Transversus Abdominis Plane Block Group Research Articles

Transversus abdominis plane block versus simple instillation of local anesthetics in the peritoneal cavity for postoperative analgesia in laparoscopic prostatectomy

Background Laparoscopic radical prostatectomy is minimally invasive technique used to treat cancer prostate. Controlling post-operative pain is one of the main concerns for better post-operative recovery. This study compared the efficacy of ultrasound guided transversus abdominis plane (TAP) block with intraperitoneal instillation of local anesthetics for reduction of postoperative pain after laparoscopic radical prostatectomy. Methods Forty adult patients scheduled for laparoscopic radical prostatectomy were randomized to receive TAP block (group I) or simple instillation of local anesthetics in the peritoneal cavity (group II). The primary outcome was assessing Visual Analogue scale (VAS) during rest and during mobilization. Secondary outcome was measuring total amounts of supplementary morphine consumption. Results There were significant lower pain scores in group II when compared to group I at rest and on movement till the end of the first 24 hours post-operatively. patients undergoing peritoneal block had reduced total amount of 24 h morphine consumption (8±1.9) in comparison to TAB block group (5.8±1). Conclusion Peritoneal block with local anesthetics provides better post-operative analgesia and reduced morphine consumption up to 24 hours after laparoscopic surgery when compared to TAP block.

Laparoscopic-assisted Transversus Abdominis Plane (TAP) Block in Patient Undergoing Laparoscopic Gynecologic Surgery: Randomized Controlled Trial

Study Objective To compare the analgesic efficacy of laparoscopic-assisted posterior Transversus Abdominis Plane (TAP) block versus lateral TAP block for post-operative pain control in patients undergoing laparoscopic gynecologic surgeries. Design Prospective randomized trial. Setting Patients undergoing laparoscopic/robotic gynecology surgeries. Patients or Participants 80 patients were randomly assigned to laparoscopic-assisted lateral (mid-axillary) TAP block and posterior TAP block. Total sample size of 80 patients with considering 10 % drop out rate, gives 85 % power (two-sided alpha =0. 05) to detect a difference of 0.7 in pain score. Interventions Laparoscopic-assisted TAP block with liposomal Bupivacaine and Bupivacaine HCL 0.5% mixed in ratio of 1:2 in milligram. We randomized patients posterior approach injection was applied in triangle of petit versus in lateral TAP block injection was performed in mid axillary line between iliac crest and lower coastal margin. Opioid consumption and Numeric Pain Rating Score (NPRS 0 to 10) were recorded at 6, 12, 24, 48 and 72 hours post-operatively. Measurements and Main Results patients in the posterior TAP block group was older than the lateral TAP block group (P-Value: 0.03). There was no difference in terms of race, BMI, ASA classification and comorbidities between two groups. Length of surgery was longer in lateral group (P-value: 0.02). There was no difference in terms of type of procedure. Patients in posterior group had less pain score at 6 h, 12h, 24h, 48h and 72 h post-operative, and they significantly used less narcotic during the first 3 days after surgery (p-value:0.009) Conclusion Laparoscopic-assisted TAP block is a new and safe technique for multimodal pain management. Posterior TAP block provides better analgesia than lateral TAP block for laparoscopy gynecologic surgeries. Posterior TAP block significantly reduces the total amount of narcotics used by patients in post-operative course.

The Effect of Transversus Abdominis Plane Block for Analgesia in Patients Undergoing Liver Transplantation: A Systematic Review and Meta-Analysis.

