Preoperative Transversus Abdominis Plane Block Research Articles

The Effect of Transversus Abdominis Plane Block Timing on Milliequivalents of Opioid Use and Immediate Postoperative Pain Scores in Patients Undergoing Minimally Invasive Hysterectomy: A Retrospective Cohort Study

To examine the effect of transversus abdominis plane (TAP) block timing (preoperative or postoperative) on postoperative opioid use (quantified via morphine milligram equivalents; MME) and pain scores in patients undergoing minimally invasive hysterectomy for benign indications. Retrospective, single-institution cohort study SETTING: Academic-affiliated community hospital PATIENTS: A total of 2982 patients were included who underwent a minimally invasive total hysterectomy between January 2018 and December 2022, excluding patients with a malignancy diagnosis, concurrent urogynecological procedure, vaginal hysterectomy, supracervical hysterectomy, or those with baseline narcotic use (opioid use within the 3 months before surgery). Patients were separated into 3 groups: no TAP blocks (n = 1966, 65.9%), preoperative TAP blocks (854, 28.6%), and postoperative TAP blocks (162, 5.4%). Summary statistics and mixed-effects regression methods were used for data analysis. There was a statistically significant lower mean use of opioids (MME 43.2 vs 53.9, p = .002) among patients who received a TAP block (either pre or postoperatively) than those who did not receive a block. However, when comparing preoperative vs postoperative patients with TAP block, there was no statistically significant difference in mean opioid use (MME 43.4 vs 42.1, p = .752). There were no differences in postoperative pain scores between patients with and without a TAP block, however, more opioids were required in patients who did not receive a TAP block to achieve the same pain scores as those who did receive a TAP block. There was a statistically significant shorter time to discharge for TAP versus patients without TAP block(median 5.5 vs 6.3 hours, p ≤ .001) as well as preoperative versus postoperative patients with TAP block (median 5.3 vs 6.2 hours, p = .001). While TAP block use at the time of minimally invasive hysterectomy reduced use of postoperative opioids, the timing of TAP block, either preoperatively or postoperatively, did not significantly affect opioid use. Preoperative compared with postoperative TAP block administration significantly shortened the time to discharge.

Transversus Abdominis Plane Block as Part of a Multimodal Analgesic Regimen in Patients Undergoing Anterior Lumbar Interbody Fusion: A Retrospective Cohort Study.

Opioids are a mainstay for pain control in patients undergoing lumbar spine surgery but are associated with a high risk of dependence and significant adverse effects. Efforts continue to be made to utilize non-narcotic agents such as regional nerve block for pain control as part of a multimodal analgesia regimen. Recently, transversus abdominis plane (TAP) blocks have proven beneficial for patients undergoing lumbar fusion procedures. The purpose of this study is to evaluate the efficacy of TAP blocks for postoperative pain control and the effect on opioid consumption and hospital length of stay (LOS) in patients undergoing anterior lumbar interbody fusion (ALIF). A retrospective review of patients undergoing elective ALIF included collection of data on demographics, LOS, pain scores using visual analog scale (VAS), opioid consumption using morphine milligram equivalents (MME) from postoperative day (POD) 0 to 5, and any complications. Patients who underwent primary ALIF or ALIF with concomitant posterolateral lumbar fusion were included. A total of 99 patients met inclusion criteria; 47 had a preoperative TAP block and 52 did not. Demographic data and number of levels fused were equally distributed between the groups. The TAP group had significantly lower MME consumption postoperatively during POD 0 to 2 and 0 to 5. VAS pain scores were lower for TAP block patients on POD 3 and 4; otherwise, there was no significant difference. LOS and complication rates were not significantly different. A multiple regression analysis found male sex to be a predictor of increased postoperative MME, while age and TAP block were significant predictors of decreased MME. The use of TAP block for patients undergoing ALIF was associated with less cumulative MME consumption in the immediate postoperative period. TAP block may be an effective tool for reducing postoperative opioid consumption in patients undergoing ALIF. The data in this study provide clinical relevance supporting the use of TAP blocks for patients undergoing ALIF procedures.

