Subcostal Transversus Abdominis Plane Block Research Articles

Efficacy of Unilateral External Oblique Intercostal Fascial Plane Block Versus Subcostal TAP Block in Laparoscopic Cholecystectomy: Randomized, Prospective Study.

This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery. After ethics committee approval, ASA I-II patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25mg pethidine as a rescue analgesic to patients with VAS ≥4. Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (P > .05). It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.

The effect of upper transabdominal plane block on diaphragm thickness in adult patients after laparoscopic cholecystectomy operation.

In this prospective and observational study, our objective was to examine the impact of subcostal transversus abdominis plane (SubTAP) block, along with intravenous analgesia techniques, on diaphragm thickness and post-operative pain following laparoscopic cholecystectomy. This study examined laparoscopic cholecystectomy patients aged 18-60 years with an American Society of Anesthesiologist score of 1-2. This study divided patients into Group 1 for SubTAP block and Group 2 for intravenous analgesia. This study had 67 patients, at least 30 from each group. Thus, diaphragm thicknesses and Visual Analogue Scale (VAS) values were compared between regional anaesthesia and intravenous analgesia groups. Pre-operative data showed no statistically significant changes between the groups, although post-extubation inspiratory thickness was closer to baseline in Group 1 patients who received regional block. The groups had different outcomes after extubation and at the post-operative 30th min (P = 0.028 and P = 0.001, respectively). There was also a significant difference in post-operative oxygen saturation and VAS scores (P = 0.001). Our receiver operating characteristic analysis determined that the threshold values for VAS parameters of 2 or 3 were 0.28 cm in inspiration, 0.18 cm in expiration and 1.29 as i/e ratio. Significant discomfort was defined as diaphragm parameter values below these limits. We found that the earlier return of diaphragmatic functions to baseline was associated with diaphragm thickness. According to the measurements made in the post-operative care unit, the regional block group effectively prevented the loss of diaphragm function.

Impact of a transversus abdominis plane block with low-dose magnesium sulphate coupled to bupivacaine on postoperative pain after laparoscopic cholecystectomy: A randomized trial

ObjectivesThe subcostal transversus abdominis plane (STAP) block has recently been included in the enhanced recovery after surgery (ERAS) protocol for laparoscopic cholecystectomy (LC). In our study on STAP for LC, we compared the effectiveness of adding low-dose magnesium sulphate (MgSO4) to bupivacaine versus using bupivacaine alone. MgSO4 was hypothesized to enhance the analgesic effects of bupivacaine and therefore aid in the recovery process. MethodsSixty patients, aged 18–65 years, ASA I–II, undergoing LC, were randomly assigned to receive bilateral STAP 15 min before skin incision with 20 ml bupivacaine 0.25 % and either 150 mg MgSO4 (BM group) or 1.5 ml normal saline (B group). Pain scores, time to initial analgesic demand, overall analgesic requirement, sedation, emetic episodes, time to get out of bed, and patient satisfaction were recorded for the first 24 h following surgery. The Mann-Whitney U test was used to analyze the non-normally distributed data between groups, while the Chi-square test or Fisher’s exact test was used to test categorical data. ResultsThe BM group had statistically significant but clinically insignificant lower pain scores at rest and during coughing in the post-anesthesia care unit (PACU) (P = 0.005 and P = 0.003), at 1 h (P = 0.005 and P = 0.015), 6 h (P = 0.009 and P = 0.003), 12 h (P = 0.017 and P = 0.001), and 24 h (P = 0.001 and P = 0.001) after surgery compared to the B group. Kaplan–Meier curves for times to the first paracetamol and morphine doses showed significant differences (log-rank test) between the groups (P = 0.001 and P = 0.003, respectively). Additionally, the total doses of paracetamol (P = 0.001) and morphine (P = 0.001) in the BM group were significantly lower than those in the B group during the first 24 h after surgery. Sedation and emetic episodes were identical between the groups. The Patient in the BM group ambulated faster (P = 0.001) and were more satisfied (P = 0.026) than those in the B group. ConclusionsAdding a low-dose (150 mg) of MgSO4 to bupivacaine in the STAP block for LC was associated with improved analgesic outcomes in the first 24 h after surgery. Ethical approvalMedical Ethics Committee of Faculty of Medicine, IRB no: 17,100,622 on November 15, 2016. Trial registrationClinicalTrials.gov (NCT03612947) on August 2, 2018.

