Transversus Abdominis Plane Research Articles

Bilateral transversus abdominis plane and rectus sheath blocks with liposomal bupivacaine for patients undergoing robotic prostatectomy.

As robotic prostatectomy surgery becomes more prevalent, it is important to identify any regional techniques to optimize patient's recovery. We evaluated the effectiveness of bilateral transversus abdominis plane (TAP) and rectus sheath (RS) blocks with liposomal bupivacaine. We hypothesized that these blocks would reduce perioperative opioid use and pain scores. A retrospective cohort of patients from May 2018 and May 2021 at a single large VA hospital were studied. We compared those not receiving a nerve block against those receiving the TAP and RS as part of an Enhanced Recovery After Surgery (ERAS) pathway starting in May 2019. The primary outcome was post-operative opioid use. Secondary outcomes were post-operative pain scores and hospital length of stay. One hundred and thirty-four patients were included in the final analysis. Eighty-one patients did not receive a block and fifty-three patients did receive a block. No difference existed between the groups in regard to median oral morphine equivalents (mg) used in PACU or any post-operative day. No difference existed in median opioid usage (mg) or pain scores between the two groups on any post-operative day. There was no difference in temporal association of median pain scores or narcotic usage between the two groups. Bilateral TAP and RS with liposomal bupivacaine did not significantly decrease post-operative opioid use, improve pain scores, or decrease hospital length of stay for patients undergoing robotic prostatectomy. Further studies need to be done to evaluate the effect of these blocks with liposomal bupivacaine.

A Change in the Educational Landscape of Regional Anesthesia: A National Survey of Anesthesiology Residency Programs to Assess the Correlation Between the Frequency of Teaching a Block Technique and Clinical Importance.

Introduction Variability regarding which blocks are performed most often can be quite high amonganesthesiology residency training programs. Which techniques are viewed by residency programs as "critical" for their graduates to know can also be inconsistent. We administered a national survey to investigate correlations between the cited importance of techniques and the relative frequency with which they are being taught. Materials and methods A three-round modified Delphi method was used to develop the survey. The final survey was sent to 143 training programs across the United States. The surveys collected information on the frequency with which thoracic epidural blocks, truncal blocks, and peripheral blocks were taught. The respondents were also asked to rate how critical each technique is to learn during residency. A correlation between the relative frequency of block teaching and cited importance to education was calculated using Kendall's Tau statistic. Results Among truncal procedures, transversus abdominis plane (TAP) block and thoracic epidural blocks were frequently viewed as "indispensable for daily practice." Among peripheral nerve blocks, interscalene, supraclavicular, adductor, and popliteal blocks were frequently viewed as indispensable. All truncal blocks showed a strong correlation between the relative frequency of block teaching and cited importance to education. However, the frequency of teaching interscalene, supraclavicular, femoral, and popliteal blocks failed to correlate with their reported importance ranking. Conclusions Perceived importance was significantly associated with the reported frequency of block teaching for all truncal and peripheral blocks except for interscalene, supraclavicular, femoral, and popliteal. The lack of correlation between the frequency of teaching and perceived importance is reflective of a changing educational landscape.

Utilization of Truncal Fascial Plane Nerve Blocks for Chronic Pain Management: A Narrative Review

Nerve blocks constitute an integral portion in the management of chronic pain. The widespread use of ultrasound imaging opened the door to a flood of newer blocks especially truncal plane nerve blocks. We reviewed the current medical literature for studies and case reports utilizing the two most common truncal plane nerve blocks, transversus abdominis plane and erector spinae plane blocks, to manage chronic pain. We found some evidence, mostly in case reports and retrospective observational studies, that supports the use of transversus abdominis plane and erector spinae plane nerve blocks, usually with steroids, as a safe and valuable part of interdisciplinary management of chronic abdominal and chest walls pain. Ultrasound-guided truncal fascial plane nerve blocks are safe, easy to learn, and proven to help with post-operative acute pain management. Although limited, our current review provides evidence from the current medical literature regarding the utility of these blocks to manage some of the challenging chronic and cancer-related pain conditions of the trunk region.