Addition of preoperative transversus abdominis plane block to multimodal analgesia in open gynecological surgery: a randomized controlled trial

BackgroundTransversus abdominis plane (TAP) block can provide effective analgesia for abdominal surgery. However, it was questionable whether TAP had additional effect in the context of multimodal analgesia (MMA). Therefore, this study aimed to assess the additional analgesic effect of preoperative TAP block when added to MMA protocol in open gynecological surgery.MethodsIn this prospective, randomized-controlled trial, 64 patients scheduled for open gynecological surgery were randomized to receive preoperative TAP block (Study group, n = 32) or placebo (Control group, n = 32) in addition to MMA protocol comprising dexamethasone, acetaminophen, flurbiprofen and celecoxib, and rescued morphine analgesia. The primary outcome was rescued morphine within 24 h after surgery. Secondary outcomes included pain scores, adverse effects, quality of recovery measured by 40-item quality of recovery questionnaire score (QoR-40) at 24 h, and quality of life measured with short-form health survey (SF − 36) on postoperative day (POD) 30.ResultsThe Study group had less rescued morphine than the control group within 24 h [5 (2–9) vs. 8.5 (5–12.8) mg, P = 0.013]. The Study group had lower pain scores at 1 h [3 (2–4) vs. 4 (3–5), P = 0.007], 2 h [3 (2–4) vs. 3.5 (3–5), P = 0.010] and 6 h [3 (2–3) vs. 3 (2.3–4), P = 0.028], lower incidence of nausea at 48 h (25.8% vs. 50%, P = 0.039), and higher satisfaction score [10 (10–10) vs. 10 (8–10), P = 0.041]. The SF-36 bodily pain score on POD 30 was higher in the Study group (59 ± 13 vs. 49 ± 16, P = 0.023).ConclusionsPreoperative TAP block had additional analgesic effect for open gynecological surgery when used as part of multimodal analgesia. Rescued morphine within 24 h was significantly reduced and the SF-36 bodily pain dimension at 30 days after surgery was significantly improved.Trial registrationwww.chictr.org.cn (ChiCTR2000040343, on Nov 28 2020).

Preoperative transversus abdominis plane block decreases intraoperative opiate consumption during minimally invasive cholecystectomy.

The ongoing epidemic of prescription opiate abuse is one of the most pressing health issues in the United States today. Consequently, analgesic adjuncts, such as multimodal drug regimens and regional anesthetic blocks (like transversus abdominis plane (TAP) block), have been introduced to the perioperative period in hopes of decreasing postoperative opiate use. However, the effect of these interventions on intraoperative opiate use has not been examined. We hypothesized that preoperative TAP block would be associated with decreased intraoperative opiate use during minimally invasive cholecystectomy. This was a retrospective review of patients undergoing minimally invasive cholecystectomy between June 2018 and January 2021. Perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. 261 patients were included in this study, of which 62 (23.8%) received preoperative TAP block and 199 (76.2%) did not. Preoperative TAP block was associated with decreased intraoperative opiate use (0.199 vs 0.312, p < 0.001), while there were no statistically significant differences associated with other analgesic adjuncts including preoperative acetaminophen (p = 0.485), celecoxib (p = 0.112), gabapentin (p = 0.165), or intraoperative ketorolac (p = 0.200). On multivariate analysis, preoperative TAP block was independently associated with decreased intraoperative opiate use (< 0.001), while chronic cholecystitis on final pathology was associated with increased intraoperative opiate use (p = 0.002). The use of preoperative TAP block was associated with decreased intraoperative opiate use during minimally invasive cholecystectomy and should be considered for routine use. Future research should investigate whether preoperative TAP blocks and a subsequent decrease of intraoperative opiates, also result in a decrease in postoperative opiate use and improvements in postoperative outcomes.

Preoperative transversus abdominis plane block decreases intraoperative opiate use during pancreatoduodenectomy.

Multimodal analgesia and regional anesthetic blocks, such as transversus abdominis plane (TAP) block, decrease postoperative opiate consumption but their effect on intraoperative opiates is unknown. This was a retrospective review of patients undergoing pancreatoduodenectomy between June 2018 and February 2021, in which perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. Of the 169 patients in the study, 51 (30.2%) received pre-surgical TAP blocks and 118 (69.8%) did not. There were no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p=0.527), celecoxib (p=0.553), gabapentin (p=0.308), intraoperative ketorolac (p=0.698) or epidural placement (p=0.086). Minimally invasive surgery had lower intraoperative opiate use compared to open (p=0.011), as well as pre-surgical TAP block compared to no pre-surgical block (5.24 vs 7.27 MED/hour, p<0.001). On multivariate linear regression, pre-surgical TAP block (p=0.001) was independently associated with decreased intraoperative opiate use. Preoperative TAP blocks were associated with decreased intraoperative opiate use during pancreatoduodenectomy and should be considered for routine use.

