Subcostal Transversus Abdominis Plane Research Articles

A Clinical Prospective Randomised Comparative Study Of Ultrasound Guided Bilateral Subcostal Transversus Abdominis Plane Block And Port Site Infiltration With Bupivacaine For Post-Operative Analgesia In Patients Undergoing Laparoscopic Cholecystectomy.

Background: Post-operative pain management is critical in laparoscopic cholecystectomy to enhance patient recovery and satisfaction. This study compares the efficacy of ultrasound-guided bilateral subcostal transversus abdominis plane (TAP) block and port site infiltration with bupivacaine for post-operative analgesia. Methods: In this prospective, randomized, comparative study, 60(30/30) patients undergoing elective laparoscopic cholecystectomy were randomly assigned to one of two groups: Group A received an ultrasound-guided bilateral subcostal TAP block with 0.25% bupivacaine (20 ml on each side), while Group B received port site infiltration with 0.25% bupivacaine (5 ml per port). The primary outcome was the duration of post-operative analgesia, assessed by the time to first rescue analgesic request. Secondary outcomes included total analgesic consumption in the first 24 hours post-operatively, pain intensity measured by the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours, and any complications related to the procedures. Results: The TAP block group (Group A) demonstrated a significantly longer duration of analgesia compared to the port site infiltration group (Group B) (p < 0.05). Group A also exhibited lower total analgesic consumption and lower VAS scores at all time points. No significant complications were observed in either group. Conclusion: Ultrasound-guided bilateral subcostal TAP block with bupivacaine provides superior post-operative analgesia compared to port site infiltration in patients undergoing laparoscopic cholecystectomy, with a longer duration of pain relief and reduced analgesic requirements. This technique should be considered a viable option for enhancing post-operative recovery in these patients.

The Effect of Postoperative Analgesia on the Day-Case Rate of Laparoscopic Cholecystectomy: A Randomised Pilot Study of the Laparoscopic-Assisted Right Subcostal Transversus Abdominis Plane Block plus Local Anaesthetic Wound Infiltration versus Local Anaesthetic Wound Infiltration only

Objective: The transversus abdominis plane (TAP) block and local anaesthetic infiltration (LAI) of port sites provide adequate analgesia after laparoscopic cholecystectomy (LC). Little is known if the two techniques affect the day-case (DC) rate of LC. We tested the appropriateness of the research design in view of a larger randomised controlled trial (RCT) – laparoscopic-assisted right subcostal TAP block plus local anaesthetic wound infiltration (STALA) versus LAI. Subjects and Methods: Sixty patients having DC LC were randomised into STALA and LAI. Participants received bupivacaine 0.5% 30 mL. Pain scores were evaluated with the Visual Analogue Scale (VAS) score, at 1 h post-surgery and at discharge. Need of postoperative intravenous (IV) opioids, DC rate, and Quality of Recovery-15 questionnaires were compared between groups and were considered as measures of efficacy of the interventions and follow-up in a definitive trial. Results: Twenty-nine participants were randomised to STALA, and 31 to LAI. Subjects in LAI group were all women (p = 0.0007) and younger (43.8 vs. 37.7 years, p = 0.023). Median VAS scores were 0 versus 1 at 1 h (p = 0.60), 0 versus 1.5 at discharge (p = 0.55). The need of IV opioids was 15/29 (51.7%) versus 13/31 (41.9%; p = 0.60). The DC rate was 93.1% versus 93.5% (p = 0.39). Fifty (83.3%) participants responded the questionnaires. Conclusions: The laparoscopically guided right subcostal TAP block provided no additional benefit to LAI on pain control after LC and DC rate. Despite the appropriate design, our findings do not support a larger RCT.

Ultrasound-guided subcostal transversus abdominis plane block versus erector spinae plane block for post-operative pain after percutaneous nephrolithotomy: A comparative observational study

In India, about 12% of the population has kidney stones, and out of these about 50% may end up with some kidney function loss or renal damage percutaneous nephrolithotomy (PCNL) is accepted as the procedure of choice for large or complex renal stones. Significant post-operative pain can occur after PCNL in first 24 hours due to distension in the renal capsule and pelvicalyceal system. The study aim was to compare the efficacy of ultrasonography guided subcostal transversus abdominis plane block with erector spinae plane block in PCNL. This observational study included 67 consecutive cases (16-65 years, ASA grade I-II) divided into 2 groups. Group A (n=33) received subcostal transversus abdominis plane (SCTAP) block and Group B (n=34) received erector spinae plane block (ESPB). Post operative pain in terms of pain scores, opioid consumption, requirement of rescue analgesic in first 24 hours was noted. Quality of recovery and any adverse events were also noted. Post-operative opioid consumption was significantly less in ESPB group (34.41 ± 27.32 mcg), compared to SCTAP Group (270.91 ± 121.41 mcg). Group B patients had better post operative quality of recovery compared to Group A patients. VAS pain scores at almost all time-points were lower in the ESPB group. ESPB provided effective postoperative analgesia and reduced fentanyl consumption postoperatively compared to SCTAP block.