Efficacy of Ultrasound Guided Continuous Transverse Abdominis Plane Block for Lower Abdominal Surgeries

Efficacy of Ultrasound Guided Continuous Transverse Abdominis Plane Block for Lower Abdominal Surgeries

Efficacy of Transversus Abdominis Plane Block for Postoperative Analgesia in Different Lower Abdominal Surgeries in a Tertiary Care Hospital-Chengalpattu District.

Transversus abdominis plane (TAP) block is one of the novel approaches and an effective method for providing postoperative analgesia in patients undergoing lower abdominal surgeries. To evaluate the efficacy and routine usage of TAP block for postoperative analgesia in different lower abdominal surgeries. It is a randomized, double-blind trial. Sixty patients undergoing lower abdominal surgeries in sub-arachnoid block with bupivicaine 0.5% were randomized to undergo TAP block (n = 30) using ropivacaine 0.375% as the study group. In the control group (n = 30), only the standard analgesic regimen (paracetamol 1 gm IV and tramadol 50 mg IV) was given. Postoperative pain was assessed using Visual Analogue Scale (VAS) at 30 min and 4, 8, 12, 16, 20, and 24 hrs. First analgesic request after TAP block was compared with a subsequent number of analgesics given postoperatively. Rescue analgesia given postoperatively at request after TAP block was paracetamol 1 gm IV and tramadol 50 mg IV. Patients who received TAP block had a significant reduction in postoperative pain scores at 30 min - 0 (0 - 1), 4 hrs - 0 (0 - 4), 8 hrs - 4 (3 - 5), 12 hrs - 1 (0 - 4), 16 hrs - 1 (1 - 2), 20 hrs -1 (0 - 2), 24 hrs -1 (0 - 1) with P-value < 0.05 in the first 24 hrs. TAP block also delayed the first rescue analgesic request (265 ± 24 min Vs. 66 ± 15 min with P-value < 0.005) and reduction in subsequent analgesic requirements in the first 24 hrs (1.04 ± 0.26 Vs. 2.3 ± 0.48 with P-value < 0.05). TAP block holds a considerable part in postoperative analgesia. Highly effective for the first 24 hrs in patients undergoing different lower abdominal surgeries, it delays the first rescue analgesic request, decreases the subsequent analgesic requirement, and augments early mobilization, discharge, and cost-effectiveness.

TRANSVERSUS ABDOMINIS PLANE(TAP) BLOCK AS A PART OF MULTIMODAL ANALGESIA AFTER CAESAREAN SECTION DELIVERY

Background: Patients after Caesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by caesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nerve stimulator. The aim of this study was to evaluate the efcacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Caesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Caesarean Section from January to March, 2023. All patients operated under spinal anaesthesia for caesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the rst 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the rst analgesic request. Result: There was reduction of VAS scores within the rst 24 hours after caesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.00(0.00-11.50) vs 39.00(7.75-60.50), p=0.001, at 4 hours 0.00(0.00–12.75) vs 17.50(13.25-24.00), p=0.000, at 6 hours 9.00(1.50-12.00) vs 22.00(14.75-45.00), p=0.000, at 12hours 13.00(11.00-16.00) vs 42.00(10.00-52.00), p=0.003, at 24 hours 10.00(8.0012.00) vs 15.50(11.25-26.00), p=0.013 respectively. The total analgesic Tramadol consumption within 24 hours was reduced in TAP block group, and time for the rst analgesic request was signicantly prolonged (286.00 vs 76.25, p=0.000) minutes. Conclusion: Bilateral TAP block provides lower postoperative severity of pain, reduced total postoperative Tramadol analgesics consumption and prolonged time for the rst analgesic request after caesarean section under spinal anaesthesia when it is used as multimodal analgesia. We recommend TAP block should be included as part of multimodal analgesia in the postoperative period for women after Caesarean Section delivery

Ultrasound-Guided Transversus Abdominis Plane (TAP) Blocks Vs. Local Infiltration Anesthesia on Post Anesthesia Care Unit (PACU) Pain Control