Efficacy of preoperative transversus abdominis plane block in acute appendicitis pain and its success in postoperative pain: a retrospective study.

The aim of this study is to determine the analgesic efficacy of Transversus Abdominis Plane (TAP) block applied before anesthesia on preoperative abdominal pain and postoperative surgical pain in acute appendicitis. Among the patients aged 18 years and older who underwent open appendectomy with the diagnosis of acute appendicitis, patients who underwent TAP block were identified retrospectively. To the aim of this study, demographic data of the patients, preoperative change in pain scores at rest and with coughing, postoperative pain scores, need for postoperative analgesics were evaluated. Twenty-two patients who underwent preanesthetic lateral TAP block were accepted as the sample of the study. Preoperative 0th minute resting and rebound pain scores due to appendicitis before TAP block were 4.63 and 7.63, respectively. Resting and rebound pain scores at the 1st, 3rd, 5th, 10th, 15th, and 20th minutes after TAP block were respectively 2.95, 2.04, 1.27, 0.68, 0.50, 0.45 and 5.59, 4.68, 3.72, 2.77, 2.22, 1.86. Both resting and rebound pain scores decreased from the 1st minute to the 15th minute, with a statistically significant difference (p<0.05). The mean pain scores at the 1st, 2nd, 6th, 12th and 24th hours postoperatively were 3.72, 2.81, 2.13, 1.86, and 1.5, respectively. Six patients did not need analgesics in the first 24 hours. Opioid was administered to only one patient postoperatively. TAP block provides effective analgesia in the preoperative abdominal pain treatment of acute appendicitis cases. It also shows that effective postoperative analgesia can be achieved even when applied preoperatively.

Preoperative Transversus Abdominis Plane Block Decreases Intraoperative Opiate Use during Pancreaticoduodenectomy

Introduction: Multimodal analgesic regimens and regional anesthetic blocks, such as transversus abdominis plane (TAP) block, have been shown to decrease postoperative opiate consumption but their effect on intraoperative opiates is unknown. Method: This was a retrospective review of patients undergoing pancreaticoduodenectomy (PD) from 6/2018-1/2021. Patient demographic and perioperative data, including operative time and medications administered were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate and multivariate logistic regression analyses were performed to determine factors affecting intraoperative opiate requirements. Analgesic adjuncts and clinically relevant patient characteristics were included in the model. Results: Of the 178 PD patients in this study, 79 (46.7 %) did not receive TAP blocks, 51 (30.2%) received TAP block at the start of surgery, and 39 (23.1%) at the end of surgery. There were no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p=0.527), celecoxib (p=0.553), gabapentin (p=0.308), intraoperative ketorolac (p=0.698) or epidural placement (p=0.086). While minimally invasive surgical approach had lower intraoperative opiate use compared to open (5.71 MED/hour, 6.98 MED/hour, p=0.011), as well as preoperative TAP block compared to no block and postoperative block (5.24, 7.18, 7.45 MED/hour, p<0.001). Multivariate logistic regression demonstrated that preoperative TAP block was the only adjunct independently predicting decreased intraoperative opiate use (OR= -2.23, CI -3.44, -1.02, p<0.001) (Figure 1). Conclusions: The use of preoperative TAP block was associated with decreased intraoperative narcotic use during pancreaticoduodenectomy and should be considered for routine use.

A Comparison of Analgesic Effect between Preoperative and Postoperative Transversus Abdominis Plane (TAP) Blocks for Different Durations of Laparoscopic Gynecological Surgery

