative pain scores assessment to open procedures, it is present with enormous ranges of postoperative ache. The present prospective, unmarried blinded, randomized manipulate study protected sixty patients scheduled for laparoscopic cholecystectomy and aimed to compare the postoperative analgesia between the posterior transversus abdominis plane block and subcostal transversus abdominis aircraft block. The patients were randomly allotted to 2 businesses- Group 1 consisted of patients who received posterior T.A.P. block with zero. 2% Ropivacaine with Dexmedetomidine 1mcg/kg and Group 2 consisted of patients who obtained subcostal T.A.P. block with zero.2% Ropivacaine with Dexmedetomidine 1mcg/kg. All patients underwent laparoscopic cholecystectomy under general anaesthesia. At the quit of the surgical operation earlier than extubation, both one of the blocks were executed on the affected person underneath ultrasound steering by the identical anaesthesiologist. The objectives of the study were to compare the postoperative pain relief based on VAS at rest and VAS at deep breathing, to compare the time taken for the administration of rescue analgesia (duration of analgesia) and to compare the time taken to perform the block.

Ultrasound guided Posterior Transversus Abdominis Plane Block versus Ilio-inguinal / ilio-hypogastric Nerves Block as a Postoperative Analgesia after Inguinal Hernia Repair.

Ultrasound guided Posterior Transversus Abdominis Plane Block versus Ilio-inguinal / ilio-hypogastric Nerves Block as a Postoperative Analgesia after Inguinal Hernia Repair.

Laparoscopic-assisted Transversus Abdominis Plane (TAP) Block in Patient Undergoing Laparoscopic Gynecologic Surgery: Randomized Controlled Trial

Study Objective To compare the analgesic efficacy of laparoscopic-assisted posterior Transversus Abdominis Plane (TAP) block versus lateral TAP block for post-operative pain control in patients undergoing laparoscopic gynecologic surgeries. Design Prospective randomized trial. Setting Patients undergoing laparoscopic/robotic gynecology surgeries. Patients or Participants 80 patients were randomly assigned to laparoscopic-assisted lateral (mid-axillary) TAP block and posterior TAP block. Total sample size of 80 patients with considering 10 % drop out rate, gives 85 % power (two-sided alpha =0. 05) to detect a difference of 0.7 in pain score. Interventions Laparoscopic-assisted TAP block with liposomal Bupivacaine and Bupivacaine HCL 0.5% mixed in ratio of 1:2 in milligram. We randomized patients posterior approach injection was applied in triangle of petit versus in lateral TAP block injection was performed in mid axillary line between iliac crest and lower coastal margin. Opioid consumption and Numeric Pain Rating Score (NPRS 0 to 10) were recorded at 6, 12, 24, 48 and 72 hours post-operatively. Measurements and Main Results patients in the posterior TAP block group was older than the lateral TAP block group (P-Value: 0.03). There was no difference in terms of race, BMI, ASA classification and comorbidities between two groups. Length of surgery was longer in lateral group (P-value: 0.02). There was no difference in terms of type of procedure. Patients in posterior group had less pain score at 6 h, 12h, 24h, 48h and 72 h post-operative, and they significantly used less narcotic during the first 3 days after surgery (p-value:0.009) Conclusion Laparoscopic-assisted TAP block is a new and safe technique for multimodal pain management. Posterior TAP block provides better analgesia than lateral TAP block for laparoscopy gynecologic surgeries. Posterior TAP block significantly reduces the total amount of narcotics used by patients in post-operative course.

Transversalis Fascia Plane Block Provides Effective Postoperative Analgesia for Cesarean Section: New Indication for Known Block

(J Clin Anesth. 2018;48:13–14. Doi:10.1016/j.jclinane.2018.04.006) Adequate analgesia after cesarean section (CS) requires sensorial blockade of the subcostal (T12), ilioinguinal (L1), and iliohypogastric (T12-L1) nerves’ cutaneous branches. However, the posterior transversus abdominis plane block, commonly used for CS, may not affect the T12 and L1 cutaneous branches. Therefore, in this study, the authors reported the first effective use of the transversalis fascia plane block (TFPB) in 2 patients, which should provide blockade of the ilioinguinal and iliohypogastric nerves.