Abstract Goals/Purpose Ultrasound-guided regional field blocks are not widely used in outpatient plastic surgery.1 These blocks have been shown to significantly decrease the number of prescribed opioids in patients who underwent abdominoplasty, liposuction, and primary submuscular breast operations. 2,3 The goal of this study is to compare ultrasound-guided TAP blocks to local infiltration anesthesia with or without blind rectus sheath blocks in patients undergoing abdominoplasty. Methods/Technique A retrospective review was conducted of patients undergoing outpatient abdominoplasty performed by the senior surgeon. Group 1 (Local) received local infiltration anesthesia with or without blind rectus sheath blocks between April 2009 and December 2013. Group 2 (TAP) received surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks between January 2014 and December 2021. Outcomes measured included opioid utilization, morphine milligram equivalents (MME) and pain level at discharge (scale from 1 to 10). All abdominoplasties were performed using the same suture materials and techniques by the senior surgeon in the same accredited outpatient surgical facility. Abdominoplasty technique included supraumbilical undermining, umbilical transposition, rectus abdominis fascial plication, progressive tension sutures, and liposuction of the flanks. Patients were excluded if other procedures were performed at the time of abdominoplasty. Results/Complications 60 patients in each of the two study groups met the study criteria for a total of 120 patients. The study groups were similar except for a lower average age in group 1 (Table 1). Patients receiving TAP blocks (group 2) had significantly lower MME requirements in the PACU (3.48 v 2.21, p=0.005). There was no difference in pain level at discharge between the two groups (2.35 v 2.17, p=0.624), (Table 1). Conclusion Surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks statistically significantly reduced opioid utilization by 36.5% in the PACU while achieving comparable patient pain scores.

Transversus abdominis plane block for anterior lumbar interbody fusion: a randomized controlled trial

BACKGROUND CONTEXTAnterior lumbar interbody fusion (ALIF) is a lumbar arthrodesis technique via an anterior approach that is less invasive than the posterior approaches. However, it is associated with specific pain in the abdominal wall. PURPOSEThe objective of this study was to determine whether performing a bilateral ultrasound-guided Transversus abdominis plane (TAP) block allows a reduction in morphine consumption in the first 24 hours after surgery. STUDY DESIGNThis study is a prospective single-center, randomized, double-blind study. PATIENT SAMPLEPatients undergoing ALIF surgery were included and randomized into two groups. Both groups received a TAP block performed at the end of surgery with either ropivacaine or placebo. OUTCOME MEASURESThe primary outcome measure was morphine consumption in the first 24 hours. The main secondary outcomes were immediate postoperative pain and opioid-related side effects. METHODSIntra- and postoperative anesthesia and analgesia protocols where standardized. A bilateral ultrasound-guided TAP block was performed with 75 mg (in 15 mL) of ropivacaine per side or isotonic saline serum depending on their assignment group. RESULTSForty-two patients were included in the study (21 per group). Morphine consumption at 24 hours (28 mg [18–35] in the ropivacaine group versus 25 mg [19–37] in the placebo group [p=.503]) were not significantly different between the two groups. CONCLUSIONTAP block with ropivacaine or placebo provided a similar postoperative analgesia when associated with a multimodal analgesia protocol for ALIF.

EFFECTS OF DEXAMETHASONE AS AN ADJUVANT TO ROPIVACAINE ON DURATION AND QUALITY OF POST-OPERATIVE ANALGESIA IN ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK IN PATIENTS UNDERGOING LOWER-SEGMENT CESAREAN SECTION

Aim: The aim of this study was to measure the effect of adding dexamethasone to ropivacaine on the duration and quality of post-operative analgesia in patients undergoing lower-segment caesarean section (LSCS) who are receiving ultrasound-guided transverse abdominal plane (TAP) blocks. Methods: An interventional, prospective, randomized, and double-blind trial was conducted at a hospital. Before beginning the investigation, the Institutional Ethics Committee permission was acquired. The patient characteristics were analyzed using the Students t-test for continuous variables and the Chi-square test for categorical variables. A total of 60 patients were randomly split into two groups of 30 each. Results: Time to first rescue analgesia was significantly shorter in Group R (11.62±3.80 h) than the Group D (19.04±4.20 h) (p&lt;0.001). The total tramadol requirement in post-operative period was significantly higher in Group R (86.67±30.55 mg) than the Group D (35.56±39.54 mg) (p&lt;0.001). Conclusion: The use of dexamethasone along with 0.1% ropivacaine prolongs the analgesic duration of TAP block in patients undergoing LSCS.