Analgesic efficacy of an opioid-free postoperative pain management strategy versus a conventional opioid-based strategy following laparoscopic radical gastrectomy: an open-label, randomized, controlled, non-inferiority trial

ObjectiveIn patients undergoing laparoscopic radical gastrectomy, the use of subcostal transversus abdominis plane block (STAPB) for completely opioid-free postoperative pain management lacks convincing clinical evidence.MethodsThis study included 112 patients who underwent laparoscopic radical gastrectomy at the 900TH Hospital of the Joint Logistics Support Force from October 2020 to March 2022. Patients were randomly divided into (1:1) continuous opioid-free STAPB (C-STAPB) group and conventional group. In the C-STAPB group, 0.2% ropivacaine (bilateral, 20 ml per side) was injected intermittently every 12 h through a catheter placed on the transverse abdominis plane for postoperative pain management. The conventional group was treated with a conventional intravenous opioid pump (2.5 μg/kg sufentanil and 10 mg tropisetron, diluted to 100 ml with 0.9% NS). The primary outcomes were the accumulative area under the curve of the numeric rating scale (NRS) score at 24 and 48 h postoperatively at rest and during movement. The secondary outcomes were postoperative recovery outcomes, postoperative daily food intake, and postoperative complications.ResultsAfter exclusion (n = 16), a total of 96 patients (C-STAPB group, n = 46; conventional group, n = 49) were included. We found there were no significant differences in the cumulative AUC of NRS score PACU-24 h and PACU-48 h between the C-STAPB group and conventional group at rest [(mean difference, 1.38; 95% CI, − 2.21 to 4.98, P = 0.447), (mean difference, 1.22; 95% CI, − 6.20 to 8.65, P = 0.744)] and at movement [(mean difference, 2.90; 95% CI, − 3.65 to 9.46; P = 0.382), (mean difference, 4.32; 95% CI, − 4.46 to 13.1; P = 0.331)]. The 95% CI upper bound of the difference between rest and movement in the C-STAPB group was less than the inferior margin value (9.5 and 14 points), indicating the non-inferiority of the analgesic effect of C-STPAB. The C-STAPB group had faster postoperative recovery profiles including earlier bowel movement, defecation, more volume of food intake postoperative, and lower postoperative nausea and vomiting compared to conventional groups (P < 0.001).ConclusionsAfter laparoscopic radical gastrectomy, the analgesic effect of C-STAPBP is not inferior to the traditional opioid-based pain management model.Trial registrationChiCTR2100051784.

Combined rectus sheath block with transverse abdominis plane block by one puncture for analgesia after laparoscopic upper abdominal surgery: a randomized controlled prospective study

BackgroundRectus sheath block (RSB) and transversus abdominis plane block (TAPB) have been shown to reduce opioid consumption and decrease postoperative pain scores in abdominal surgeries. However, there are no reports about the one-puncture technique of RSB combined with TAPB for perioperative pain management during laparoscopic upper abdominal surgery.MethodsA total of 58 patients were randomly assigned to the control group (C), the TAP group (T), and the one-puncture technique of RSB combined with TAPB group (RT). The patients in group C did not receive any regional block. The patients in group T received ultrasound-guided subcostal TAPB with 30 mL of 0.33% ropivacaine on each side. The patients in the RT group received a combination of RSB and TAPB with 15 mL of 0.33% ropivacaine in each plane by one puncture technique. All patients received postoperative patient-controlled intravenous analgesia (PCIA) after surgeries. The range of blocks was recorded 20 min after the completion of the regional block. The postoperative opioid consumption, pain scores, and recovery data were recorded, including the incidence of emergence agitation (EA), the times of first exhaust and off-bed activity, the incidence of postoperative nausea and vomiting, dizziness.ResultsThe range of the one-puncture technique in group RT covered all areas of surgical incisions. The visual analogue scale (VAS) score of the RT group is significantly lower at rest and during coughing compared to groups T and C at 4, 8, 12, and 24 h after surgery, respectively (P < 0.05). The consumption of sufentanil and the number of postoperative compressions of the analgesic pumps at 24 and 48 h in the RT group are significantly lower than those in groups T and C (P < 0.05). The incidence of EA in the RT group is significantly lower than that in groups T and C (P < 0.05).ConclusionThe one-puncture technique of RSB combined with TAPB provides effective postoperative analgesia for laparoscopic upper abdominal surgery, reduces the incidence of EA during PACU, and promotes early recovery.Trial registrationChiCTR, ChiCTR2300067271. Registered 3 Jan 2023, http://www.chictr.org.cn.