Aim. This study aims to compare the postoperative analgesia between preoperative and postoperative ultrasound-guided transversus abdominis plane (TAP) blocks for different durations of laparoscopic gynecological surgery. Methods. A total of 120 patients, ASA I-III, 18–65 years of age, were divided randomly into 2 groups: preoperative TAP group (pre-TAP group) and postoperative TAP group (post-TAP group). Patients in the pre-TAP group (n = 60) and post-TAP group (n = 60) received bilateral TAP blocks of 0.375% ropivacaine, 40 mL, preoperatively and postoperatively, respectively. Duration of surgery, postoperative pain score, consumption of analgesics, and postoperative nausea and vomiting (PONV) during the first 24 h postoperatively were recorded. Results. For all the patients in the two groups, similar analgesia was obtained with no statistical difference. The same results were found in duration of surgery &lt;180 min. Meanwhile, patients undergoing surgery &gt;180 min in the post-TAP group obtained lower postoperative pain score, lower analgesics consumption, and higher satisfaction score than those in the pre-TAP group. Conclusion. Postoperative TAP block could offer better postoperative analgesia than preoperative TAP block for patients undergoing surgery &gt;180 min. No difference was found in analgesia effect between preoperative TAP block and postoperative TAP block for patients undergoing surgery &lt;180 min.

Reducing Opioid Dependence and Improving Patient Experience for Living Kidney Donors with Transversus Abdominis Plane Block

Rapid recovery after laparoscopic living donor nephrectomy (LLDN) for kidney donation is highly desirable for living kidney donors. To uphold rapid recovery, good analgesia with minimal adverse effects, including those related to opioid dependence, is essential. A pre-operative transversus abdominis plane (TAP) block with liposomal bupivacaine can effectively aid in perioperative pain management, while reducing opioid requirements. We conducted a single-center retrospective study involving patients 18 years and older who underwent LLDN to determine whether a TAP block with liposomal bupivacaine is efficacious in pain management after LLDN, while reducing opioid use. The study group comprised of patients who received a preoperative TAP block with liposomal bupivacaine in place of hydromorphone patient-controlled analgesia (PCA) and the control group included patients who received hydromorphone PCA post-operatively. Both groups were supplemented with oral and intravenous analgesics for breakthrough pain, as needed. The primary endpoint was reduction in post-operative opioid use in morphine milligram equivalents (MME). Secondary endpoints included: post-operative pain scores, postoperative length of stay, and re-hospitalizations within 7 days of discharge. Sixty-six patients were included in our study, with 33 in each group. Patients in both groups were well matched demographically. The study group who received TAP block demonstrated a significant reduction in post-operative opioid use (92.05 MME vs. 53.98 MME, p &lt; 0.05) when compared to the control group who received hydromorphone PCA. Both groups achieved similar analgesia with comparable pain scores. There was no difference between postoperative hospital lengths of stay for both groups. Two patients in the control group were re-admitted due to small bowel obstruction within seven days of discharge. In conclusion, TAP block with liposomal bupivacaine significantly reduced postoperative opioid use, while also proving to be safe, efficacious and feasible in patients undergoing LLDN.

Preoperative transversus abdominis plane block decreases intraoperative opiate use during pancreaticoduodenectomy

Presenter: Jorge G Zarate Rodriguez MD | Washington University, St. Louis Background: Due to the adverse effects associated with opioids and the ongoing epidemic of abuse of these medications, there has been an increased interest in decreasing the use of narcotic medication in the perioperative setting. Several adjuncts are routinely used, including preoperative dosing of multimodal analgesics and regional anesthesia with transversus abdominis plane (TAP) block, but the effect of these interventions on intraoperative opiate use is unknown. Of these adjuncts, we hypothesized that preoperative TAP block would be associated with decreased intraoperative opiate use. Methods: A retrospective review of patients undergoing pancreaticoduodenectomy (PD) from June 2018 to January 2021 was performed. Perioperative data, including operative time and medication administration were collected. Intraoperative opiate medications were used to calculate a total morphine equivalent dose (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. Results: 190 patients underwent PD during the study period, 9 patients received methadone intraoperatively and were excluded from analysis. 83 (45.9%) did not receive TAP blocks, 59 (32.6%) received TAP block at the start of surgery, and 39 (21.5%) at the end of surgery. As summarized in Table 1, the univariate analysis showed no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p = 0.291), celecoxib (p = 0.417), gabapentin (p = 0.392), or intraoperative ketorolac (p = 0.350) administration. Minimally invasive surgical approach compared to open (6.40 MED/hour versus 7.33 MED/hour, p = 0.065) and epidural placement (p = 0.515) also did not significantly affect intraoperative opiate use. While patients receiving preoperative TAP blocks had lower intraoperative opiate use compared to both patients without blocks and with postoperative blocks (5.95, 7.51, 7.89 MED/hour, p = 0.001). Multivariate linear regression demonstrated that preoperative TAP block was the only adjunct significantly associated with decreased intraoperative opiate use (p = 0.002). Conclusion: The use of preoperative TAP block was associated with decreased intraoperative narcotic use during pancreaticoduodenectomy and should be considered for routine use.