Ultrasound-guided regional anaesthesia using transversus abdominis plane (TAP) block is a newer and safer method that can be used in patients undergoing liver transplant surgeries. This systematic review and meta-analysis was done to quantify the analgesic potential and opioid-sparing capability of TAP block in these patients. The studies comparing TAP-block to conventional analgesic regimens for liver transplant were searched. The studies evaluating the comparative 24-h morphine consumption during postoperative period in patients undergoing liver transplant surgeries were searched and included as the primary outcome in the analysis. We found two randomised controlled trials and two retrospective studies that on meta-analysis showed that TAP block group had significantly lower requirement of morphine (WMD=27.59 mg; 95% CI: 33.47-21.70) at 24 h for pain mitigation. Also, postoperative nausea and vomiting was lower (RR=0.76; 95% CI: 0.47-1.22) but not statistically significant. Ultrasound-guided TAP block provides postoperative analgesic efficacy in patients undergoing liver transplant surgeries. This study was registered in International prospective register of systematic reviews [PROSPERO: CRD42018094595].

Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption.
 Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section.
 Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively.
 Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.
 Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

Evaluate the Feasibility of Surgical Transversus Abdominis Plane Block for Postoperative Analgesia After Cesarean Section.

Transversus abdominis plane (TAP) block is a fascial plane block providing postoperative analgesia after lower abdominal surgeries including Cesarean section. Conventionally, it is administered under ultrasound guidance or by blind technique. We studied a novel transperitoneal surgical TAP block for providing safe and effective analgesia after Cesarean section through transverse incision. A hundred patients who fulfilled the inclusion criteria were included in the study after obtaining informed written consent. They were randomized in two groups: Group A with surgical TAP block and Group B without TAP block as control. Surgical TAP block was administered by transperitoneal route before the closure of peritoneum with 0.25% bupivacaine (dose adjusted with weight of the patient), and visual analogue score was assessed by a blind assessor. Time for rescue analgesia was noted and analyzedwith the 'two independent sample ttest.' The duration of postoperative analgesia in hours was significantly longer in the TAP block group compared with the control group (5.14 ± 1.63 vs 2.61 ± 0.89, p < 0.001). There was no reported complication of the surgical technique or any adverse effect of the used drug. Surgical TAP block via the transperitoneal route is a safe, easy and effective mode of providing postoperative analgesia after Cesarean section. This technique does not need any costly specialist equipment, overcomes the technical limitations of ultrasound-guided TAP block and can be used in obese patients also. It has almost no side effects, and the technique can be easily mastered.

Pain Control after Laparoscopic Radical Prostatectomy: Comparison between Unilateral Transversus Abdominis Plane Block and Wound Infiltration

Background and Objectives: To determine the efficacy of unilateral transversus abdominis plane (TAP) block versus wound local infiltration for postoperative pain following laparoscopic radical prostatectomy (LRP). Methods: Data of consecutive patients who underwent extraperitoneal LRP and received either wound infiltration or unilateral TAP block for analgesia were retrospectively analyzed. The patients were divided into 2 groups based on the technique used. We compared pain intensity scores and on-demand analgesic use both during the hospital stay and post-discharge between the 2 groups. Results: A total of 48 patients were included, 27 received unilateral TAP blocks (group 1) and 21 were managed with wound infiltration (group 2). The unilateral TAP block group showed lower median pain scores on postoperative days (POD) 1 with pain scores being 0.2 (0–4) and 0.8 (0–4), respectively (p < 0.05). On POD2, the median pain intensity was 0.9 (0–5) and 1.6 (0–6) in groups 1 and 2, respectively (p < 0.05). The median number of on-demand analgesic doses during the POD1 was 0.2 (0–2) and 0.4 (0–2) in groups 1 and 2, respectively (p = 0.19). On POD2, the patients received 0.5 (0–2) and 1.1 (0–3) on-demand doses in groups 1 and 2, respectively (p < 0.05). Conclusion: Unilateral TAP block might improve pain control more pronounced after LRP than wound infiltration.

Comparison of ultrasound-guided iliohypogastric/ilioinguinal nerve block and transversus abdominis plane block for analgesia after cesarean section: A retrospective propensity match study.