Use of subcostal and lateral transverse abdominal plane blocks as part of multimodal analgesia in a calf undergoing omphalitis surgical correction

AbstractThis report describes the combined use of the ultrasound‐guided subcostal and lateral transversus abdominis blocks as part of the multimodal analgesia in a 3‐month‐old calf, presented for omphalitis surgical repair. It was premedicated with xylazine, anaesthesia was induced with ketamine and maintained by isoflurane in oxygen. The block was performed with lidocaine 2%, and flunixin meglumine was administered pre‐ and postoperatively. Postoperative pain was scored, and rescue analgesia was not required intra‐ and postoperatively. Pain assessment and multimodal analgesia are crucial in food‐producing animals. Employing bilateral ultrasound‐guided lateral and subcostal transversus abdominis plane block can prove advantageous as part of the multimodal analgesia protocol for calves undergoing umbilical surgeries. Furthermore, it is essential to delv into the discussion of lidocaine's toxic dosage when applied in locoregional techniques.

Comparison of Quality of Recovery between Modified Thoracoabdominal Nerves Block through Perichondrial Approach versus Oblique Subcostal Transversus Abdominis Plane Block in Patients Undergoing Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial

Modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) provides a wide analgesic range. Herein, we examined the quality of recovery (QoR) of M-TAPA for total laparoscopic hysterectomy (TLH) compared with oblique subcostal transversus abdominis plane block (OSTAPB) and measured plasma levobupivacaine concentrations (PClevo). Forty female patients undergoing TLH were randomized to each group. Nerve blocks were performed bilaterally with 25 mL of 0.25% levobupivacaine administered per side. The primary outcome was changes in QoR-15 scores on postoperative days (POD) 1 and 2 from the preoperative baseline. The main secondary outcomes were PClevo at 15, 30, 45, 60, and 120 min after performing nerve block. Group differences (M-TAPA—OSTAPB) in mean changes from baseline in QoR-15 scores on POD 1 and 2 were −11.3 (95% confidence interval (CI), −24.9 to 2.4, p = 0.104; standard deviation (SD), 22.8) and −7.0 (95% CI, −20.5 to 6.6, p = 0.307; SD, 18.7), respectively. Changes in PClevo were similar in both groups. The post hoc analysis using Bayesian statistics revealed that posterior probabilities of M-TAPA being clinically more effective than OSTAPB were up to 22.4 and 24.4% for POD 1 and 2, respectively. In conclusion, M-TAPA may not be superior to OSTAPB for TLH.

The Impact of Ultrasound-Guided Subcostal Transversus Abdominis Plane (SCTAP) Block on Postoperative Pain Relief in a Patient Undergoing Cholecystectomy: A Case Report

Introduction: Handling post-operative pain in cholecystectomy requires several considerations, especially in terms of pain management. Various multimodal analgesia strategies to optimize postoperative pain control include epidural catheter placement, intravenous opioids, and the recently introduced ultrasonography (USG)-guided subcostal transversus abdominis plane (SCTAP) block. This case report aims to describe the postoperative analgesic effectiveness of ultrasound-guided SCTAP block in a patient undergoing open cholecystectomy.&#x0D; Case presentation: A 57 year old female patient with a diagnosis of multiple cholelithiasis, cholecystitis, was planned to undergo cholecystectomy, under general anesthesia and SCTAP block, with an ultrasound probe placed under the costal margin, the transversus abdominis muscle fascia was identified and local anesthetic infiltration laterally with bupivacaine plain 0.25 % 20 ml each on the left and right sides. Postoperatively, the patient returned to the room and received oral analgesics without opioids for pain management.&#x0D; Conclusion: Ultrasound-guided SCTAP blocks provide effective postoperative analgesia, reduce the need for postoperative analgesics, while supporting recovery after open cholecystectomy.

Rectus Sheath and Subcostal Transversus Abdominis Plane Blocks as Main Anesthetic Technique for Open Cholecystectomy: A Case Report

Anesthetic techniques used for open cholecystectomy are traditionally general anesthesia, neuraxial anesthesia, or both due to convenience and safety profile. Peripheral nerve blocks are usually only used for postoperative analgesia for this type of surgery. We report a case of a patient with obstructive jaundice in severe cholangitis and hypovolemic hypernatremia who underwent open cholecystectomy and T-tube drain under right-sided rectus sheath and subcostal transversus abdominis plane blocks.

