Received Transversus Abdominis Plane Block Research Articles

Multimodal Analgesia Transversus Abdominis Plane Block-Ketorolac Combination being Superior to Paracetamol-Ketorolac as Postoperative Pain Management after Cesarean Section in an Indonesian Hospital

Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.

Multimodal Analgesia Transversus Abdominis Plane Block-Ketorolac Combination being Superior to Paracetamol-Ketorolac as Postoperative Pain Management after Cesarean Section in an Indonesian Hospital

Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.

Multimodal Analgesia Transversus Abdominis Plane Block-Ketorolac Combination being Superior to Paracetamol-Ketorolac as Postoperative Pain Management after Cesarean Section in an Indonesian Hospital

Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.

Multimodal Analgesia Transversus Abdominis Plane Block-Ketorolac Combination being Superior to Paracetamol-Ketorolac as Postoperative Pain Management after Cesarean Section in an Indonesian Hospital

Aim: This study aimed to compare the outcome of multimodal analgesia using transversus abdominis plane block combined with ketorolac and multimodal analgesia oral paracetamol combined with ketorolac in postoperative pain after cesarean section. Background: Post-caesarean section pain resulted in prolonged recovery time, inhibited early breastfeeding initiation, and prolonged hospitalization. Multimodal analgesia is an important component of post-cesarean section pain management but has not been established in many Indonesian hospitals. Methods: This study was a retrospective, observational analytic study on 46 patients who received low-dose sub-arachnoid block anesthesia. A total of 24 subjects received bilateral transversus abdominis plane block employing ultrasonography-guided lateral approach, with Ropivacaine 0.25% in a total volume of 30cc combined with intravenous ketorolac 30 mg/8 h (Group B). A total of 22 subjects received oral paracetamol 500 mg/6 h combined with intravenous ketorolac 30 mg/8 h (Group A). Numeric Rating Scale (NRS), length of hospitalization, and mobilization time were analyzed using the T-test at a significance level of p<0.05 (confidence interval of 95%). Results: The NRS and mean time to start mobilization of patients who received transversus abdominis plane block combined with ketorolac were significantly better than patients who received paracetamol combined with ketorolac (p<0.05). There was no significant difference in the length of hospitalization between the two techniques (p>0.05). Both modalities resulted in improvement in pain intensity over the mild pain range. Conclusion: Multimodal analgesia transversus abdominis plane block combined with ketorolac is superior to paracetamol combined with ketorolac for postoperative pain management after cesarean section.

Study of Analgesic Effect of Magnesium Sulphate with Bupivacaine in Ultrasonogram Guided Transversus Abdominis Plane Block for Post-Operative Analgesia in Lower Uterine Cesarean Section

Background: Transversus abdominis plane (TAP) block has proven to be an effective component of postoperative pain management for different abdominal procedures particularly in Lower uterine cesarean section (LUCS) done under Sub arachnoid block. Magnesium sulphate (MgSO4) is a N-methyl-D-aspartate receptor antagonist has the potential to act as an adjuvant in TAP block. For this reason this study was planned to assess the role of Magnesium Sulphate as an adjuvant to bupivacaine in ultrasound-guided transverse abdominis plane (TAP) blocks for postoperative analgesia in patients undergoing LUCS after regression of block of Sub arachnoid block.
 Methods: This was a hospital based randomized controlled trial which was conducted in Dhaka Medical College Hospital (DMCH) at the department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine for 2 years of period. Formal ethical approval was taken from the Ethical Review Committee (ERC) of DMC. Patients having LUCS were approached for the study. A total of 60 patients of LUCS under Sub arachnoid block were selected in the study among them 30 patients received TAP block with bupivacaine 0.25% with saline, and the other 30 received bupivacaine 0.25% with 150 mg Magnesium Sulphate immediately following surgery. Primary outcome was focused on duration of analgesia, pain score, time of first need of rescue analgesic and total opioid consumption. Pre-block and immediately post block Visual analog pain scores (VAS) (0–10) were obtained. After pre-anesthetic checkup & discussion about study procedures written informed consent was taken from the patient. Separate case record form was used in each case. Data analysis was done by SPSS version 22.
 Observation and Results: Mean age of group B (GB) and group-BM (GBM) patients were 25.57± 2.76 & 25.9 ± 3.17SD (years). No significant difference demographic profile was observed (p>0.05). Mean duration of analgesia was significantly prolonged in Group BM compared to Group B (263.13 ± 34.39) min vs. 222.23 ± 30.58 min; P-value <0.001) which was evident by increased VAS score at 16th hour postoperatively in magnesium sulphate group than normal saline group. Total postoperative requirement of opioid was also lower in Group BM (p<0.05).
 Conclusion: Magnesium Sulphate could be used as an adjuvant with bupivacaine in ultrasound guided transversus abdominis plane (TAP) blocks for management of post-operative analgesia in LUCS patient.
 CBMJ 2021 January: vol. 10 no. 01 P: 09-17

