Percutaneous peritoneal dialysis access procedures (PPAP) are commonly employed for peritoneal dialysis (PD) catheter placement in patients with end-stage renal disease (ESRD). However, traditional techniques such as the blind Seldinger method can lead to complications, particularly bowel perforation and catheter malposition. We report a safe and effective technique for PD catheter placement utilized in a 73-year-old male with ESRD. This novel approach involves lifting the abdominal wall and directly visualizing the puncture site with ultrasound, thereby minimizing the risk of bowel injury. Additionally, the combined use of transversus abdominis plane (TAP) and rectus sheath (RS) block provides effective postoperative analgesia. This technique is particularly beneficial in resource-limited settings, offering a safer, adaptable, and analgesia-optimized alternative for PD catheter placement.

Efficacy of laparoscopic-assisted transversus abdominus plane (LA-TAP) block for minimally invasive gynecologic surgeries (MIGS): A randomized controlled trial.

Oblique subcostal transversus abdominis plane block versus transmuscular quadratus lumborum block for postoperative analgesia and quality of recovery in laparoscopic gynecological surgery: a prospective randomized controlled double-blind trial.

Maintaining an optimal nociception-analgesia balance is essential in clinical anesthesia. Traditional monitoring relies on brainstem reflexes, whereas electroencephalographic (EEG) indices, such as alpha power attenuation and phase-amplitude coupling (PAC), show promise as markers of nociceptive processing. However, their physiological mechanisms and relationship to postoperative pain remain unclear. This prospective cohort study included 58 patients undergoing laparoscopic surgery under either conventional general anesthesia or general anesthesia combined with a transversus abdominis plane block. Intraoperative EEG recordings were analyzed for frequency-band power and PAC across surgical stages (incision, insufflation, and post-opioid administration). Generalized estimating equations with Bonferroni post-hoc correction were used to assess EEG patterns and their association with postoperative pain. The alpha band power and modulation index of delta-alpha PAC decreased during surgical incision, insufflation, followed by recovery after opioid administration. While alpha power changes did not differentiate the effects of the nerve block, delta-alpha PAC changes significantly reflected nerve block effectiveness during incision (coefficient: 0.81; 95% CI, 0.11-1.51; P = 0.02). However, no association was observed between perioperative EEG patterns and postoperative pain scores. Laparoscopic surgical stimulation reduces EEG alpha power and delta-alpha PAC. Delta-alpha PAC demonstrated greater sensitivity than alpha power measures in distinguishing nociceptive input and reflecting the nerve block effects, suggesting its potential as an intraoperative nociception-analgesia marker. However, perioperative EEG patterns showed limited value in predicting postoperative pain, suggesting that postoperative pain perception is shaped by more complex mechanisms requiring further investigation.

We aimed to evaluate the analgesic effects of erector spinae plane (ESP) block compared to oblique subcostal transversus abdominis plane (TAP) block in patients undergoing emergency laparotomy. This randomized controlled trial included adults undergoing emergency laparotomy with midline incision. Participants were randomized to receive either ESP or oblique subcostal TAP block before the surgery. Postoperatively, static and dynamic numerical rating scale (NRS) were assessed at 1, 2, 4, 8, 12, 18, and 24 h. The primary outcome was 24 h analgesic consumption. Secondary outcomes included time to first postoperative analgesic request, NRS, time to independent movement, return of bowl function, and patient satisfaction. Seventy patients were included in the final analysis. The ESP block group had lower analgesic consumption than the TAP block group (median: 3 [IQR: 3, 3] vs. 6 [IQR: 3, 6] morphine equivalent in mg; P value <0.001) with longer time to first analgesic consumption and lower early postoperative NRS scores. Time to independent movement and number of patients who passed flatus during the first 24 h were comparable between the groups. Patient satisfaction was higher in the ESP block group than in the TAP block group at 24 h postoperatively. In patients undergoing emergency laparotomy with a midline incision, both ESP block and TAP blocks provided effective postoperative analgesia with similar profiles in terms of return of bowel function and time to ambulation. ESP block provided a modestly better early postoperative analgesia and higher overall patient satisfaction than TAP block.

Transversus Abdominis Plane Block, Intrathecal Morphine, or Their Combination for Postoperative Analgesia Following Total Abdominal Hysterectomy. A Comparative Study.