Effective and adequate post-operative analgesia for cesarean section is in demand due to increasing rates of cesarean deliveries, and may help promote recovery, ambulation and breastfeeding. Local nerve block has been applied as post-operative analgesia for maternal patients receiving cesarean section; specifically, lateral abdominal transversus abdominis plane block (TAPB) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance have been proven to be effective. The present study aimed to compare the analgesic effect of TAPB and IHINB in maternal females undergoing cesarean section. Propensity-matched females who received cesarean section (n=124) were retrospectively enrolled and divided into the TAPB group (n=62) and the IHINB group (n=62) according to their post-operative analgesia treatment. All of the patients have been given spinal-epidural anesthesia during the operation, while they received either TAPB or IHINB for post-operative analgesia. Demographic and clinical data were collected and compared, including time to first morphine request, cumulative morphine consumption, visual analogue scale (VAS) score and adverse events. Due to propensity matching, there was no significant difference between the two groups in their baseline characteristics (all P>0.05). The log-rank test indicated no significant difference in the Kaplan-Meier curves for the time to first morphine request between the two groups (P=0.575). The VAS score and cumulative morphine consumption at 6 and 12 h was similar between the two groups (all P>0.05). However, these two parameters were significantly lower in the IHINB group at 24 and 48 h (P<0.001). Uni- and multivariate logistic regression analysis indicated that the method of block was not an independent influencing factor regarding postoperative pain relief (P=0.628). There was also no difference between the two groups in adverse events of analgesia (all P>0.05). In conclusion, the present study demonstrated that TAPB and IHINB achieved a comparably satisfactory analgesic effect after cesarean section. However, the analgesic effect of IHINB was better than that of TAPB at the later stages.

Comparison of Analgesic Efficacy of Ultrasound Guided Subcostal Transversus Abdominis Plane Block with Port Site Infiltration Following Laparoscopic Cholecystectomy

Patients have significant pain following laparoscopic cholecystectomy. Several modalities have been used to manage this pain. Subcostal transversus abdominis plane (TAP) block is one of the components of multimodal analgesia and has been described as an effective technique for postoperative pain management. This study compares the impact of subcostal TAP block with port site local infiltration following laparoscopic cholecystectomy for postoperative pain and opioid consumption. This is a prospective, randomized, interventional study. Sixty patients were enrolled and divided into two groups having 30 patients in each group. Group A received bilateral ultrasound guided subcostal TAP block with 10 mL of 0.25% bupivacaine after the completion of surgery. Group B received similar amount of local anesthetic infiltrated over all the laparoscopic port sites. Pain at rest and on movement was assessed using VAS scale in post-operative period at 0 min, 30 min, 2, 4, 6, 12 and 24 hours. Time of first rescue analgesic requirement and total opioid consumption over 24 hours were recorded. Patients receiving Subcostal TAP block had reduced postoperative pain as compared to port site infiltration and statistically significantly in first two hours after surgery. The 24 hours opioids consumption was significantly less (125mg ±25.42 versus 175mg ±25.42, p <0.001) in Subcostal TAP block group. Time for request of first rescue analgesic was prolonged in patients receiving the Subcostal TAP block (3.20±0.84 hours vs 1.70±0.65 hours, p <0.001). Ultrasound guided bilateral Subcostal TAP block provides effective post-operative analgesia and reduces opioid consumption in patients undergoing laparoscopic cholecystectomy.

Postoperative analgesic effect of transversus abdominis plane block in the anesthesia of open intestinal surgeries