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.

Ultrasound-guided quadratus lumborum block verses transversus abdominis plane block for post-operative analgesia in patients undergoing total abdominal hysterectomy: A prospective observational study

Background: Total abdominal hysterectomy (TAH) is a major surgical procedure associated with significant post-operative pain and discomfort. Ultrasound-guided (USG) quadratus lumborum (QL) and transversus abdominis plane (TAP) block are regional analgesic techniques that have role in post-operative pain management after TAH. Aims and Objectives: This study aims to compare quality of post-operative analgesia and analgesic consumption in USG-guided QL block and TAP block in patients undergoing TAH under spinal anesthesia. Materials and Methods: Hundred patients scheduled for TAH were observed over a period of 2 years. The patients who had received either TAP block or QL block were assigned in two groups. Patients who received TAP block after spinal anesthesia were labeled as Group A and patients who received QL block after spinal anesthesia were labeled as Group B. Postoperatively, VAS score, rescue analgesia, analgesic consumption, and hemodynamic parameters were observed at 0, 1, 3 6, 9, 12, 18, 24, and 48 h. Statistical Analysis: Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. P&lt;0.05 was considered statistically significant. Results: Time for rescue analgesic requirement was higher in the Group B than the Group A (mean±SD: 16.5±3.096 h vs. 8.5±1.998 h) (P&lt;0.001). Group B had significantly less analgesic demand (P&lt;0.001) at 12, 24, and 48 h postoperatively. The VAS at rest and movement was significantly reduced in Group B at all times. Hemodynamic parameters and post-operative side effects between two groups remained insignificant. Conclusion: USG-guided quadratus lumber block provided prolonged analgesia as compared to TAP block in patients undergoing TAH after spinal anesthesia. USG-guided quadratus lumber block provides better multimodal post-operative analgesia relief in patients.

Transversus abdominis plane block by landmark technique with ropivacaine versus bupivacaine for post-operative analgesia in patients undergoing lower segment caesarean section deliveries

Transversus Abdominis Plane (TAP) Block is an efficacious abdominal field block which is widely used component of multimodal analgesia. Compare the efficacy of Inj. Ropivacaine 0.2% and Inj. Bupivacaine 0.2% when used in TAP block for post-operative analgesia in lower segment caesarean section deliveries(LSCS) done under spinal anaesthesia. Randomized double blinded prospective study conducted after institutional ethics committee in our institute. We have recruited sixty patients scheduled for an elective LSCS which were enrolled into two groups to receive TAP block with bupivacaine 0.2% 15ml Group B (n=30) versus ropivacaine 0.2% 15ml Group R (n=30) + dexamethasone 2mg bilaterally. TAP block was administered on completion of surgery. Primary objective was to compare time to rescue analgesia in postoperative period. Secondary Objectives wereto compare hemodynamic response during postoperative period, measure the intensity of pain using visual analogue scale (VAS), number of analgesic doses in first 24 hours, patient satisfaction with pain management and complications if any.SPSS software 16 version. Time for rescue analgesia was shorter in Group B (6.7 hour) than in Group R (9.47 hour) (p = 0.00). VAS was lower in Group R. Higher dose of analgesics was required in Group B (p=0.008). All this led to higher patient satisfaction score in Group R. This study concludes that 0.2% ropivacaine provided a longer duration of analgesia compared to 0.2% bupivacaine when used in TAP block for post-operative analgesia in LSCS deliveries.