Ultrasound‐guided modified subcostal transversus abdominis plane block in a foal undergoing omphalectomy

SummaryA 7‐day‐old, 60 kg, Purebred Spanish Horse filly was referred with the mare to Complutense University of Madrid, Veterinary teaching hospital for elective omphalectomy. Upon admission, clinical examination was unremarkable except for a thickening of the umbilical area. Haematology and biochemistry values were within the normal range. On abdominal ultrasound (US) examination, a well‐defined, rounded (24 mm of diameter) area that contained heterogeneous material with numerous hyperechoic foci with acoustic shadowing was seen within the inner portion of the umbilical pedicle, between both umbilical arteries. Surgical correction with omphalectomy was scheduled. To provide perioperative analgesia, the transversus abdominis plane (TAP) block was considered. Under general anaesthesia, TAP block was performed in both left and right hemi‐abdominal walls with a modified subcostal approach with two‐site injections. A spinal needle was inserted under US guidance. During surgery, end‐tidal concentration of isoflurane was maintained at 0.7%–0.9%. Surgery was completed uneventfully and no signs of nociceptive input were observed, suggesting an adequate level of analgesia. Therefore, this TAP block technique may be considered to provide analgesia for surgical procedures involving the abdominal wall in foals.

A O02 How effective is the right subcostal laparoscopically-guided transversus abdominis plane block on pain control after laparoscopic cholecystectomy? A randomised controlled trial

Abstract Background The transversus abdominis plane (TAP) block is effective on pain relief after laparoscopic cholecystectomy (LC). The procedure can be done under laparoscopic or ultrasound guidance and is often performed by injecting multiple abdominal areas. Data on the efficacy of the loco-regional block performed in the right subcostal region only are scanty. This study compared the effect of the right subcostal TAP block under laparoscopic guidance to the infiltration of local anesthetic to the port sites only (ILA) on pain relief, after elective LC. Methods A sample of 60 participants, 30 per arm, was estimated (two-sided a = 0.05%, power = 80%). Subjects having day-case (DC) LC were randomized into TAP block and ILA. Participants received Bupivacaine 0.5% 30 ml: TAP block – 20 ml in TAP block + 10 ml into the midline ports; ILA – 20 ml into the midline ports + 10 ml into the right-sided ones. Pain scores at rest at 1-hour post-surgery and at discharge, were evaluated with the Visual Analogue Scale score system. DC rate, Quality of Recovery-15 questionnaires, oral intake of opioids at day 3 and 7, were assessed too. Results Subjects in the ILA group were all women (p=0.0007) and younger (43.8 vs 37.7 years, p=0.023) than the TAP block. The median postoperative pain scores were 0 vs 1 at 1 hour (95% CI -1.99 to 1, p=0.60), 0 vs 1.5 at discharge (95% CI -2 to 0.99, p=0.55). The DC rate was 93.1% vs 93.5% (p=0.39). Six (10%) patients remained in hospital after surgery (postoperative pain [3], nausea [1], challenging surgical procedure [1], late theatre schedule [1]). Questionnaire scores and oral opioids intake did not differ between groups, on postoperative day 3 and 7. Conclusions The laparoscopically-guided right subcostal TAP block did not provide additional benefit to ILA on pain control, after LC.

A randomized comparative study of transversus abdominis plane block (tap) with 0.25% bupivacaine and 0.375% ropivacaine in the duration of post-operative analgesia in upper abdominal laparoscopic surgeries

Transversus abdominis plane (TAP) block is a successful postoperative analgesia technique in laparoscopic surgeries. This study compared the analgesic efficacy of 0.25% bupivacaine and 0.375% Ropivacaine in TAP block as post-operative analgesia for upper abdomen laparoscopic surgeries.: This randomized, double-blinded comparative study was conducted at the Dr Jeyasekharan Medical Trust and Nursing Home for 18 months. Seventy-one consenting adult patients undergoing upper abdominal laparoscopic surgeries qualifying the inclusion criteria to undergo Bilateral Subcostal TAP Block were included. The patient was labelled group A or B according to a computer-generated randomization list. TAP block was administered using 30 ml (15 ml on each side) of 0.25% bupivacaine (A) or 0.375% ropivacaine (B). Similar premedication and induction were given to all patients. : Among 71 patients in group A, males were 5 (14.7%), and females were 29 (85.3%). In group B, males were 7 (18.9%), and female was 30 (81.1%). There is no significant difference in gender, age, and BMI between groups. The mean duration of analgesia with 0.375% ropivacaine (10.21±3.36 hrs.) was significantly higher than 0.25% bupivacaine (6.38±2.03 hrs.). In the first 24 hours postoperatively, the mean total tramadol consumption was 147.06±11.94 mg in group A and 117.57±31.11 mg in group B, which is statistically significant.: This study concludes that 0.375% 30ml ropivacaine given as a TAP block under ultrasound guidance significantly prolonged the post-operative analgesia duration compared to 0.25% 30ml bupivacaine.