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

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

Efficacy of Magnesium Sulfate as an Adjuvant to Bupivacaine in Transversus Abdominis Plane Block for Abdominal Hysterectomy Surgeries.

Background Major abdominal surgeries are often accompanied by excruciating pain, which, if not adequately managed, can reduce patient comfort and satisfaction, delay mobilization, compromise respiratory and cardiac functioning, and increase healthcare costs. The transversus abdominis plane (TAP) block is an efficient and safe complement to multimodal postoperative analgesia for abdominal surgery. This study evaluates the efficacy of combining magnesium sulfate (MgSO4) with bupivacaine for TAP block in patientsposted for total abdominal hysterectomy (TAH). Methodology Seventy female patients between the ages of 35 and 60 who were scheduled to have a TAH under spinal anesthesia were divided randomly into two groups of 35 each: group Bupivacaine (B) and group Bupivacaine-Magnesium sulfate (BM). Group B received 18 milliliters (mL) of bupivacaine 0.25 percentage (%) 45 milligrams (mg) with 2 mL normal saline (NS) whereas group BM received 18 mL of bupivacaine 0.25% (45 mg) with 1.5 mL of 10% weight/volume (w/v) MgSO4 (150 mg) and 0.5 mL NS in the ultrasonography-guided (USG) bilateral TAP block performed after the end of surgery. Groups were compared for the postoperative visual analog scale (VAS) scores, the time required for first rescue analgesia, the number of analgesic rescues at various time intervals, patient satisfaction score, and any side effects. Results Postoperative VAS scores at 4, 6, 12 and 24th hour (hr) (p < 0.05) in group BM were lower compared to group B.Time required for rescue analgesia was significantlyprolonged in group BM (882.94 ± 70.22 minutes) compared to group B (459 ± 100.53 minutes) with minimal usage of rescue analgesia (p < 0.05)up to 12 hr.In group BM, the patient satisfaction score was higher (p = 0.001). Conclusion In addition to a considerable reduction in post operative VAS scores and overall use of rescue analgesia, the addition of magnesium to bupivacaine significantly prolongs the TAP block and increases the initial postoperative period of bearable pain.

Implementing novel modalities into an institutional enhanced recovery after bariatric surgery (ERABS) protocol.

Enhanced recovery after bariatric surgery pathways are associated with improved postoperative outcomes. This study aims to assess efficacy and safety of three novel protocol contributions (transversus abdominis plane blocks, ketamine and fosaprepitant), as well as their impact on length of stay (LOS) and on postoperative complications. Effectiveness and safety were retrospectively investigated in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) over a 6-year period in a single institution. Group 1 patients were not exposed to any of our suggested interventions, whereas Group 2 were exposed to all of three. Between January 2015 and August 2021, 1480 patients underwent primary SG (77.6%) or RYGB (22.4%); of those, 1132 (76.5%) and 348 (23.5%) were in Groups 1 and 2, respectively. Mean BMI and age were 45.87 versus 43.65kg/m2 and 45.53 versus 44.99years in groups 1 and 2, respectively. Suggested interventions were associated with lower operative times (84.79 ± 24.21 vs. 80.78 ± 32.8min, p = 0.025). In Group 2, the mean LOS decreased in 0.18day (1.79 ± 1.04 vs. 1.60 ± 0.90; p = 0.004). Overall complication rates were 8% and 8.6% for groups 1 and 2, respectively; readmission rates were 5.7% (64 pts) vs. 7.2% (25 pts), p > 0.05. Reoperations were less prevalent in Group 2 (1.5% vs. 1.1%; p = 0.79). Focus on optimized pain management, allied to a superior PONV control, may be relevant contributors for a lower LOS without negative impacts in complications rates.