Successful Laparoscopic Surgery without Neuromuscular Blockade in a Patient with Malignant Hyperthermia Susceptibility

Malignant hyperthermia (MH) is a life-threatening clinical syndrome of hypermetabolism involving skeletal muscle. Susceptibility to MH is inherited in an autosomal dominant manner. Its common trigger is exposure to volatile anesthetic agents or depolarizing muscle relaxants. Deep neuromuscular blockade using muscle relaxants can improve the quality of surgical conditions and prevent cardiorespiratory adverse events during laparoscopic surgery. Here we report a case of successful laparoscopic surgery under anesthetic management without neuromuscular blockade in an MH-susceptible patient. A 22-year-old woman with a family history of MH underwent laparoscopic excision of ovarian endometrioma under total intravenous anesthesia and a posterior transversus abdominis plane block. The surgery was completed uneventfully. Our experience suggests that this type of anesthetic management is useful when performing laparoscopic surgery in MH-susceptible patients.

Comparison of dermatomal sensory block following ultrasound-guided transversus abdominis plane block by the lateral and posterior approaches: A randomized controlled trial.

Background and Aims:Ultrasound (US)-guided transversus abdominis plane (TAP) block is used as a part of a multimodal analgesic regimen in the postoperative period. Lateral approach TAP block (LTAP) has been widely used for postoperative analgesia after lower abdominal surgeries. Posterior approach TAP block (PTAP), which is achieved by more posterior blockade of the anterior ramus of the spinal nerve, also provides profound postoperative analgesia after transverse lower abdominal incision. We investigated the dermatomal sensory block following LTAP and PTAP under US guidance.Material and Methods:Twenty-seven adult female patients undergoing the laparoscopic resection of ovarian tumors under general anesthesia were randomly divided into two groups, those receiving LTAP (Group L, n = 14) and those receiving PTAP (Group P, n = 13). Before induction of general anesthesia, all patients were given bilateral TAP blocks with 15 ml of 0.25% levobupivacaine on each side under US guidance, and the sensory blockade was evaluated.Results:The data are expressed as median (interquartile range [IQR]). PTAP produced a median sensory blockade to sharp touch of three dermatomal segments (IQR 3–4), the most cephalad being T-10 (IQR T-9–T-10), whereas LTAP produced blockade of a median of two segments (IQR 2–2, P = 0.002), the most cephalad being T-10 (IQR T-10–T-10, P = 0.005).Conclusions:PTAP produced a sensory block that involved a greater number of dermatomes and involvement of more cephalad dermatome blocked to sharp touch, compared with LTAP under US guidance.

Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study.

BackgroundDue to the importance of pain control after abdominal surgery, several methods such as transversus abdominis plane (TAP) block are used to reduce the pain after surgery. TAP blocks can be performed using various ultrasound-guided approaches. Two important approaches to do this are ultrasound-guided lateral and posterior approaches. This study aimed to compare the two approaches of ultrasound-guided lateral and posterior TAP blocks to control pain after cesarean section.Materials and methodsIn this double-blind clinical trial study, 76 patients scheduled for elective cesarean section were selected and randomly divided into two groups of 38 and underwent spinal anesthesia. For pain management after the surgery, one group underwent lateral TAP block and the other group underwent posterior TAP block using 20cc of ropivacaine 0.2% on both sides. Pain intensity was evaluated based on Numerical Analog Scale (NAS) at rest and when coughing, 2, 4, 6, 12, 24 and 36 hours after surgery.ResultsThe pain at rest in the posterior group at all hours post surgery was lower than the lateral group, especially at 6, 12 and 24 hours after the surgery and the difference was statistically significant (p=0.03, p<0.004, p=0.001).ConclusionThe results of this study show that ultrasound-guided posterior TAP block compared with the lateral TAP block was more effective in pain control after cesarean section.

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.

Comparison of posterior and subcostal approaches to transverse abdominis plane block for postoperative analgesia of cesarean delivery

Objective To evaluate the effectiveness of posterior and subcostal transversus abdominis plane(TAP) block in analgesia for patients undergoing cesarean delivery. Methods At the end of the operation, 100 cases of participants with cesarean delivery are randomized divided into two different group. Patients in group A (n=50) received an ultrasound-guided posterior TAP block using 20 ml of 0.375% ropivaeaine on each side. Group B (n=50) underwent a subcostal TAP block with same solution. Patient controlled intravenous analgesia (PCIA) had also been applied. The resting and exercise VAS scores were evaluated at 2, 6, 12 h and 24 h after operation. The consumption of butorphanol within 24 h after operation, the number of successfully delivered doses within 24 h after operation were recorded. The rate of participants' satisfaction and the rate of adverse reactions were also recorded. Results The exercise VAS scores at 2,6,12 h after operation in group A [(0.8±1.0), (2.1±0.9), (2.0±0.9)] were significantly lower than scores in group B [(1.8±1.4), (4.3±1.9), (4.6±2.2)] (P<0.05). The consumption of butorphanol and the number of successfully delivered doses within 24 h after operation were also lower than in group B(P<0.05), while the rate of satisfaction were higher in group A(7.9±1.6) than in group B (7.1±2.3)(P<0.05). The incidence of adverse reactions was also significantly lower in group A than in group B (P<0.05). Conclusions Compared with the subcostal approach, ultrasound-guided posterior TAP could afford a better effectiveness in in analgesia for patients undergoing cesarean delivery. Key words: Transversus abdominis plane block; Cesarean section; Ropivacaine; Postoperative analgesia