Efficacy of preincisional versus post incisional unilateral ultrasound-guided transversus abdominis plane block in patients undergoing appendectomy under subarachnoid block

Background: Transversus abdominis plane (TAP) block produces effective postoperative analgesia and reduces postoperative opioid consumption after abdominal surgeries. It could be instituted preoperatively or postoperatively. Objectives: This study determined which period of institution of TAP block is more efficacious in postoperative analgesia in patients undergoing open appendicectomy. Patients and Methods: Eighty patients undergoing open appendicectomy were randomized, of which eight were excluded for various reasons (these were; three for protocol violations, four declined further participations, while one for prolonged surgery). A total of 72 patients received SAB, of which half received (n = 36) TAP block with 20 ml of 0.375% plain marcaine before skin incision (preoperative TAP block group) while the other half (n = 36) received same volume and concentration of TAP block at the end of surgery (postoperative TAP block group). Pain was evaluated postoperatively at rest and on movement by numerical rating scale (NRS) over 24 h. Results: Pain scores were significantly lower in the preoperative TAP block group than in the postoperative TAP block group, especially in the first 6 h (P < 0.001) postoperatively; although, both demonstrated lower pain score. Furthermore, total analgesic consumption (paracetamol and tramadol) was significantly higher in the postoperative TAP block group (P = 0.001 and P = 0.002). Conclusion: Preoperatively, administered TAP block increases time to first analgesic request, provides a longer duration of analgesia and reduces total analgesic requirement in comparison to postoperative TAP block in patients undergoing open appendicectomy.

The transversus abdominis plane block may reduce chronic postoperative pain one year after TAPP ingunial hernia repair

IntroductionChronic postoperative inguinal pain (CPIP) is defined as pain impacting daily activities lasting at least 3 months. With an incidence of 0.5–6.0%, chronic pain affects many patients who underwent inguinal hernia repair (IHR). Early severe postoperative pain has been described as a risk factor for CPIP. Thus, we aim to investigate the impact of the transversus abdominis plane (TAP) block on CPIP. MethodsFrom 2013 to 2019 we collected data from individuals who were operated on electively in TAPP technique and who received a preoperative TAP block. ResultsData from 289 patients were selected. 259 patients were male. The mean age was 59.93 years and the mean BMI was 25.72 kg/m2. 252 patients suffered from a primary inguinal hernia. No mesh fixation was conducted. 21 patients reported pain at rest, 26 pain under physical exertion and 13 patients required treatment of their pain. In 6.25% of cases patients reported CPIP. We compared our findings with data from the German Herniamed Registry (unilateral, primary IH, men, no mesh fixation; n = 8.799), because we assume that the majority of these patients did not receive a TAP block. The rate of pain under physical exertion (9.2% vs. 10.05%) and pain requiring treatment (2.45% vs. 2.95%) one year after surgery slightly differs without a statistical significance. ConclusionsWe assume that the TAP block may reduce CPIP, postoperative pain during physical exertion and pain requiring treatment following IHR in TAPP technique. Additional randomized clinical trials are mandatory to evaluate the hypothesis.

Association of the addition of a transversus abdominis plane block to an enhanced recovery program with opioid consumption, postoperative antiemetic use, and discharge time in patients undergoing laparoscopic bariatric surgery: a retrospective study

BackgroundIncreasing numbers of laparoscopic bariatric surgeries are being performed and enhanced recovery from anesthesia and surgery (ERAS) protocols have been implemented to optimize care for these patients. We evaluated the...

Preoperative Transversus Abdominis Plane (TAP) Block with Liposomal Bupivacaine for Bariatric Patients to Reduce the Use of Opioid Analgesics.