Background: Post-cesarean section (CS) pain satisfaction remains an issue. The purpose of this research was to evaluate the effectiveness of the transversus abdominis plane (TAP) block in comparison to intravenous analgesia controlled by patients for managing pain after CS in Iraq. Objectives: The study aimed to evaluate pain intensity as the primary outcome, alongside secondary outcomes including vital signs, nausea, vomiting, medication use, and inflammatory markers. Methods: A quasi-experimental study was conducted at Wasit Investment Hospital in Kut, Iraq, involving 78 pregnant women undergoing elective CS. Sampling was conducted among eligible women who signed an informed consent form. Participants were classified into two groups based on the type of analgesia received after CS. The first group included women who received a TAP block using bupivacaine (n = 39). The second group consisted of those who used a patient-controlled analgesia (PCA) pump containing nalbuphine (n = 39). Pain intensity was measured using the Short Form McGill Pain Questionnaire (SF-MPQ; Arabic version) at 2, 4, 6, 12, and 24 hours following the CS. Laboratory tests, including a complete blood cell count (CBC) and high-sensitivity C-reactive protein (hs-CRP), were performed 24 hours after surgery. Results: There were no notable differences in the demographic, clinical, or laboratory characteristics between groups (P &gt; 0.05). Pain levels assessed using the SF-MPQ at 2, 4, and 6 hours post-surgery were notably lower in the TAP block group than in the PCA group (P = 0.009, P = 0.005, and P = 0.001, respectively). A positive and significant relationship between hs-CRP levels and pain intensity was identified across all measurement times in the TAP block group. Conclusions: The findings of this study showed that the use of a TAP block technique provided more effective pain relief than PCA during the first 6 hours after a CS.

Transverse abdominal plane block with low-dose sufentanil vs high-dose sufentanil for postcesarean pain: a double-blind study.

The impact of local and regional analgesia on pain and opioid consumption in patients undergoing open upper gastrointestinal surgery: a network meta-analysis of randomised controlled trials.

Adjuvants in transversus abdominis plane blocks to prolong analgesia duration following cesarean delivery: A systematic review and network meta-analysis.

Comparative Study between Different Adjuvants to Levobupivacaine for Transversus Abdominis Plane Block (TAB) for Assessing the Postoperative Pain and The Quality of Patients Recovery in Cesarean Sections Procedure: Randomized controlled trial

Transversus Abdominis Plane Block Versus Quadratus Lumborum Block for Post-Operative Analgesia after Unilateral Lower Abdominal Surgeries: A Prospective Randomized Double Blinded controlled study

Objective This study aims to unravel the clinical effects of total intravenous anesthesia (TIVA) versus combined intravenous-inhalational anesthesia, each with ultrasound-guided transversus abdominis plane (TAP) block, in gynecologic laparoscopic surgery. Methods In this prospective randomized controlled trial, 100 patients undergoing gynecologic laparoscopic surgery were randomly assigned to either a control group (balanced inhalation anesthesia + TAP block) or an observation group (TIVA + TAP block) (n = 50 each). Postoperative recovery, pain scores (VAS at 2, 6, 12, 24, and 48 h), hemodynamics (SpO2, heart rate, SBP) at key surgical stages, and stress markers (cortisol, PGE2), and complications were recorded. Results Baseline characteristics were comparable. The observation group showed faster spontaneous respiration recovery, awakening, and extubation (all p < 0.05), though ambulation, flatus, and hospital stay did not differ (p > 0.05). VAS scores were lower in the observation group at all time points (p < 0.05). Hemodynamics remained stable in both groups. Postoperative cortisol and PGE2 rose in both groups but were lower in the observation group (p < 0.05). Nausea/vomiting incidence was reduced with TIVA (p < 0.05). Conclusion TIVA combined with ropivacaine TAP block accelerates early recovery, improves analgesia, attenuates surgical stress, and reduces nausea/vomiting.

Background and Aim: Open hernia surgery is a common surgery and is often associated with signifi cant postoperative pain. Regional blocks are part of multimodal analgesia to enhance pain management in post post-operative period. Here we are comparing two different blocks, namely Transversus Abdominis Plane block (TAP) and the Transversalis Fascia block (TFB), in inguinal hernia surgery, with aim of fi nding out which is better in optimizing pain relief in post post-operative period. Study Design: Prospective comparative double-blind randomized study Methods: Forty-six individuals have been enrolled in this research after meeting exclusion as well as inclusion criteria. They have been divided into two groups. Following surgery, Group A had TAP block or Group B received TFB block. Both groups used 20 cc of 0.25 % injections of bupivacaine and adrenaline (5 mcg/ml). Patients' VAS ratings and the need for analgesics at 4-hour intervals were tracked for a whole day. Result: Statistical analysis has been performed by utilizing SPSS (Version 28) along with G*Power 3.1.9.4 software. Statistically significant difference was indicated by times for first rescue analgesic needed in Group A and B, which were 10.9 ± 5.64 and 14.2 ± 5.04 hours, respectively. The p-value was 0.019. With a p-value of 0.006, Group A's and Group B's respective twenty-four hour total analgesic requirements were 1.52 and 1.0. Conclusion: According to the findings, the TFB is superior to TAP block regarding to controlling postoperative pain after inguinal hernia surgery