Comparison of postoperative analgesia effects between subcostal anterior quadratus lumborum block and transversus abdominis plane block in bariatric surgery: a prospective randomized controlled study

BackgroundCurrently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery.Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period.However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV).Methods and designThis study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days.DiscussionOpioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery.Trial registrationChiCTR ChiCTR2300070556. Registered on 17 April 2023.

Preoperative Bilateral External Oblique Intercostal Plus Rectus Sheath Block for Postoperative Pain Management Following Laparoscopic Cholecystectomy: A Noninferior Double-Blind Placebo-Controlled Trial.

The transversus abdominis plane (TAP) block has proven efficacy and is an important component of multimodal analgesia in laparoscopic cholecystectomy (LC). The external oblique intercostal (EOI) block can provide a dermatomal sensory blockade of T6 to T10 using an anterior axillary line injection. The bilateral rectus sheath (RS) block can significantly reduce early postoperative pain caused by umbilical or periumbilical incisions. The current study aimed to compare the analgesic efficacies of ultrasound-guided subcostal TAP (UG-TAP) combined with the RS block and ultrasound-guided EOI (UG-EOI) combined with the RS block for LC. Patients were randomly assigned to TAP or EOI group. Patients in TAP group received UG-TAP combined with an RS block. Patients in EOI group received UG-EOI combined with an RS block. The primary outcome was postoperative 24-hour sufentanil consumption. A total of 49 patients were included in the final analysis. The postoperative 24-hour sufentanil consumption in the EOI group was significantly lower than that in the TAP group (9.79±10.22 vs. 18.67±12.58µg; P [noninferiority] <0.01; noninferiority confirmed). Fewer patients in the EOI versus TAP group had a numerical rating score of >3 during motion. Furthermore, the mean postoperative 48-hour sufentanil consumption was lower in the EOI versus TAP group (11.54±11.70 vs. 23.04±17.10µg; P =0.01). The mean postoperative 24-hour Quality of Recovery-15 score was higher in the EOI versus TAP group (135.21±4.40 vs. 131.91±5.11; P =0.02). These findings suggest that UG-EOI combined with an RS block was superior to UG-TAP combined with an RS block for postoperative pain management in patients undergoing LC.

Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial

BackgroundA bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.MethodsIn...

Ultrasound-guided erector spinae plane block versus oblique subcostal transverse abdominis plane block for postoperative analgesia and stress response in inguinal herniorrhaphy

Background Hernia of the inguinal region is a common ailment that frequently necessitates surgical intervention. Inguinal hernia repair is linked to substantial pain after the surgery and a potential for the occurrence of persistent pain in the long run. The increased utilization of ultrasonography in anesthesiology departments has led to the development of novel regional block technology in clinical settings. Aim Compare between ultrasound-guided erector spinae plane block (ESPB) and oblique subcostal transverse abdominis plane block (OSTAPB) for patients undergoing inguinal hernia repair regarding the quality of anesthesia as the primary outcome. Patients and methods Fifty-six patients were recruited and were randomized to receive ultrasound-guided ESPB or OSTAPB after induction of general anesthesia. The main outcome was the quality of anesthesia and the stress response (cortisol level) between the two techniques. The secondary outcomes were the duration of sensory block, changes in intraoperative hemodynamics, total amount of rescue analgesia, and incidence of complications. Results In the current study, at 8 and 12 h postoperative, the visual analog scale score was statistically significantly higher in the OSTAPB group. The percentage of cases that required rescue analgesia and the total dose of rescue analgesia were significantly higher in the OSTAPB group. After the surgery, the cortisol level was significantly higher in the OSTAPB group. Conclusion Ultrasound-guided ESPB improved analgesic control by decreasing postoperative pain score and reducing postoperative rescue analgesia intake. Also, the same technique was associated with lower stress response.

Combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane block for postoperative analgesia in gastric cancer patients: A double-blinded randomized controlled trial