Combination of Rectus Sheath Block and Subcostal Transversus Abdominis Plane Block as the Sole Anesthesia for an Open Gastrostomy in a High-risk Patient

Truncal blocks are widely used for postoperative analgesia, but are rarely used for surgical anesthesia. Herein is reported the success of an open gastrotomy under truncal blocks in a patient for whom general anesthesia and neuraxial blockade were undesirable. A 79-year-old man, with advanced esophageal cancer presented with several comorbidities; including cardiomyopathy, ischemic heart disease, and prior cerebral infarction. Difficulty in airway management was anticipated due to the mass’s compression on the airway. Anesthesia was achieved using a combination of truncal blocks; this being the rectus sheath block and the subcostal transversus abdominis plane block, supplemented by intravenous fentanyl for managing visceral pain.

A Randomized Controlled Trial of Ropivacaine Alone and In Combination with Dexamethasone for Oblique Subcostal Transversus Abdominis Plane (OSTAP) Block in Open Cholecystectomy

A Randomized Controlled Trial of Ropivacaine Alone and In Combination with Dexamethasone for Oblique Subcostal Transversus Abdominis Plane (OSTAP) Block in Open Cholecystectomy

Comparative Study between Erector Spinae Plane Block and Transversus Abdominis Plane Block for Postoperative Pain Management of Patients Undergoing Laparoscopic Cholecystectomy

Abstract Study Objective Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. Since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post-operative analgesia. The proper management of post-operative pain ensures early ambulation of patients and obviates many post-operative complications. The subcostal approach of TAP block was described by Hebbard et al. for postoperative analgesia especially for upper abdominal surgeries. Ultrasound-guided erector spinae plane (US-ESP) block is a novel technique targeting ventral rami, dorsal rami of the spinal nerves. Design Prospective randomized, double blinded study. Setting After obtaining approval from the Research Medical Ethical Committee of Faculty of Medicine Ain shams University and obtaining an informed written consent from patients, this study will be conducted in the operating theatres of Ain shams University Hospitals. Patients Patients ASA 1 or 2 undergoing laparoscopic cholecystectomy. The patients will be randomly divided into two equal groups, They will be enrolled in group (1) for erector spinae plane block and group (2) for oblique subcostal transversus abdominis plane block. Each group contain 30 patients, 60 patients were included in final analysis Interventions Erector spinae plane block was performed in the ESP group and oblique subcostal transversus abdominis block was performed in the OSTAP group. Measurements Postoperative nalbuphine consumption and pain scores between groups were compared. Main Results Postoperative nalbuphine consumption was 18.31±5.11 mg in the ESP group and 30.51±9.19 mg in the OSTAP group ( p &amp;lt; 0.001). VAS scores at almost all time-points were lower in the ESP group according to the repeated measures analysis. Conclusion Ultrasound-guided ESP block reduced postoperative nalbuphine consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. This technique can be a promising mode of postoperative analgesia

Unilateral Subcostal Transversus Abdominis Plane Block in Laparoscopic Cholecystectomy for Pain Control Comparison with Conventional Port Site and Peritoneal Infiltration