Objective To evaluate the postoperative analgesic effect of transversus abdominis plane block(TAPB) under guidance of ultrasonic in the anesthesia of intestinal surgeries on intestinal tumor patients. Methods Eighty patients undergoing intestinal tumors with lateral rectus incision, American Society of Anesthesiologists(ASA)Ⅰ-Ⅲ were randomly devided into two groups: group TAPB(group T, n=40) and group control (group C, n=40). After induction of general anesthesia, anesthesia was maintained with sevoflurane to keep the Bispectral Index(BIS) value within 40-60. In group T, one side TAPB was performed under ultrasound guidance. In group C, 10 μg sufentanil was given both at the time point of incision and before peritoneal closure. Numerical Rating Scale(NRS) pain scores, pressing times of patient-controlled infusion analgesia (PCIA), postoperative nausea and vomiting(PONV) scores were recorded at designed time points postoperative [post-anesthesia care unit(PACU), 2, 6, 12, 24 h]. Results NRS scores in group T were lower than those in group C at postoperative PACU (0 vs 2.9±1.1), postoperative 2 h (0 vs 3.1±0.7), postoperative 6 h (1.2±0.5 vs 3.7±0.9, P<0.05). Cumulative pressing times of PCIA in group T were less than those in group C at postoperative PACU (0 vs 1.1±0.7), postoperative 2 h (0.5±0.9 vs 2.0±1.2), postoperative 6 h (1.7±1.1 vs 4.5±2.3), postoperative 12 h (4.5±2.2 vs 8.5±3.3) and postoperative 24 h (8.1±3.3 vs 12.8±3.1, P<0.05). PONV scores in group T were significantly lower than those in group C at postoperative PACU (0 vs 2.1±0.9), postoperative 2 h (0 vs 1.7±0.8), postoperative 6 h (0 vs 2.2±0.6), postoperative 12 h (0.9±0.6 vs 2.2±0.7) and postoperative 24 h (0 vs 2.1±0.9, P<0.05). Conclusions TAPB could provide better analgesia effect, reduce postoperative dosage of opioids and the PONV scores. Key words: Transversus abdominis plane block; Intestinal cancer; Incision pain

Postoperative analgesia after total abdominal hysterectomy: Is the transversus abdominis plane block effective?

Analgesic protocol is needed following gynecologic surgery to ensure early mobilization, decrease the duration in the post-anesthetic care unit and hospitalization, and provide patient comfort. Transversus abdominis plane (TAP) blocks are used in the treatment of acute postoperative pain after lower abdominal surgery. TAP block may be a better choice of postoperative pain control. In the present study, the efficacy of ultrasound-guided TAP block on pain control and postoperative opioid consumption was evaluated in patients undergoing a total abdominal hysterectomy. Fifty patients undergoing total abdominal hysterectomy were included in this study. Patients were divided into TAP block (n = 25) and control groups (n = 25). Both groups postoperative patient-controlled analgesia (PCA) was planned during 24 h postoperatively. Patients were assessed 1, 2, 4, 6, 12, 18, and 24 h postoperatively using the Visual Analog Scale (VAS), Ramsey Sedation Score, PCA demand, morphine consumption, first analgesic requirement time, and adverse reactions. When compared with the control group, the time to first analgesic requirement in the TAP block group was significantly lower (P < 0.05). The amount of additional analgesia also differed significantly (P < 0.001). In the TAP group, the VAS was significantly lower at 2, 4, 6, 12, 18, and 24 h postoperatively compared to the control group (P < 0.05). There was no statistically significant difference in adverse reactions. TAP block can effectively treat postoperative pain as part of multimodal analgesia in patients undergoing total abdominal hysterectomy.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block versus local infiltration during paediatric laparoscopic surgeries.

Background and Aims:The purpose of this study was to compare the analgesic efficacy of ultrasonography-guided transversus abdominis plane (TAP) blocks with local port site infiltration in children undergoing laparoscopic surgeries.Methods:After ethics committee approval and informed consent, 92 children aged 2–12 years posted for laparoscopic surgeries were randomly divided into Group T and Group L. Port site infiltration was performed in Group L by the surgeon at the time of port placement and end of surgery with 0.4mL/kg of 0.25% bupivacaine. Bilateral TAP block was performed in Group T after induction of anaesthesia, under ultrasonographic guidance with a Logiq E7 GE portable ultrasound unit and a linear 5–10 MHz probe. A 22G hypodermic needle and 0.4 mL/kg of 0.25% bupivacaine were used on each side for the TAP block. The parameters recorded were intraoperative haemodynamics, opioid requirements, postoperative pain scores and the need for rescue analgesia in the first 6 h postoperatively.Results:The median (interquartile range) pain scores were significantly lower in the TAP block group than the local infiltration group at 10 min [2 (0–2.5) vs 2 (3–4); P = 0.011], 30 min [1.5 (0–3) vs 3 (2–5);P < 0.001], 1 h [1.5 (0–2) vs 2 (2–3);P < 0.001] and 2 h [2 (0–2) vs 2 (1.5–2.5); P = 0.010] postoperatively. The need for intraoperative opioids and rescue analgesia was also significantly lower in the TAP block group (P < 0.001).Conclusion:TAP block is superior to local infiltration for intra- and immediate postoperative analgesia in paediatric laparoscopic surgeries.