Study objectiveWe conducted this double-blinded randomized controlled trial to examine whether the combination of dexamethasone and dexmedetomidine as adjuvants of transversus abdominis plane (TAP) block could improve analgesia efficacy and duration for gastric cancer patients. DesignRandomized controlled trial. SettingThe preoperative area, operating room, postanesthesia recovery room and bed ward. PatientsA total of 312 adult patients (104 per group) with gastric cancer were included. InterventionsPatients received bilateral subcostal TAP block with three different anesthetics (60 ml 0.25% ropivacaine added with 10 mg dexamethasone and 1 μg·kg-1 dexmedetomidine [A] or 10 mg dexamethasone [B] or 1 μg·kg-1 dexmedetomidine [C]). MeasurementsThe primary outcome was the incidence of moderate-to-severe pain 24 h on movement. Secondary outcomes included incidence of moderate-to-severe pain, pain score, opioids use, recovery quality and adverse events. Main resultsThe incidence of moderate-to-severe pain on movement 24 h postoperatively of group A was significantly lower than group B (45.19% vs 63.46%; RR 0.71; 95% CI, 0.55 to 0.92) and group C (45.19% vs 73.08%, RR 0.62; 95% CI, 0.49 to 0.79). The median moving pain scores decreased significantly at 24 h (3.00 [3.00,5.00] vs 4.00 [3.00,6.00] vs 4.00 [3.00,5.00]; P < 0.001). There were significant differences in the opioids consumption within the first 24 h (27.5 [17.0,37.2] vs 30.0 [20.0,42.0] vs 32.0 [25.0,44.0] mg; P = 0.01) and the duration to first rescue analgesia (65.5 ± 26.7 vs 45.9 ± 34.5 vs 49.2 ± 27.2 h; P = 0.04). ConclusionsThe combination with dexamethasone and dexmedetomidine as adjuvants for TAP block reduced the incidence of moderate-to-severe pain and pain score both on movement and at rest at 24 h with prolonged duration to first rescue analgesia after gastric cancer surgery.Trial registration number: ChiCTR2000037981.

Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial

BackgroundUltrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores.MethodsThe study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events.ResultsThere was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events.ConclusionBoth RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.

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.

Intraperitoneal instillation versus port-site infiltration or subcostal transversus abdominis plane block for post-operative analgesia following laparoscopic cholecystectomy

Background Although pain after laparoscopic surgery is less compared with open cholecystectomy, pain management in the first 24 to 72 h in the postoperative period is tricky and most patients complain of pain with cough, breathing and mobilization during the initial hours. The aim of this study was to evaluate the most efficacious route of analgesia in patients following laparoscopic cholecystectomy by comparing port-site wound infiltration, intraperitoneal infiltration and subcostal transversus abdominis plane block in providing post-operative analgesia following laparoscopic cholecystectomy. Methods This was an observational study performed on patients who underwent elective laparoscopic cholecystectomy at a tertiary care hospital in Mangalore. Group A received bupivacaine instilled in gallbladder fossa after removal of gall bladder before closure. Group B received Bupivacaine as an infiltration into the skin incision site (fascia, muscle, preperitoneal space) at each of the four port sites based on the length of the skin incision before closure. Group C received bupivacaine as subcostal transversus abdominis plane block under ultrasound guidance immediately postclosure. Collected data was entered in Microsoft Excel 2007 and analyzed using SPSS version 22.0 to find frequency, Mean and SD. Significance was assessed using Kruskal–Wallis test, χ 2 test and ANOVA for repeated measures. Results Hemodynamic parameters, i.e. the heart rate and mean arterial pressure were comparable at the end of 2 h and 4 h. At 6 and 8 h postoperatively however, visual analog scale was significantly better in group C compared with groups A and B. Time until the first analgesic request in group C was 359.35±45.55 min which was significantly lesser than the other two groups. Only three patients from group B had shoulder tip pain which was not seen in the other two groups. Conclusion Infiltration of bupivacaine at port sites is helpful in providing effective analgesia for upto 2 h post operatively whereas intraperitoneal instillation is both effective at meeting analgesic requirements as well as preventing shoulder tip pain. However, the substantial finding of our study is in providing further evidence to existing data that Subcostal transversus abdominis plane block can produce effective analgesia for laparoscopic cholecystectomy, effectively reduces analgesic requirement, and ensures faster recovery.

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.

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.

Is the application of subcostal transversus abdominis plane block effective for pain control in classical four-port laparoscopic cholecystectomy?

The utilization of transversus abdominis plane (TAP) block for postoperative pain management has proven to be efficacious. The purpose of this inquiry is to evaluate the effectiveness of right-sided TAP blockade guided by ultrasonography (USG) in managing pain subsequent to laparoscopic cholecystectomy. A total of 60 patients were equallydistributed into two groups. The control group was comprised of patients who did not receive a TAP block, whereas the TAP block group consisted of patients who underwent an ultrasound-guided, right-sided unilateral subcostal TAP block with 20 mL of 0.25% bupivacaine. A Verbal Numerical Rating Scale was administered to all participants for pain assessment at postoperative intervals of 0th, 6th, 12th and 24th hours. Additionally, the overall amount of supplementary analgesic used after surgery, age distribution among each gender classification and body mass index range categories as well as operation time duration; use or non-use of drain; and incidence rate for postoperative complications were recorded for each patient individually. The mean age of participants was 47.72 ± 13.80 years, with a female-to-male ratio of 41/19. The control group exhibited significantly higher pain scale measurements than the block group at the postoperative 0th and the postoperative 24th hour. Drain replacement yielded notably higher pain scores for both TAP and control groups at the postoperative 0th hour. Neither BMI nor operation duration had significant effects on postsurgical pain in either patient group—whether or not they received a TAP block treatment. Our research shows that the implementation of a TAP block and exclusion of surgical area drainage placement yield favorable results in mitigating postoperative pain. Notably, BMI and procedure duration do not exhibit any discernible impact on postoperative pain management.

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.