Objective: To compare image-guided unilateral subcostal transversus abdominis plane (STA) block with infiltration of local anaesthetic both port site and peritoneal for post-operative analgesia for laparoscopic gall bladder surgery.&#x0D; Study Design: Quasi-experimental study&#x0D; Place and Duration of Study: Department of Anesthesia, Combined Military Hospital, Quetta Pakistan, from Nov 2018 to Apr 2019.&#x0D; Methodology: The study sample (n=80) was divided into two Groups, one for image-guided subcostal transversus abdominis plane block and the other for peritoneal and port site infiltration of local anaesthetic. Anaesthesia was induced with intravenously administered propofol, atracurium, nalbuphine, and intraoperative non-opioid analgesia with ketorolac following which endotracheal intubation was done. The level of abdominal pain was assessed.&#x0D; Results: The mean opioid consumption at the 24th post-operative hour was 22.75±8.55 in Group-A and 43.20±11.80 in GroupB. Mean total opioid consumption was 111.40±35.99 and 218.90±63.91 in Group-A and B, respectively. The mean VAS score at the 24th post-operative hour was 1.20±0.96 in Group- A and 3.12±1.63 in Group-B. The results showed a significant mean difference between opioid consumption and VAS pain score at the 24th hour (p&lt;0.05).&#x0D; Conclusion: The unilateral Subcostal transversus abdominis plane block proved a superior alternative to port site and peritoneal infiltration combined for laparoscopic cholecystectomy.

Comparison of modified thoracoabdominal nerve block through perichondral approach and subcostal transversus abdominis plane block for pain management in laparoscopic cholecystectomy: a randomized-controlled trial.

The modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) is a novel regional analgesic technique that can provide analgesia for both the lateral and anterior abdominal walls. This study aimed to compare the analgesic effect of M-TAPA with that of the subcostal transversus abdominis plane block (TAPB) in patients undergoing laparoscopic cholecystectomy (LC). Sixty patients scheduled to undergo elective LC were randomly assigned to receive either M-TAPA or subcostal TAPB during anesthesia induction. The primary outcome was the maximum pain intensity during movement within the first 12 hours postoperatively, measured using an 11-point numeric rating scale (NRS). Secondary outcomes included changes in NRS scores during rest, coughing, and movement, which were assessed at 1, 2, 4, 6, and 12 hours postoperatively and immediately before discharge. Additionally, postoperative nausea and vomiting, and patient satisfaction were recorded as secondary outcomes. Data from 56 patients were analyzed, and no significant difference was observed in the primary outcome between the two groups (M-TAPA: 5.5 [interquartile range (IQR): 5-7] vs . subcostal TAPB: 5 [IQR: 4-7], median difference: 0, 95% confidence interval: -1 to 1, P = 0.580). Furthermore, no significant differences in secondary outcomes were observed between the two groups. No significant difference was observed in the analgesic effect between the two techniques. Consequently, further research is necessary to compare the efficacy of M-TAPA with other well-established regional analgesic techniques.

Comparing ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach with oblique subcostal transversus abdominis plane block for patients undergoing laparoscopic cholecystectomy: a randomized, controlled trial

BackgroundLaparoscopic cholecystectomy(LC) causes significant postoperative pain. Oblique subcostal transversus abdominis plane(OSTAP) block was described for postoperative analgesia, especially for upper abdominal surgeries. Modified thoracoabdominal nerves block through perichondrial approach(M-TAPA) block is a new technique defined by the modification of the thoracoabdominal nerves through perichondrial approach (TAPA) block, in which local anesthetics are delivered only to the underside of the perichondral surface. The primary aim of this study was to evaluate the effect of M-TAPA and OSTAP blocks as part of multimodal analgesia on postoperative opioid consumption in patients undergoing LC.MethodThe present study was designed as a randomized, controlled, prospective study. Seventy-six adult patients undergoing LC were randomly assigned to receive either bilaterally M-TAPA or OSTAP block after the induction of anesthesia and before surgery using bupivacaine 0.25%, 25 ml. The primary outcome was assessed as postoperative 24 h opioid consumption, between groups were compared. Secondary outcomes were Numerical Rational scale(NRS) scores, time to first opioid analgesia, patient recovery, using the Quality of Recovery-15 (QoR-15) scale, nausea and vomiting, sedation score, metoclopramide consumption, and evaluating the analgesic range of dermatome.ResultsThe mean tramadol consumption at the postoperative 24th hour was higher in the group OSTAP than in group M-TAPA (P = 0.047). NRS movement score at 12th hour was statistically significantly lower in group M-TAPA than in group OSTAP (P = 0.044). Dermatomes showed intense sensory analgesia between T7-11 in both groups, and it was determined that there was proportionally more involvement in the group M-TAPA. There were no differences between the groups in terms of other results.ConclusionsAfter the LC surgery, ultrasound-guided M-TAPA block effectively reduced opioid consumption, postoperative pain, and QoR-15 scores similar to OSTAP block.Clinical trial registrationThe study was registered prospectively at clinicaltrials.gov (trial ID: NCT05108129 on 4/11/2021).