Comparison of Analgesic Effect of Transversus Abdominis Plane (TAP) Block versus Conventional Analgesics in Patients Undergoing Different Obstetrics and Gynecological Surgeries

Comparison of Analgesic Effect of Transversus Abdominis Plane (TAP) Block versus Conventional Analgesics in Patients Undergoing Different Obstetrics and Gynecological Surgeries

PD31-01 IMPACT OF TRANSVERSUS ABDOMINUS PLANE NERVE BLOCK DURING KIDNEY TRANSPLANTATION ON PATIENT POST-OPERATIVE OPIOID USAGE: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED STUDY

You have accessJournal of UrologyCME1 Apr 2023PD31-01 IMPACT OF TRANSVERSUS ABDOMINUS PLANE NERVE BLOCK DURING KIDNEY TRANSPLANTATION ON PATIENT POST-OPERATIVE OPIOID USAGE: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLINDED STUDY William Jevnikar, Michael Gross, Hannah Kerr, Venkatesh Krishnamurthi, Alvin Wee, Yi-Chia Lin, and Mohamed Eltemamy William JevnikarWilliam Jevnikar More articles by this author , Michael GrossMichael Gross More articles by this author , Hannah KerrHannah Kerr More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Alvin WeeAlvin Wee More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplantation is a life-altering procedure with excellent surgical outcomes. However, options for post-operative analgesia are limited by pre-existing renal dysfunction and most centers rely heavily on opioids for pain control. Transversus Abdominus Plane (TAP) blocks provide abdominal wall analgesia and may reduce surgical site pain. We aim to determine the effectiveness of intraoperative surgeon-administered TAP block for reducing post-operative opioid usage and pain in kidney transplantation patients. METHODS: Patients undergoing kidney transplantation via either a standard Gibson incision or the anterior rectus sheath (ARS) approach were randomized intraoperatively 1:1 to TAP block (a combination of liposomal and unbound bupivacaine) or normal saline via the reflected abdominal wall prior to bringing the kidney into the field. Patients and treating team were blinded to randomization. Post-operative opioid usage, pain via dedicated survey, and length of stay for both groups were recorded. Differences between groups were calculated via t-test, χ2 and Mann Whitney U tests. RESULTS: 128 patients were randomized and were evenly distributed (Table 1). Patients receiving the TAP block required fewer morphine milligram equivalents (MME) (30.0 vs 60.3, p=0.002) and had a lower maximum pain score (6 vs 7, p=0.039) compared to placebo. MME was reduced with TAP in both the ARS (p=0.024) and Gibson subsets (p=0.020). 27 of the patients receiving an ARS incision used no opiates while inpatient, with significantly more patients having received the TAP vs placebo (20 vs 7, p=0.001). CONCLUSIONS: TAP block reduced MME usage by half for each surgical approach. 26% of the cohort did not require any opioids following transplantation including half of all patients receiving the combination of ARS and TAP block. The TAP block is an easily-implemented adjunct with the ability to significantly decrease the post-operative opioid use in renal transplantation with the additional possibility of opioid-free transplantation in select patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e900 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Jevnikar More articles by this author Michael Gross More articles by this author Hannah Kerr More articles by this author Venkatesh Krishnamurthi More articles by this author Alvin Wee More articles by this author Yi-Chia Lin More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in postoperative pain management after laparoscopic sleeve gastrectomy