Effect of transversus abdominis plane block on postoperative rehabilitation of colorectal cancer patients

Objective To evaluate the effect of transversus abdominis plane block(TAPB) on postoperative recovery of patients with colorectal cancer. Methods Sixty patients with colorectal cancer undergoing elective laparoscopic surgery were randomized into two groups (n=30): transversus abdominis plane block group (group TAPB) and control group (group C). Patients in group TAP and group C respectively received postoperative TAPB and patient-controlled intravenous analgesia(PCIA). The VAS scores, bed rest time, and the time of first exhaustion were recorded 4, 8, 12, 24 h after operation. The protein levels of plasma IL-6, TNF-α, and C-reactive protein(CRP) were determined before surgery, immediately after surgery, and 4, 12, 24 h after surgery. Results The VAS scores 4, 8, 12, 24 h after TAPB in group TAPB were significantly lower than those in group C(P<0.05). Patients in group TAPB had shorter bed rest time and earlier exhaustion than patients in group C(P<0.05). The protein levels of IL-6, TNF-α and CRP in group C did not differ immediately after surgery, but were significantly reduced 4, 12, 24 h after surgery, compared with those in group C (P<0.05). Conclusions TAPB can effectively relieve postoperative pain and reduce the production of inflammatory factors, therefore is beneficial for patients' postoperative rehabilitation. Key words: Transversus abdominis plane block; Colorectal cancer; Fast track

Laparoscopic-guided transversus abdominis plane block versus trocar site local anesthetic infiltration in gynecologic laparoscopy

BackgroundRelieving postoperative pain and prompt resumption of physical activity are of the utmost importance for the patients and surgeons. Infiltration of local anesthetic is frequently used methods of pain control postoperatively. Laparoscopically delivered transversus abdominis plane block is a new modification of ultrasound-guided transversus abdominis plane block.This study was conducted to compare the efficacy of laparoscopic-guided transversus abdominis plane block with trocar site local anesthetic infiltration for pain control after gynecologic laparoscopy.ResultsNo statistically significant difference between the two groups in mean visual analogue scale at 1, 18, and 24 h (P = 0.34, P = 0.41, and P = 0.61, respectively), while the mean visual analogue scale was significantly lower in the laparoscopic-guided transversus abdominis plane block group than in the trocar site local anesthetic infiltration group at 3, 6, and 12 h (P = 0.049, P = 0.011, and P = 0.042, respectively). No statistically significant difference was observed in the cumulative narcotics consumed at 3 h (P = 0.52); however, women with transversus abdominis plane block have consumed significantly less amount of narcotics than women with trocar site infiltration at 6, 12, and 24 h (P = 0.04, P = 0.038, and P = 0.031 respectively). Patient satisfaction was significantly higher in the laparoscopic-guided transversus abdominis plane block group (P = 0.035).ConclusionLaparoscopic-guided transversus abdominis plane block is more effective in reduction of both pain scores in the early postoperative period and the cumulative narcotics consumption than trocar site local anesthetic infiltration in gynecologic laparoscopy.Trial registrationClinical Trials.gov NCT02973451

Comparison of Three-Quadrant Transversus Abdominis Plane Block and Continuous Epidural Block for Postoperative Analgesia After Transperitoneal Laparoscopic Nephrectomy.