BackgroundPostoperative visceral pain remains a major challenge following laparoscopic hysterectomy. While stellate ganglion block (SGB) is increasingly utilized for acute and chronic pain management, limited evidence exists regarding its efficacy in modulating visceral pain after gynecologic laparoscopy. This study aimed to evaluate whether ultrasound-guided SGB could reduce early postoperative visceral pain intensity and opioid consumption.MethodsIn this prospective, randomized controlled trial, 90 patients undergoing laparoscopic hysterectomy were allocated (1:1:1) to receive ultrasound-guided SGB combined with transversus abdominis plane block (TAPB) (SGB group), TAPB alone (TAP group), or no nerve block (control group). The primary outcome was visceral pain intensity, assessed using visual analog scale (VAS) scores at rest and during movement at 1, 3, 6, 24, and 48 hours postoperatively. Secondary outcomes included rescue analgesia requirements and complications.ResultsThe linear mixed-effects model revealed that the SGB group exhibited a significantly greater reduction in visceral pain intensity at rest and during movement at 1, 3, and 6 hours compared to the TAP and control groups (P < 0.05). Notably, the percentage of patients requiring rescue analgesia was significantly lower in the SGB group compared to the TAP and control groups (14.3% vs. 32.1% and 48.1%, respectively, P < 0.05). No statistically significant differences in incisional pain were detected among the three groups at any time point (P > 0.05).ConclusionUltrasound-guided SGB effectively alleviates early postoperative visceral pain and reduces opioid demand, supporting its role as a valuable addition to multimodal analgesia protocols in laparoscopic hysterectomy.

This review addresses the issue of perioperative analgesia in patients with morbid obesity undergoing bariatric surgery. Conventional opioid analgesia is associated with complications, including a high risk of respiratory adverse events, postoperative dyspeptic disorders, and the development of opioid-induced hyperalgesia, particularly in patients with morbid obesity. In this context, multimodal analgesia strategies, including regional anesthesia as their component, represent a promising alternative. The conducted analytical review of current published data indicates that modern regional anesthesia techniques, including transversus abdominis plane block (TAPB), quadratus lumborum block (QLB), and erector spinae plane block (ESPB), when integrated into multimodal analgesia, provide effective control of postoperative pain, a substantial reduction in opioid burden, and minimization of associated adverse effects. Ultrasound guidance is mandatory when performing blocks in patients with morbid obesity, as it allows overcoming technical difficulties associated with excessive development of subcutaneous adipose tissue. QLB may surpass TAPB in the duration of analgesic effect and in effectiveness regarding the visceral component of pain, whereas epidural anesthesia, despite its high effectiveness, is associated with technical challenges when performed in this patient population. This review presents a detailed comparative analysis of various regional anesthesia techniques (TAPB, QLB, rectus sheath block [RSB], thoracic paravertebral block [TPVB], epidural anesthesia, IIB/IHB), with assessment of their level of evidence, technical complexity, safety profile characteristics, and spectrum of potential risks. This analysis provides clinicians with a methodological basis for a reasoned choice of the optimal technique, taking into account the type of planned surgical intervention, the level of technical equipment of the healthcare institution, and the individual anatomical and physiological characteristics of the patient. The main limitations hindering the widespread implementation of regional anesthesia techniques in clinical practice are also considered.

Despite the recovery advantages of minimally invasive surgical techniques, moderate to severe pain after laparoscopic colorectal surgery is a common barrier to improving postoperative recovery quality. To evaluate whether intrathecal morphine (ITM) combined with transversus abdominis plane block (TAPB) improves postoperative recovery quality after laparoscopic colorectal surgery. This prospective, double-blind randomized clinical trial was conducted at Sun Yat-sen University Cancer Center between October 15, 2024, and February 15, 2025. Adults scheduled for elective laparoscopic colorectal surgery were randomized 1:1 to ITM or saline placebo. Data were analyzed from March 1, 2025, to March 31, 2025. Both groups received liposomal bupivacaine for TAPB as part of standard enhanced recovery after surgery (ERAS) protocol. The intervention group received ITM, 3 µg/kg, while the control group received intrathecal normal saline. The primary outcome was the Quality of Recovery 15 (QoR-15) score at 24 hours postoperatively. Secondary outcomes included postoperative pain scores, cumulative opioid consumption (in morphine milligram equivalents [MME]), time to first flatus, time to first ambulation, incidence of adverse effects, and length of hospital stay. A total of 252 patients were included in the intention-to-treat analysis (mean [SD] age, 58.4 [11.1] years; 112 female patients [44.4%]). At 24 hours postoperatively, the intervention group had significantly higher mean (SE) QoR-15 scores compared to the control group (114.95 [1.04] vs 102.22 [0.76]; mean difference, 12.21; 95% CI, 9.91-14.51; P < .001), indicating better recovery quality. Postoperative mean (SD) morphine consumption was lower in the intervention group compared to the control group (4.4 [6.4] MME vs 10.4 [11.1] MME; mean difference, -6.59; 95% CI, -8.88 to -4.31; P < .001). The intervention group also had a reduced incidence of nausea (23.8% vs 37.3%; adjusted risk difference, -15.06%; 95% CI, -26.60% to -3.52%; P = .01), but a high incidence of pruritus was observed in the intervention group (19.0% vs 3.2%; adjusted risk difference, 15.08%; 95% CI, 7.26%-22.90%; P < .001). Per the results of this randomized clinical trial, in laparoscopic colorectal surgery, ITM combined with TAPB can significantly enhance early postoperative recovery and analgesia, albeit with an increased risk of pruritus. This strategy may be a valuable component of multimodal analgesia regimens following laparoscopic colorectal surgery. ClinicalTrials.gov Identifier: NCT06636864.