Postoperative pain remains the most common challenge following inpatient and outpatient surgeries, and, therefore, opioid analgesics are widely used during the perioperative period. The aim of this study is to examine the efficiency of transversus abdominis plane (TAP) block using liposomal bupivacaine in reducing the use of opioid analgesics during the perioperative period of bariatric procedures. A retrospective chart review was performed on 191 patients who underwent a laparoscopic bariatric procedure between September 13, 2017, and February 26, 2018. A total of 97 patients received TAP block with liposomal bupivacaine, and 94 patients did not receive TAP block. Baseline patient characteristics were comparable between the two groups. The mean age was 43.7 and 41.1years, and the mean preoperative body mass index (BMI) was 45.6 and 46.1kg/m2 in TAP and non-TAP groups, respectively. In the TAP group, 65 patients (69.2%) received intravenous (IV) hydromorphone or morphine while 93 (95.9%) did in the non-TAP group (p < 0.0001). In the TAP group, 44 (46.8%) received oral opioid analgesic while 73 (75.3%) did in the non-TAP group (p < 0.0001). The odds of receiving IV hydromorphone or morphine for TAP group was about 0.10 times the corresponding odds for non-TAP group, and the odds of receiving oral opioid analgesic for the TAP group was about 0.29 times the corresponding odds for the non-TAP group. The use of preoperative TAP block with liposomal bupivacaine significantly decreased the use of IV and oral opioid analgesics. A larger prospective study may be needed to further validate the results.

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

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

Efficacy of preoperative transversus abdominis plane block for analgesia after kidney transplantation

Objective To evaluate the efficacy of preoperative transversus abdominis plane block(TAPB)for analgesia after kidney transplantation. Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 18-64 yr, with body mass index of 18-24 kg/m2, scheduled for elective kidney transplantation, were divided into 2 groups(n=20 each)using a random number table: TAPB group and routine analgesia control group(group C). After induction of anesthesia, ultrasound-guided TAPB was performed on the operated side with 0.5% ropivacaine 20 ml in group TAPB.Patient-controlled intravenous analgesia with sufentanil was provided to all the patients after surgery.Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score within 24 h after surgery≤3.The consumption of anesthetics during surgery and amount of sufentanil consumed and requirement for rescue analgesic within 24 h after surgery were recorded.Ramsay sedation scores were recorded at 2, 4, 6, 12 and 24 h after surgery.The occurrence of nausea and vomiting, pruritus and respiratory depression within 24 h after surgery were recorded.TAPB-related complications were also recorded in group TAPB. Results Compared with group C, the consumption of remifentanil was significantly reduced during surgery, and the amount of sufentanil consumed within 24 h after surgery was decreased (P 0.05). No patients required rescue analgesic in two groups.TAPB-related complications were not found in group TAPB. Conclusion Preoperative TAPB reduces the perioperative opioid consumption and enhances the efficacy of postoperative analgesia in the patients undergoing kidney transplantation. Key words: Abdominal muscles; Nerve block; Kidney transplantation; Analgesia

Transversus abdominis plane block in robotic gynecologic oncology: A randomized, placebo-controlled trial

ObjectiveAlthough robotic surgery decreases pain compared to laparotomy, postoperative pain can be a concern near the site of a larger assistant trocar site. The aim of this study was to determine the efficacy of transversus abdominis plane (TAP) block on 24-hour postoperative opiate use after robotic surgery for gynecologic cancer. MethodsSixty-four subjects with gynecologic malignancies who were scheduled to undergo robotic surgery were enrolled into the study. They were randomized to receive a unilateral TAP block to the side of the assistant port via ultrasound guidance. The block was comprised of 30cc of 0.25% bupivacaine with 3mcg/mL epinephrine or saline. Opiate use was measured and converted into IV morphine equivalents. Patient-reported pain was measured using the Brief Pain Inventory (BPI) and Visual Analog Scale (VAS). ResultsThe treatment group used a mean of 64.9mg morphine in the first 24h compared to 69.3mg for controls (primary outcome, p=0.52). After age-adjustment, the treatment group used a mean of 11.1mg morphine less than controls (p=0.09). Postoperative pain scores assessed by the BPI (6.44 vs. 6.97, p=0.37) and the VAS (3.12 vs. 3.61, p=0.30) were equivalent. Block placement was uncomplicated in 98.4% of participants with mean BMI of 35.3kg/m2. Linear regression revealed an approximate 8.1mg decrease in morphine equivalents used per additional decade of life (p=0.0008). There was a positive correlation between the amount of opiates and BMI with an additional 8.8mg of morphine per 10kg/m2 increase in BMI (p=0.0012). ConclusionsTAP block is safe and feasible in this patient population with a large proportion of morbid obesity. Preoperative TAP block does not significantly decrease opiate use. However; based on these data, a clinically useful nomogram has been created to aid clinicians in postoperative opiate-dosing for patients based on age and BMI.