Background Patients undergoing abdominal surgeries may benefit from an ultrasound-guided quadratus lumborum block (QLB) as one of the postoperative pain management techniques. Objective This study compares the effects of bilateral ultrasound guided Transversus abdominis plane (TAP) block versus bilateral ultrasound guided QLB on postoperative analgesia in patients having laparoscopic sleeve gastrectomy (LSG) under general anaesthesia (GA). Patients and methods 45 patients who were scheduled for elective LSG participated in a randomized controlled trial. All patients were given 1–2 μg/kg of intravenous fentanyl as intraoperative narcotic during GA. QLB Group (15 patients): received ultrasound-guided QLB using 0.2 mL/kg of 0.25% bupivacaine per side after induction of general anaesthesia. TAP Group (15 patients): received ultrasound-guided TAP block using 0.2 mL/kg of 0.25% bupivacaine per side after induction of general anaesthesia. Control Group (15 patients): received general anaesthesia and then 1 gm IV paracetamol and 30 mg IV ketorolac within first hour and 8 h postoperative. Results QLB group used pethidine as rescue analgesia mush less than other groups with highly statistically significant difference (P value&lt;0.001). Also, there was statistically significant difference between groups in number of patients needed rescue analgesia (60% of QLB group, 86.7% of TAP group and 100% of control group). Also, the QLB group had superior clinical pain scores than the other groups with a statistically significant difference at PACU arrival, 30 min, 2 h, and 4 h postoperative. The TAP group had a lower VAS score than the control group, with a statistically significant difference at PACU arrival and 4 h postoperative. In comparison to the TAP group, the VAS score was lower in the QLB group, with a statistically significant difference at 30 min postoperatively. MAP was significantly lower in the QLB group than in the control group at PACU entry, 30 min, and 6 h postoperatively. However, MAP was lower in the QLB group than in the TAP group, with a statistically significant difference only at the 12- and 24-hour post-operative time points. HR was less significantly in QLB group than control group at 30, 2, 12, 24 h postoperatively, when comparing the HR between the QLB and TAP groups, the difference became statistically significant only at the 12-hour post-operative time. Conclusion In compared to TAP block and IV analgesics, QLB was the most efficient method for delivering analgesia following LSG.

MP32-07 SURGEON-ADMINISTERED ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCKS DURING RADICAL CYSTECTOMY: DESCRIPTION OF TECHNIQUE AND PERIOPERATIVE OPIOID REQUIREMENT

You have accessJournal of UrologyCME1 Apr 2023MP32-07 SURGEON-ADMINISTERED ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCKS DURING RADICAL CYSTECTOMY: DESCRIPTION OF TECHNIQUE AND PERIOPERATIVE OPIOID REQUIREMENT Justin Refugia, Hilary Brownstead, Parth Thakker, Randy Casals, Corey Able, Emily Roebuck, and Matvey Tsivian Justin RefugiaJustin Refugia More articles by this author , Hilary BrownsteadHilary Brownstead More articles by this author , Parth ThakkerParth Thakker More articles by this author , Randy CasalsRandy Casals More articles by this author , Corey AbleCorey Able More articles by this author , Emily RoebuckEmily Roebuck More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Implementation of standardized analgesic regimens is paramount to developing enhanced recovery after surgery (ERAS) protocols for radical cystectomy (RC). Transversus abdominis plane (TAP) blocks have demonstrated decreased length of stay (LOS) and perioperative opioid requirement. To date, no studies have reported on ultrasound (US) guided blocks performed by the surgeon in this setting. In this study, we present our technique for surgeon-administered, US-guided TAP (sUTAP) blocks and review postoperative opioid requirements. METHODS: We retrospectively reviewed patients that received sUTAP blocks just prior to incision for RC. The blocks were performed with US-guidance to advance the needle into the transversus abdominis plane at the anterior axillary line between the subcostal margin and iliac crest. Next, 25-cc of an anesthetic solution was instilled into this plane and the procedure was repeated on contralateral side (total of two injection sites). The primary objective was overall perioperative opioid requirement. Due to protocol changes, we also compared two groups of patients that received a 50-cc mixture of: 0.25% bupivacaine mixed with liposomal-bupivacaine (LB) or 0.25% bupivacaine only. Analyses were performed on demographics, surgical and anesthetic details, and perioperative medications. RESULTS: Between 2020 and 2022, we identified 47 patients that received sUTAP blocks during RC. The men (79%) had a median age of 70 years (IQR 61-75), and women (21%) had a median age 77 years (IQR 67-80). RC approach was open (81%) or robotic (19%). Urinary diversion was with ileal conduit (53%) or cutaneous ureterostomy (47%). Overall median perioperative MMEs: intraoperative – 85 (53-107), POD0 – 25 (15-45), POD1 – 15 (0-40), POD2 – 7.5 (0-25), POD3 – 2.5 (0-16), and POD4 – 0 (0-11). The overall median length of stay was 4 days (IQR 3-6). LB was included for 14 patients (30%) and intraoperative/POD1 MMEs were higher than the 33 patients (70%) that received bupivacaine only (p<0.05). CONCLUSIONS: Our results suggest that addition of sUTAP blocks may reduce postoperative opioid requirements. Learning our technique should be considered by surgeons that are developing ERAS protocols for RC. Further comparative studies between anesthesia-administered TAP blocks and other peri-operative regional pain management modalities may clarify efficacy of sUTAP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e442 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Refugia More articles by this author Hilary Brownstead More articles by this author Parth Thakker More articles by this author Randy Casals More articles by this author Corey Able More articles by this author Emily Roebuck More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement PDF downloadLoading ...