Postoperative Analgesic Efficiency of Transversus Abdominis Plane Block with and without Magnesium Sulphate after Surgical Repair of Moderate Size Umbilical Hernia

Abstract Background The transversus abdominis plane (TAP) block is a known approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work The aim of this study is to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing surgical repair of moderate sized umilical hernia under general anathesia. As regard postoperative pain and opioid consumption using Visual Analogue scale VAS. Patients and Methods the study was carried out on 40 patients who was undergo surgical hernial repair, after ethical approval of Ain Shams University Hospital and informed consent from patients ,patients assigned in two group ,each group include 20 patients, Group 1: receive TAP block with Bupivacaine 0.25% 20 ml per side. Group 2: receive TAP block with Bupivacaine 0.25% 18 mL+2 ml magnesium sulphate. Results By the end of our study we found that VAS pain score was less in group II than in group I at 0,1,2 and 24 hours postoperatively and most significant at 4,6 and 12 hours the VAS score less in group II than group I (p value &amp;lt;0.05).And the mean time for first rescue analgesic dose was delayed in group II (872.87±265.25mins) compared to group I(466.54±118.29mins) (p value &amp;lt;0.001). Conclusion MgSO4 as an adjuvant to Bupivacaine in Ultra-sounded guided TAP block reduces postoperative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.

Comparative Study between Ultrasound Guided Oblique Subcostal Transversus Abdominis Plane Block and Local Wound Infiltration as Postoperative Analgesia in Hepatectomy

Abstract Background Poorly controlled acute pain after hepatectomy is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after hepatectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 60 randomly chosen patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I ,II and III scheduled for hepatectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores for 12 h after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration. Conclusion oblique subcostal TAP block was effective in reducing postoperative pain scores at rest and movement for 12-24 hours and lower total 24-h postoperative opioid and analgesic consumption after hepatectomy under general anesthesia, compared to local wound infiltration.

Comparison between Ultrasound Guided Transversus Abdominis Plane Block versus Ultrasound Guided IlioInguinal/Iliohypogastric Nerves Block for Postoperative Analgesia in Patients Undergoing Unilateral Oblique Inguinal Hernia Repair Under General Anesthesia

Abstract Background Inguinal hernia considered the third common disease in surgeries for adults after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. Objectives The aim of this study is to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to ilioinguinal/iliohypogastric nerves block after unilateral inguinal hernia repair regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 70 randomly chosen patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia, in Ain Shams University Hospitals after approval of the medical ethical committee. Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores at 4 h and 6 h after operation, delay time for rescue analgesia and decrease total need of analgesic in first 24 h post operative compared with patients who received ilioinguinal/ iliohypogastric nerves block. Conclusion TAP block was effective in reducing postoperative pain scores for 4-6 hours, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to ilioinguinal/iliohypogastric nerves block. This technique can be a promising mode of postoperative analgesia when epidural catheter insertion is contraindicated.

English

BACKGROUND Inguinal hernia is a frequently encountered surgical problem. General anaesthesia carries the risk of possible airway complications. Regional blocks improve acute post-operative pain, decrease post-operative visual analogue scale (VAS) score and patient can mobilise early. The purpose of this study was to compare the effectiveness of transversus abdominis plane (TAP) block vs. paravertebral (PVB) block for post-operative analgeia in inguinal hernia surgeries. METHODS We conducted a research on 64 patients of age &gt; 18 years with American society of Anaesthesiologists (ASA I – III) to undergo unilateral inguinal herniorrhaphy. Patients were randomized into two groups. Group T received TAP block in which 20 ml of 0.25 % bupivacaine was injected and Group P underwent PVB in which 5 ml of bupivacaine (0.25 %) at each segment from T10-L1 was injected slowly (total dose of 20 ml). Post-operative VAS score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any was noted. RESULTS The demographic data of both the groups were comparable. Also, pre and postoperative heart rate, blood pressure, IV fluids, ephedrine use, operative time and complications were statistically insignificant. As compared to group T, group P had lower VAS score from 2nd – 12th hour which was statistically significant (P &lt; 0.05). Although more time is required to perform paravertebral block but the time for request of first rescue analgesia was quite prolonged in paravertebral block. Time of ambulation in group P was significantly lower than group T. CONCLUSIONS PVB requires more time to perform due to multiple site of injection, the comparison of both techniques in the present study revealed that PVB showed relatively higher efficacy in the management of post-operative pain, early ambulation and had significant reduction in dose requirement of additional analgesia (diclofenac) and antiemetics (ondansetron) over tap block. KEYWORDS Paravertebral Block, Transversus Abdominis Block, Inguinal Hernia