The analgesic efficacy of transversus abdominis plane blocks in ileostomy takedowns: a retrospective analysis

Study ObjectiveTo evaluate the analgesic efficacy of transversus abdominis plane (TAP) blocks in patients undergoing ileostomy reversal. DesignRetrospective chart review. SettingUniversity-affiliated hospital. SubjectsThe charts of 104 consecutive patients who underwent ileostomy reversal between November 1, 2008 and December 31, 2009 were reviewed. The charts of 69 patients were included in the study. Of these, 31 received a preoperative TAP block. MeasurementsPatients’ opioid requirements intraoperatively, in the Postanesthesia Care Unit (PACU), and during the 24-hour period after discharge from the PACU were recorded and converted to intravenous (IV) morphine equivalents. Patient-reported numerical pain scores (0-10) from the PACU and from the 24-hour postoperative period also were recorded. Additional nonopioid means of perioperative analgesia were noted, as were duration of stay in the PACU and the hospital. Main ResultsPatients receiving TAP blocks required statistically significantly fewer opioids intraoperatively (P = 0.002), in the PACU (P = 0.003), and over the 24-hour period postoperatively (P = 0.01) than did patients who did not receive a TAP block. Mean numerical pain scores while in the PACU and for 24 hours postoperatively also were significantly lower (P = 0.015 and P = 0.019, respectively) in patients receiving a TAP block, as were numerical pain scores immediately on arrival at the PACU (P = 0.013). ConclusionTAP blocks are an effective means of reducing perioperative pain in patients undergoing ileostomy reversal.

A Dose-Ranging Study of the Effect of Transversus Abdominis Block on Postoperative Quality of Recovery and Analgesia After Outpatient Laparoscopy

Postoperative pain can delay functional recovery after outpatient surgery. Multimodal analgesia can improve pain and possibly improve quality of recovery. In this study, we evaluated the dose-dependent effects of a preoperative transversus abdominis plane (TAP) block on patient recovery using the Quality of Recovery 40 (QoR-40) questionnaire after ambulatory gynecological laparoscopic surgery. Global QoR-40 scores range from 40 to 200, representing very poor to outstanding quality of recovery, respectively. Healthy women undergoing outpatient gynecological laparoscopy were randomly allocated to receive a preoperative TAP block using saline, ropivacaine 0.25%, or ropivacaine 0.5%. Needle placement for the TAP blocks was performed using ultrasound guidance and 15 mL of the study solution was injected bilaterally by a blinded investigator. QoR-40 score and analgesic use were assessed 24 hours postoperatively. The primary outcome was global QoR-40 score at 24 hours after surgery. Data were analyzed using the Kruskal-Wallis test. Post hoc pairwise comparisons were made using the Dunn test with P values and 95% confidence intervals Bonferroni corrected for 6 comparisons. Seventy-five subjects were enrolled and 70 subjects completed the study. The median (range) for the QoR-40 score after the TAP block was 157 (127-193), 173 (133-195), and 172 (130-196) for the saline group and 0.25% and 0.5% ropivacaine groups, respectively. The median difference (99.2% confidence interval) in QoR-40 score for 0.5% bupivacaine (16 [1-30], P=0.03) and 0.25% bupivacaine (17 [2-31], P=0.01) was more than saline but not significantly different between ropivacaine groups (-1 [-16 to 12], P=1.0). Increased global QoR-40 scores correlated with decreased area under the pain score time curve during postanesthesia recovery room stay (ρ=-0.56, 99.2% upper confidence limit [UCL]=-0.28), 24-hour opioid consumption (ρ=-0.61, 99.2% UCL=-0.34), pain score (0-10 scale) at 24 hours (ρ=-0.53, 99.2% UCL=-0.25), and time to discharge readiness (ρ=-0.65, 99.2% UCL=-0.42). The aforementioned variables were lower in the TAP block groups receiving ropivacaine compared with saline. The TAP block is an effective adjunct in a multimodal analgesic strategy for ambulatory laparoscopic procedures. TAP blocks with ropivacaine 0.25% and 0.5% reduced pain, decreased opioid consumption, and provided earlier discharge readiness that was associated with better quality of recovery.