The effect of TAP block use in postoperative analgesic in cesarean section.

TAP (transversus abdominis plane) block is an important parameter of multimodal analgesia in the control of postoperative pain in cesarean section cases. In our study, we aimed to compare the analgesic consumption, patient satisfaction rate, vital signs, and visual analog scale (VAS) scores of ASA II patients with and without TAP block in cesarean surgery. This study was designed as a retrospective review of prospectively collected data and an open-label and randomized clinical trial. The files of 180 patients who underwent elementary cesarean section between January 2019 and December 2019 were analyzed. The ASA score, anesthesia method, age, weight, height, parity, TAP block application, VAS score, analgesia duration, the additional analgesic requirement for maintenance, patient satisfaction, postoperative nausea, vomiting, urinary retention, and other complications were recorded. The 180 patients included in the study were divided into 6 groups: Group 1 - General anesthesia, Group 2 - General anesthesia + TAP block, Group 3 - Spinal anesthesia, Group 4 - Spinal anesthesia + TAP block, Group 5 - Epidural anesthesia, and Group 6 - Epidural anesthesia + TAP block. There was no significant difference between the groups in terms of demographic variables. The VAS scores of the first 24 hours were significantly different for Group 1. VAS scores in the 1st and 3rd hours were significantly higher in Group 1 than in the other groups. The groups without TAP block had significantly higher VAS scores at the 12th hour. Furthermore, the VAS score in Group 6 at 24 hours was significantly the lowest, and the earliest analgesic requirement was in Group 1. When the number of analgesic needs of the patients in 24 hours was examined, Group 1 was found to be significantly the highest, and Group 6 was significantly the lowest of all groups. The epidural anesthesia + TAP block Group had the lowest VAS score, the fewest analgesic requirements, the longest analgesia length, and the highest patient satisfaction.

Comparative evaluation of bupivacaine with magnesium sulphate and dexamethasone as adjuvants in ultrasound-guided transversus abdominis plane block for open unilateral inguinal hernia surgeries: A randomised controlled trial.

Inguinal hernia repair is associated with moderate to severe pain that is most extreme in the first 24 hours. The aim of this study was to compare the efficacy of dexamethasone versus magnesium sulphate (MgSO4) with bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for patients undergoing unilateral inguinal hernioplasty. Eighty patients were randomly allocated to two groups to receive ultrasound-guided TAP block postoperatively with either 20 ml of 0.25% bupivacaine with 8 mg of dexamethasone (Group BD) or 20 ml of 0.25% bupivacaine with 250 mg of MgSO4 (Group BM). Patients were assessed for the first 24 hours after surgery for pain at rest and movement using a numerical rating scale (NRS). Two mg/kg of tramadol was administered as rescue analgesia. The time to first demand tramadol, total consumption of tramadol, patient satisfaction score and side effects were evaluated. The time to the first dose of rescue analgesia was significantly longer in BD group (596.13 ± 57.93 min) than in the BM group (422.50 ± 51.95 min). The NRS scores in the BD group were significantly lower compared to the BM group both at rest and on movement. The total requirement of tramadol was significantly less in the BD group (154.55 ± 59.11 mg) compared to the BM group (270.25 ± 105.72 mg). The incidence of side effects was lower and patient satisfaction was higher in BD group compared to BM group. Bupivacaine with dexamethasone in TAP block after unilateral open inguinal hernioplasty provides increased duration of analgesia and decreased requirement for rescue analgesics compared to magnesium sulphate, with lesser side effects and better patient satisfaction.