BackgroundPostoperative pain management is important for the early recovery of the living donor patient. Patient-controlled opioid analgesia, epidural analgesia, or a combination of both is the preferred pain management after abdominal surgery although these approaches have serious side effects. The transversus abdominis plane (TAP) block has been increasingly used for postoperative pain management and the addition of dexamethasone to local anesthetic can prolong the duration of action.ObjectivesThis study evaluated the efficacy of ultrasound-guided three-quadrant TAP block analgesia with the addition of dexamethasone, compared to the continuous epidural analgesia in postoperative cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic living donor nephrectomy.MethodsA prospective randomized control study was conducted on 50 patients with ASA I-II, 18 - 65 years old, BMI 18 - 30, and undergoing transperitoneal laparoscopic donor nephrectomy under general anesthesia. The patients were randomly assigned into either a three-quadrant TAP block group (n = 25) with 20 mL of 0.25% bupivacaine plus dexamethasone 8 mg or a continuous epidural group (n = 25) using 0.125% bupivacaine postoperatively. The morphine consumption and the numerical rating scale (NRS) at rest and movement were evaluated at 2, 6, 12, and 24 hours postoperatively. The postoperative first-time mobilization and duration of urinary catheter usage were recorded.ResultsPatients demographic characteristics were similar in the two groups. During 24 hours after the surgery, cumulative morphine consumption (P = 0.232), the NRS at rest and movement (P > 0.05), and the first-time mobilization (P = 0.075) were not significantly different between the groups, except that the NRS during movement at 12 hours was significantly lower in the TAP block group (P = 0.004). The duration of urinary catheterization was significantly longer as a side effect in the continuous epidural group (P < 0.001).ConclusionsThe three-quadrant TAP block with the addition of dexamethasone showed comparable analgesic effects as the continuous epidural analgesia in cumulative opioid consumption and pain scale in the first 24 hours following transperitoneal laparoscopic donor nephrectomy.

Efficacy of ultrasound-guided quadratus lumborum block for analgesia after laparoscopic cholecystectomy

Objective To evaluate the efficacy of ultrasound-guided quadratus lumborum block for analgesia after laparoscopic cholecystectomy. Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡ patients, aged 18-64 yr, with body mass index of 20-27 kg/m2, scheduled for elective laparoscopic cholecystectomy, were divided into 2 groups (n=30 each) using a random number table method: ultrasound-guided transversus abdominis plane block group (group T) and ultrasound-guided quadratus lumborum block group (group Q). In T and Q groups, bilateral ultrasound-guided transversus abdominis plane block and quadratus lumborum block were performed after general anesthesia induction, respectively, with 0.25% ropivacaine 20 ml for each side.All the patients received patient-controlled intravenous analgesia with morphine after surgery, and visual analoge scale scores were maintained ≤3 in the two groups.The cumulative consumption of morphine was recorded at 2, 4, 6, 12, 24 and 48 h after surgery.The occurrence of adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression was observed and recorded in the analgesic period.The operation time for nerve blocks and nerve blocks-related complications such as bleeding, accidental puncture into the abdominal cavity or intestinal injuries were recorded. Results Compared with group T, the cumulative consumption of morphine was significantly decreased at 6, 12, 24 and 48 h after surgery in group Q (P 0.05). There were no adverse reactions such as nausea, vomiting, pruritus, over-sedation and respiratory depression or nerve blocks-related complications in the two groups. Conclusion Ultrasound-guided quadratus lumborum block provides better efficacy than transversus abdominis plane block when used for analgesia after laparoscopic cholecystectomy. Key words: Nerve block; Analgesia; Ultrasonography; Laparoscopy

Comparative Study Between Lumbar Epidural Versus Transversus Abdominis Plane Block For Postoperative Analgesia After Lower Abdominal Surgeries