The new trending pain-free cesarean section: TAP block versus IV PCA

BackgroundWomen's pain satisfaction post-cesarean section remains a challenge. Accurate assessment of pain severity of post-cesarean section helps to choose the most appropriate anesthetic approach, drug, and dose, as well as improvement of treatment of postoperative pain. Our objective was to compare the efficacy of ultrasound-assisted transversus abdominis plane (TAP) block versus IV patient-controlled analgesia (PCA) in the first 24 h postoperative in women who underwent cesarean section. The primary outcome was postoperative pain at 2, 4, 6, 12, and 24 h. The secondary outcomes were intestinal mobility, early mobilization, nausea, vomiting, heart rate, and respiratory rate.ResultsA cross-sectional study has been conducted on 70 women who are planned for elective cesarean section. They were divided into 2 groups; “group A” (n = 35), women who received TAP block, and “group B” (n = 35), those who received PCA. Pain score, heart rate, respiratory rate, intestinal motility, nausea, and vomiting have been assessed 2, 4, 6, 12, and 24 h postoperatively. The degree of pain was significantly lower in “group B” than in “group A” in all time intervals (p < 0.001). Heart rate was significantly higher in women in “group B” compared to those in “group A” only at 2 and 4 h postoperative (p < 0.001). Nausea and vomiting were also significantly higher in women in “group B” compared to those in “group A” (p value 0.03 and 0.04, respectively). Regarding intestinal motility, it was audible in “group A” earlier than in “group B.”ConclusionsBoth TAP block and PCA are effective in postoperative pain relief after cesarean section; however, PCA is more superior, especially for visceral pain. Nevertheless, TAP block has the privilege of avoiding systemic action of opioids used in PCA. PCA can easily be applied while TAP block needs more training and an intraoperative ultrasound machine. Complications and side effects of both were minimal when adjusting the doses.

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.

Transversus Abdominis Plane Block in Robotic Gynecologic Oncology Surgery

Objective: Although minimally invasive surgery decreases opiate requirements compared to laparotomy, achieving adequate postoperative pain relief continues to be a concern. We aimed to determine the efficacy of transversus abdominis plane block on postoperative opiate use, pain levels, and time of discharge following robotic hysterectomy for surgeries performed by our division of gynecologic oncology. Design: This is a retrospective analysis of patients who underwent robotic hysterectomy. Methods: After induction of general anesthesia, patients received transversus abdominis plane block and underwent robotic hysterectomy. Patients who did not receive the transversus abdominis plane block received local analgesia. A non-narcotic pain control regimen was used pre- and postoperatively and supplemented with narcotic analgesics as needed. Length of stay, pain levels (score of 0-10), and opioid consumption were reviewed and compared between the two groups. Results: Following power calculation, 140 patients were studied: 70 received a transversus abdominis plane block and were matched to 70 patients who received local anesthesia. All patients received our Enhanced Recovery Pathway. After controlling for age, BMI, total surgical time, and number of ports, there were no differences in pain scores at 1 hour (p = 0.13) and at discharge (p = 0.06), time to discharge (p = 0.09), amount of opioids required (p = 0.11), or time to void (p = 0.07). Conclusions: This study demonstrated that when well-established Enhanced Recovery Pathway is utilized, transversus abdominis plane block was equivalent to local anesthesia in reducing postoperative opioid consumption and pain scores.

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.