V10-09 SURGEON ADMINISTERED LAPAROSCOPIC GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023V10-09 SURGEON ADMINISTERED LAPAROSCOPIC GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOLLOWING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Pushan Prabhakar, Hariharan Ganapathi, Ahmed Eldefrawy, Jorge Caso, and Murugesan Manoharan Pushan PrabhakarPushan Prabhakar More articles by this author , Hariharan GanapathiHariharan Ganapathi More articles by this author , Ahmed EldefrawyAhmed Eldefrawy More articles by this author , Jorge CasoJorge Caso More articles by this author , and Murugesan ManoharanMurugesan Manoharan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe the technique of a surgeon-administered laparoscopic guided transversus abdominis plane block and evaluate the safety and efficacy of the block in patients underwent robot-assisted laparoscopic prostatectomy (RALP). METHODS: A consecutive series of patients who underwent RALP were administered laparoscopic guided transversus abdominis plane block by the surgeon. A validated numeric pain rating scale was used to record their pain during their postoperative hospital stay. Also, the morphine milligram equivalents (MME) for pain medications were calculated. RESULTS: A total of 61 patients were included in the analysis, 57 patients were discharged within 24 hours and 4 patients were discharged the following day. The mean pain score prior to discharge (24 hr) was 3.64 ± 1.81 (range 1-8). The MME for postoperative day 1 was 13.7 ± 11.03 (range 0-49) and 10.91 ± 8.77 (range 0-25) for postoperative day 2. There were no block related complications. CONCLUSIONS: The surgeon administered laparoscopic TAP block is a safe pain management tool. Studies compared laparoscopic guided TAP block with ultrasound-guided TAP block and reported no discernible differences in the efficacy of pain management following general surgical procedures. Direct visualization of the administration site minimizes complications such as iatrogenic visceral injury by the needle or administration of the local anesthetic in the wrong plane. In addition, the surgeon-administered block also potentially reduces the additional time taken to set up an ultrasound guided TAP block which requires an anesthesiologist and an ultrasound machine. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e928 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pushan Prabhakar More articles by this author Hariharan Ganapathi More articles by this author Ahmed Eldefrawy More articles by this author Jorge Caso More articles by this author Murugesan Manoharan More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of effects of transversus abdominis plane block and thoracic epidural anesthesia mediated activation of inflammasome on postoperative medication, pain, and recovery in patients undergoing laparoscopic colorectal surgery.

This work was developed to compare the effects of transversus abdominis plane block (TAPB) and thoracic epidural anesthesia (TEA) mediated activation of inflammasome on postoperative medication, pain, and recovery in patients undergoing laparoscopic colorectal surgery. Then, the effects of two anesthesia methods on postoperative analgesia of patients were investigated and compared, aiming to provide reference for the selection of postoperative analgesia methods of laparoscopy. In this work, patients undergoing laparoscopic colorectal surgery were rolled into a TAPB group (30 patients) and a TEA group (30 patients). The blood pressure and stress indexes of the patients at different time points were observed and compared, and the doses of anesthetic drugs were recorded. Postoperative pain scores were evaluated, and postoperative recovery of the two groups was compared. Meanwhile, the peripheral venous bloods were extracted from the two groups before and after surgery for the determination of inflammasome proteins, and the detection results were compared. Data showed that the dose of sufentanil in TEA group was notably inferior to that in TAPB group (p<0.05). The blood pressure indexes in the TEA group decreased remarkably (p<0.05), while their changes in the TAPB group were stable. The slower point heart rate (HR), lower mean arterial pressure (MAP), and lower levels of cortisol (Cor) and norepinephrine (NE) in the TEA group were found when compared with the TAPB group during the period from pneumoperitoneum establishment to post-ventilation. After pneumoperitoneum establishment, blood oxygen saturation (SpO2) in the TEA group was lower than that in the TAPB group at the same time point (p<0.05). The postoperative visual analog scales (VAS) score and numerical rating scale (NRS) score in TEA group were lower than those in TAPB group (p<0.05). After surgery, the protein level in TEA group was significantly lower than that in TAPB group (p<0.05). In short, the activation of inflammasome mediated by TEA could reduce the anesthetic agents used after laparoscopic colorectal cancer surgery and reduce the surgical stress response. In addition, TEA exerted a little effect on early immunity, which was safe and feasible, contributing to postoperative analgesia and recovery. In addition, its application value in laparoscopic postoperative analgesia was higher than TAPB.