Background: Postoperative pain is a potent cause of adverse effects in many organ systems thus anterior abdominal wall analgesia after abdominal surgery may assist in improving postoperative outcome. The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma -induced nociceptive impulses. Aim of the work: to compare the analgesic efficacy of transversus abdominis plane block with lumber epidural analgesia for postoperative pain relief following lower abdominal surgeries. Patients and methods: The present study was carried out at Al-Azhar University Hospitals (Al-Hussien and SayedGalal) after institutional ethics and informed consent. 90 adult patients were randomized into three groups (30 patients in each group): Lumbar epidural group, Transversus abdominis plane block group and A Control group. Results: As regards postoperative hemodynamic data, higher readings appeared within the control group, while the epidural group and TAP group showed lower readings with no statically difference among the three groups, except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and application of the TAP block. As regard pain scoring using the visual analog scale (VAS), the results showed no statically difference among the three groups with (P>0.05), except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and application of the TAP block, highest readings were realized among the control group at these two time periods in comparison with the other two groups with P 30 kg/m2.

Comparative Study Between Lumbar Epidural Versus Transversus Abdominis Plane Block For Postoperative Analgesia After Lower Abdominal Surgeries

Background: Postoperative pain is a potent cause of adverse effects in many organ systems thus anterior abdominal wall analgesia after abdominal surgery may assist in improving postoperative outcome. The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma -induced nociceptive impulses. Aim of the work: to compare the analgesic efficacy of transversus abdominis plane block with lumber epidural analgesia for postoperative pain relief following lower abdominal surgeries. Patients and methods: The present study was carried out at Al-Azhar University Hospitals (Al-Hussien and SayedGalal) after institutional ethics and informed consent. 90 adult patients were randomized into three groups (30 patients in each group): Lumbar epidural group, Transversus abdominis plane block group and A Control group. Results: As regards postoperative hemodynamic data, higher readings appeared within the control group, while the epidural group and TAP group showed lower readings with no statically difference among the three groups, except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and application of the TAP block. As regard pain scoring using the visual analog scale (VAS), the results showed no statically difference among the three groups with (P>0.05), except at the first 10 minutes and 20 minutes time periods after starting the epidural analgesia and application of the TAP block, highest readings were realized among the control group at these two time periods in comparison with the other two groups with P 30 kg/m2.

Contribution of Ultrasound-Guided Transversus Abdominis Plane Block to Intraoperative Anesthesia in children - Randomized Controlled Study

Aim: The aim of this study is to investigate the contribution of transversus abdominis plane (TAP) block supported by intravenous ketamine sedation in children on intraoperative anesthesia and analgesia. Method: A total of 60 patients aged between 2 and 6 years, were included in the study. The patients were divided in three groups; the TAP block and ketamine group; the TAP block by inserting the laryngeal mask(LMA) and sevoflurane grup; and the LMA and sevoflurane group. Peroperative heart rates(HR), mean arterial pressures(MAP), amount of sevoflurane used, postoperative pain scores, number of children needing rescue analgesia, time required for the first analgesia were recorded. Results: Of the patients average age was 4 ± 1.1. There was no difference between the two block groups, in terms of HR and MAP; HR were higher and MAP were lower in the only sevoflurane group. In the group supported by a TAP block, the amount of sevoflurane used decreased(p<005). In the postoperative period, the HR, MAP and pain scores were higher in the only sevoflurane group(p <0,05). Rescue analgesia was applied to less number of patients in the groups with added block. There were longer analgesia durations in the block-supported groups(p<0.05). Conclusion: In this study, it was determined that TAP block added to general anesthesia or sedation in pediatric lower abdominal surgery reduced the need for intraoperative anesthesia, provided a more stable intraoperative hemodynamics and analgesia, and provided less pain scores, longer analgesia duration and less analgesia need in the postoperative period.

Optimized efficacy of transversus abdominis plane block combined with oxycodone in patients undergoing kidney transplantation