Comparative Study of the Analgesic Efficacy of Intrathecal Fentanyl with Ultrasound-Guided Transversus Abdominis Plane Block after Lower Segment Cesarean Section.

Background:This study was conducted to compare the analgesic efficacy of intrathecal fentanyl with ultrasound-guided transversus abdominis plane (TAP) block after lower segment cesarean section. The objectives of the study were to compare the effects of subarachnoid fentanyl versus TAP block with respect to duration of postoperative analgesia, time for first analgesic request, total analgesic consumption in 24 h, time to first breastfeed and Apgar score at 1 and 5 min.Materials and Methods:Sixty-two patients undergoing elective or emergency cesarean delivery were recruited for the study in a prospective, randomized, single-blind manner. The patients were randomly allocated to either intrathecal fentanyl group (Group F) or TAP block group (Group T) after determining the eligibility criteria. Group F patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy with 25 mcg of fentanyl. Group T patients received subarachnoid block with 10 mg of 0.5% bupivacaine heavy prior to surgery and at the end of surgery, they received TAP block with 0.25% bupivacaine 20 mL on each side.Results:Group T had significantly longer time for the first analgesic request (7.65 ± 1.23 h) than group F (4.10 ± 0.32 h). The total analgesic consumption in 24 h was significantly less in Group T (1.0 ± 0) than Group F (2.13 ± 0.34). The Visual Analogue Scale scores at rest and on movement were significantly less in Group T than Group F at all-time points. The Apgar score at 1 and 5 min and time to first breast feed were comparable between the two groups. The incidence of side effects was less in Group T.Conclusion:This study indicated that ultrasound-guided TAP block has a better analgesic as well as safety profile compared to intrathecal fentanyl for cesarean delivery.

To Compare 0.25% Ropivacaine And 0.25% Bupivacaine In Tap Block For Postoperative Analgesia In Patients Undergoing Abdominal Surgeries.

INTRODUCTION Pain has been defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.1 Pain is the most dreaded problem which a person fears after any surgery. The transversus abdominis plane (TAP) block is an anaesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall.4 Since the thoracolumbar nerves originating from the T6 to L1 spinal roots run into this plane and supply sensory nerves to the anterolateral abdominal wall5, the local anaesthetic spread in this plane can block the neural afferents and provide analgesia to the anterolateral abdominal wall. AIM AND OBJECTIVES Aim of study was to compare 0.25% Ropivacaine and 0.25% Bupivacaine in TAP block for postoperative analgesia in patients undergoing Abdominal Surgeries. The following parameters were compared: A. To study the effectiveness of transverses abdominis plane block for post-operative analgesia in Abdominal Surgeries. B. To compare the duration of analgesia and its effectiveness conferred by 0.25% Ropivacaine and 0.25% Bupivacaine. C. Total requirement of rescue analgesia. D. To watch for occurrence of side effects, if any MATERIALS AND METHODS A comparative clinical study was carried out on 60 adult patients belonging to ASA grade I or II, scheduled for elective Abdominal Surgeries. All patients were administered spinal anaesthesia with bupivacaine heavy 0.5%, 2.0-4.0 ml with 25 G spinal needle at L2-L3 or L3-L4 vertebral interspace. The patients were randomly allocated in two groups and study drug was injected at the end of surgery according to the group. The volume of administered drug kept constant (20 ml). Group I: Patients received TAP BLOCK on each side with 10ml 0.25% Ropivacaine. Group II: Patients received TAP BLOCK on each side with 10ml 0.25% Bupivacaine. CONCLUSION Transversus Abdominis Plane Block (TAP Block) provides better postoperative analgesia in various abdominal surgeries. 0.25% ropivacaine and 0.25% bupivacaine are equally effective in TAP block and provides effective postoperative analgesia but ropivacaine group shown longer duration of action compared to bupivacaine which was statistically significant without causing any increased adverse effects.