A Comparative Evaluation of Post-operative Pain Management Using Erector Spinae Plane Block and Oblique Transverse Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy.

Introduction Acute pain following laparoscopic surgeries interferes with the rehabilitation of the patient. Knowledge about the pain pathway from a particular area helps in blocking pain transmission at different sites. Ultrasonography (USG)-guided peripheral nerve blocks help in controlling pain better than non-steroidal anti-inflammatory drugs (NSAIDS) and opioids since they directly act by interrupting the pain pathway and interfere less with the physiology of the body. This study was planned with the objectives to evaluate the analgesic efficacy of USG-guided erector spinae plane block (ESPB)and oblique subcostal transversus abdominis plane (OSTAP) block in patients undergoing elective laparoscopic cholecystectomy, to compare the analgesic requirements in both groups, and to compare the VAS scores in both groups. Materials and methods A total of 138 patients were randomized into two groups, with 69 patients in each group, and received either bilateral ESP (group 'E') or bilateral OSTAP (group 'O'). Those in group E received the block at the T7 level, and those in group O received the block in the subcostal region, with 20 ml of 0.2% ropivacaine and 4 mg of dexamethasone. The procedures were done after securing the airway. The total analgesic requirement and visual analogue scale (VAS) scoring in the first 24 hours post-operatively were observed, along with intra-operative opioid consumption. The opioid requirement, block-related complications, and patient feedback regarding post-operative pain control were also assessed. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 23.0 (IBM Corp., Armonk, NY). Continuous and categorical data were analyzed using appropriate statistical analysis. A p-value <0.05 was considered statistically significant. Results The VAS scores were significantly lower during the first post-operative day in group E than in group O. In group E, VAS scoring was less than 4 for the first 24 hours post-surgery. In group O, VAS scores remained greater than or equal to 4 after four hours post-surgery, thereby indicating that the patients required opioids. Only seven patients in group E received tramadol, compared to 62 patients in group O. The mean tramadol requirement of seven patients in group 'E' was 65.71 ± 26.3 mg, and the mean tramadol requirement of 62 patients was 114.56 ± 36.8 mg (p = 0.0012). The patients in group 'O' demanded tramadol significantly more times than those in group 'E'. Conclusion It was concluded that USG-guided ESP block provides better pain control and decreases consumption of opioids post-operatively than OSTAP block in patients undergoing laparoscopic cholecystectomy surgeries. The block was found to be safe with no adverse effects, therefore it can be a part of multimodal analgesia.

ANALGESIC EFFICACY OF ULTRASOUND GUIDED BILATERAL SUBCOSTAL TRANSVERSUS ABDOMINIS MUSCLE PLANE BLOCK AND PORT SITE INFILTRATION WITH BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: To evaluate the postoperative analgesic efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane block in comparison to port-site local anesthetic infiltration in patients undergoing elective lapa­roscopic cholecystectomy. Methodology: It was a Quasi experimental study, conducted in Combined Military Hospital Rawalpindi, over 6 months, from 13/4/21 till 13/10/2021. Patients numbering 92 of both genders fulfilling inclusion criteria were incorporated and placed into 2 groups equally. Group O (n=46) underwent ultrasound guided bilateral subcostal transversus abdominis plane block using 0.25% bupivacaine with volume dosage of 0.4ml/kg divided by 2, one part for each side. In Group-P (n=46) total dose of bupivacaine (0.25%, volume dose of 0.4ml/kg) was divided by total number of ports used and one portion was infiltrated at each port-site at the completion stage of surgery. Post-operative pain score, quantity of post-operative analgesia and patient satisfaction scores were calculated. Results: Mean tramadol usage in Group-O was 109.56 ± 15.04 mg compared with 155.21 ± 22.18 mg of Group-P (p value &lt;0.001 for both). Visual Analog pain scores were lesser in Group-O all the times. Patient satis­faction scores were 3.30 ± 0.66 and 2.71 ± 0.98 for Group-O and Group-P respectively. Conclusion: Ultrasound guided subcostal Transversus abdominis plane block is effective in contributing to post-operative analgesia following laparoscopic cholecystectomy and is superior to port site infiltration. It decreas­es pain scores, post-operative analgesia requirement and increments patient satisfaction compared with port-site infiltration.