Objective To evaluate the optimized efficacy of transversus abdominis plane (TAP) block combined with oxycodone in patients undergoing kidney transplantation. Methods Ninety patients of both sexes, aged 22-45 yr, weighing 45-75 kg, of American Society of Anesthesiologists physical status Ⅲ, scheduled for elective living donor kidney transplantation, were divided into 3 groups (n=30 each) using a random number table: blank control group (group C), TAP block group (group TAP) and TAP block combined with oxycodone group (group TAP+ O). Ultrasound-guided lateral approach to TAP block was performed on the operated side with the mixture (20 ml) of 0.375% ropivacaine and 5 mg dexamethasone at 30 min before induction of anesthesia in TAP and TAP+ O groups.Anesthesia was induced by injecting midazolam, target-controlled infusion of remifentanil and propofol and injecting cisatracurium.The patients were mechanically ventilated after placement of the laryngeal mask airway, and the end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.Propofol and remifentanil were intravenously injected and sevoflurane was inhaled to maintain anesthesia, and cis-atracurium was intermittently injected to maintain muscle relaxation.Narcotrend value was maintained at 37-46 during operation.Oxycodone 0.1 mg/kg was intravenously injected at 20 min before the end of surgery in group TAP+ O.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil 1.5 μg/kg in 100 ml of normal saline at the end of surgery, the PCIA pump was set up to deliver a 2 ml bolus dose, a 20 min lockout interval and background infusion at a rate of 1.5 ml/h, and visual analog scale score was maintained ≤4.The consumption of intraoperative remifentanil and effective pressing times of PCIA within 24 h after surgery were recorded.Blood samples were collected at 1 day before surgery and 2 and 5 days after surgery from the median cubital vein for determination of blood urea nitrogen and creatinine (Cr) concentrations in serum.The occurrence of nausea and vomiting, dizziness and headache, respiratory depression and TAP block-related complications (hematoma at puncture site, injury to abdominal organs, local anesthetic intoxication) was recorded within 24 h after surgery. Results Compared with group C, the consumption of intraoperative remifentanil was significantly reduced, the effective pressing times of PCIA within 24 h after surgery were decreased, and the concentrations of creatinine and blood urea nitrogen in serum were decreased at 2 days after surgery in TAP and TAP+ O groups(P 0.05). TAP block-related complications were not found in TAP and TAP+ O groups (P>0.05). There was no significant difference in the incidence of nausea and vomiting or dizziness and headache among three groups (P>0.05). Conclusion TAP block combined with oxycodone can reduce the intraoperative consumption of opioids, inhibit postoperative hyperalgesia and be helpful for early recovery of transplanted kidney function in patients undergoing kidney transplantation. Key words: Nerve block; Abdominal muscles; Qxycodone; Renal transplantation

Postoperative analgesia efficacy of quadratus lumborum block versus transversus abdominis plane block in patients undergoing caesarean section

Objective To compare the postoperative analgesic effect of ultrasound-guided quadratus lumborum block(QLB) and transversus abdominis plane block(TAPB) block in caesarean delivery with median incision in the lower abdomen. Methods Eighty patients undergoing caesarean delivery with the median incision of the lower abdomen, classified as ASA Ⅰ or Ⅱ, were randomly divided into QLB group(group Q, n=40) and TAPB group (group T, n=40). Puerperants were scheduled for caesarean delivery under combined spinal and epidural anesthesia with median incision in the lower abdomen. After surgery, patients in group Q received ultrasound-guided QLB with bilateral ropivacaine(20 ml of 0.375%) injection into thoracolumbar fascia behind quadratus lumborum. Patients in group T received ultrasound-guided TAPB with ropivacaine(20 ml of 0.375%) bilaterally. The resting and exercise VAS scores and the consumption of sufentanil 4, 8, 12, 24, 48 h after operation were recorded. The incidences of postoperative adverse reactions and patients' satisfaction with postoperative analgesia were also documented. Results There was no significant difference in postoperative resting VAS scores between the two groups(P>0.05). The exercise VAS scores 8, 12, 24, 48 h after operation and the consumption of sufentanil in group Q were significantly lower than those in group T(P<0.05). Patients in group Q had lower incidence of adverse reactions(P<0.05). Conclusions Ultrasound-guided bilateral QLB with ropivacaine can reduce the consumption of opioid drugs after caesarean delivery, reduce the exercise VAS score, and improve patients' satisfaction. Key words: Quadratus lumborum block; Caesarean section; Postoperative analgesia