EARLY RECOVERY FOLLOWING ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK (TAP) IN ABDOMINAL CONTOURING SURGERIES

Background:The transversus abdominis plane (TAP) block is a well-known regional nerve block that is used for the pain control after various inguinal andabdominal surgeries. The most effective and well known method of administering the TAP block is under ultrasound guidance.Till now only few studies have evaluated analgesic efficacy of TAP block in Abdominoplastysurgical procedure, in which post-operative pain is a major concern for both surgeon as well for the patient. Objectives:We conducted retrospective cohort study to assess efficacy of ultrasound-guided bilateral TAP block, in controlling post-operative pain in abdominoplasty patients. Methods:Sixty Patients who had undergone Lipoabdominoplasty procedurewere studied retrospectively. The patients who had received TAP block were assigned as groups A and those patients who had not received any TAP block were assigned as group B, with thirty Patients in each group.The patients in two groups were compared for their demographic characteristics, pain intensity on mobilization, time to first rescue analgesic dose (visual analog scale (VAS) score ≥ 5 or on demand), opioid consumptionand incidence of nausea-vomitingepisodes during first post-operative 24 hours. Results:The patients in two groups were similar in demographic characteristics. Patients in group A (TAP block group) had required significantly smaller mean dose of postoperative opioids (Group A: 5mg Group B: 75 mg P = &lt;0.000) and hadsignificantly longer mean time of first request for analgesic medication (Group A: 8 hours 11 minutes Group B: 1 hours 20 minutes P = &lt;0.000).Median VAS score on mobilization was significantly lower in Group A(group A: 1 Group B: 5).Only Three patients in group A as compared to 18 patients in group B had experienced nausea and vomiting in post-operative period. Conclusions:The ultrasound guided TAP block provide more effective analgesia after Lipoabdominoplasty, which allows more comfortable early post-operative mobilization, decreases opioid requirement as well as opioid related side-effects, Therefore ultrasound guided TAP block should be considered in most of lipoabdominoplasty patients for better patient experience and outcome.

Transversus Abdominis Plane Block With Liposomal Bupivacaine Versus Thoracic Epidural for Postoperative Analgesia After Deep Inferior Epigastric Artery Perforator Flap-Based Breast Reconstruction.

Autologous breast reconstruction with abdominally based free flaps has traditionally been associated with a longer hospital stay and higher initial cost relative to other reconstructive methods. One important component of this course is postoperative pain control. Thoracic epidural anesthesia is considered among the most effective methods for pain control in the immediate postoperative period following these procedures. Recently, our institution began using 4 quadrant transversus abdominis plane (TAP) blocks with liposomal bupivacaine. Encouraging trends were observed with utilization of TAP blocks; however, we sought to quantify this effect compared with that of thoracic epidural anesthesia. This study would contribute to a growing body of evidence supporting an enhanced recovery pathway for microvascular breast reconstruction. Thirty patients who underwent deep inferior epigastric artery perforator flap-based breast reconstruction from January 2016 to April 2017 were evaluated. Fifteen patients received thoracic epidural anesthesia, and 15 received 4 quadrant TAP blocks with liposomal bupivacaine. Opioid consumption was evaluated and compared for the first 3 days postoperatively. All opioids were converted to oral morphine equivalents (OMEs) for standardization. Day of discharge, day of Foley removal, and several traditionally opioid-related adverse effects were also recorded and compared. On postoperative days 0, 1, 2, and 3, opioid consumption among those given epidural anesthesia compared with those who received TAP blocks with liposomal bupivacaine was 34.9 versus 32.6 OMEs (P = 0.81), 98.9 versus 92.4 OMEs (P = 0.78), 59.7 versus 56.0 OMEs (P = 0.79), and 59.6 versus 24.5 OMEs (P = 0.005*), respectively. Total opioid consumption for the epidural group was 253.1 versus 205.4 OMEs for the TAP block group (P = 0.2743). Time until removal of Foley was 2.7 days for patients with an epidural and 2.1 days for those receiving TAP blocks (P = 0.0056*). Length of stay for those receiving epidural was 4.33 days compared with 3.53 days for those receiving TAP blocks (P = 0.0002*). When using TAP blocks with liposomal bupivacaine, a statistically significant effect on postoperative day 3 and decreased opioid utilization overall were observed. Patients also had their Foley removed sooner and were discharged from the hospital earlier.