Dermatomal spread following posterior transversus abdominis plane block in pediatric patients: our initial experience.

Several techniques for the transversus abdominis plane (TAP) block have been described. The extent of sensory changes using an ultrasound-guided posterior TAP block (pTAP) remains unclear in pediatric patients. The primary aim of this study was to report the extent of sensory changes achieved with pTAP; specifically the highest thoracic dermatome anesthetized. Secondary outcomes were pain scores (PS), opioid consumption, and complications. We retrospectively reviewed the medical records of patients less than 21 years of age undergoing abdominal surgery with a unilateral or bilateral pTAP(s) for postoperative analgesia. The local anesthetic was placed posterior to the termination of the transversus abdominis muscle where the thoracolumbar fascia overrides the quadratus lumborum muscle. The extent of sensory changes, pain scores, and opioid consumption were analyzed. A total of 10 patients (15 pTAP blocks) met the inclusion criteria. The mean (sd; range) age and weight were 15 years (5 years; range 7-20 years) and 57 kg (21 kg; 27-97 kg), respectively. The cephalad dermatome levels achieved were: T7 in 6/15 (40%); T8 in 10/15 (67%); and T9 in 14/15 (93%). An inferior dermatome level of T12/L1 and sensory extension from midaxillary line to the midline was documented in 15/15 blocks. The mean intraoperative and postanesthesia care unit (PACU) opioid consumption in morphine equivalents were 0.34 mg·kg-1 (sd = 0.12 mg·kg-1 ) and 0.04 mg·kg-1 (sd = 0.05 mg·kg-1 ), respectively. PACU pain scores were mild (<4) in 60%, moderate (4-7) in 30%, and severe (>7) in 10% of patients. No complications were reported. The current uncertainty regarding sensory blockade limits the clinical application of TAP blocks. While the midaxillary approach results in unpredictable sensory changes of the abdomen, we reliably achieved sensory changes up to a T9 level in 93% of the blocks. In this small series of patients, we demonstrate a high technical success rate of achieving cutaneous analgesia to the abdominal wall. These results should encourage clinical studies of the efficacy of this block for abdominal surgery in pediatric patients.

Transversus Abdominis Plane Versus Ilioinguinal and Iliohypogastric Nerve Blocks for Analgesia Following Open Inguinal Herniorrhaphy.

ObjectivesWe hypothesized that preoperative (pre-op) ultrasound (US)-guided posterior transversus abdominis plane block (TAP) and US-guided ilioinguinal and iliohypogastric nerve block (ILI+IHG) will produce a comparable analgesia after Lichtenstein patch tension-free method of open inguinal hernia repair in adult men. The genital branch of the genitofemoral nerve will be blocked separately.MethodsThis is a prospective, randomized, controlled, and observer-blinded clinical study. A total of 166 adult men were randomly assigned to one of three groups: a pre-op TAP group, a pre-op ILI+IHG group, and a control group. An intraoperative block of the genital branch of the genitofemoral nerve was performed in all patients in all three groups, followed by postoperative patient-controlled intravenous analgesia with morphine. The pain intensity and morphine consumption immediately after surgery and during the 24 hours after surgery were compared between the groups.ResultsA total of 149 patients completed the study protocol. The intensity of pain immediately after surgery and morphine consumption were similar in the two “block” groups; however, they were significantly decreased compared with the control group. During the 24 hours after surgery, morphine consumption in the ILI+IHG group decreased compared with the TAP group, as well as in each “block” group versus the control group. Twenty-four hours after surgery, all evaluated parameters were similar.ConclusionUltrasound-guided ILI+IHG provided better pain control than US-guided posterior TAP following the Lichtenstein patch tension-free method of open inguinal hernia repair in men during 24 hours after surgery. (ClinicalTrials.gov number: NCT01429480.)