BackgroundTo evaluate comparative outcomes of wound infusion catheter (WC) vs epidural analgesia (EP) for analgesia following midline laparotomy for abdominal surgery.MethodsA systematic search of PubMed, Cochrane Library, and Scopus was conducted, and all randomised controlled trials (RCTs) comparing WC vs EP for analgesia after midline laparotomy were included. Overall pain scores, total morphine consumption, respiratory depression, catheter-related complications, time of first bowel movement, and length of hospital stay (LOS) were set as outcome parameters for the meta-analysis. Subgroups of catheter positions, including preperitoneal, rectus sheath and transversus abdominis plane block as deep WC and subcutaneous WC, were examined for pain scores superiority.ResultsTwelve RCTs were pooled in a meta-analysis, involving a total of 778 patients who received WC (n = 390) or EP (n = 388). There was no significant difference in pain scores at rest and movement between WC and EP groups at 24 hours [P = .85 and P = .30, respectively] and 48 hours [P = .33 and P = .06, respectively]. However, subgroup analysis, excluding subcutaneous catheters, showed favourable pain scores on movement at 48 hours of use (mean difference [MD] -0.97, P = .03). The LOS was notably shorter in the WC group [MD, -0.50; P < .001]. There were no significant differences between both groups in cumulative morphine consumption [P = .33], return of bowel function [P = .13], respiratory depression [P = .43], or catheter-related complications [P = .16].ConclusionWC generally provides a comparable postoperative analgesia to EP; however, it is associated with shorter LOS and a slight superiority of analgesia of deep catheters. Comparing different types of nerve blocks and positions of catheters in future research may optimise the use of WC.

Managing postoperative pain in patients following bariatric surgery is challenging. Although transversus abdominis plane block (TAPB) and erector spinae plane block (ESPB) have proved effective for pain relief, the analgesic efficacy between them remains controversial. This network meta-analysis was conducted to compare the postoperative analgesic efficacy of ESPB and TAPB in bariatric surgery. PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to select randomised controlled trials (RCTs) examining the analgesic efficacy of ESPB or TAPB in bariatric surgery. The primary outcome was 24-hour postoperative opioid consumption. Secondary outcomes included postoperative pain scores at early, middle, and late period, and time to first rescue analgesia. Network meta-analysis (NMA) was conducted using a frequentist approach. Fourteen RCTs involving 1,063 patients were eligible for this NMA. This NMA showed that ESPB ranked highest in reducing 24-hour postoperative opioid consumption (0.970), decreasing middle and late postoperative pain scores (0.936 and 0.897, respectively), and prolonging the time to first rescue analgesia (0.955). However, TAPB was the best choice for early-pain relief (0.847). Both techniques can provide effective postoperative analgesia, while ESPB is more effective in reducing 24-hour postoperative opioid consumption, alleviating middle and late postoperative pain, and prolonging the time to first rescue analgesia. However, further studies are needed to determine the optimal postoperative analgesic regimen for bariatric surgery.

The transversus abdominis plane (TAP) block is widely used to enhance postoperative analgesia after cesarean sections (CS). This study aimed to compare the effect of combining the transversalis fascia plane (TFP) block with the TAP block versus intrathecal morphine (ITM) on postoperative recovery quality assessed using the Obstetric Quality of Recovery-10 (ObsQoR-10T) score. This prospective, randomized clinical trial was conducted at a single university hospital. One hundred patients undergoing elective CS under spinal anesthesia were randomized into two groups. Group ITM received spinal anesthesia comprising 10mg 0.5% hyperbaric bupivacaine, 15µg fentanyl, and 100µg morphine. Group TAP + TFP received spinal anesthesia with 10mg of 0.5% hyperbaric bupivacaine and 15µg of fentanyl, without intrathecal morphine. In the TAP + TFP group only, bilateral TAP and TFP blocks were performed at the end of surgery, whereas no block was administered in the ITM group. Postoperative analgesia was provided using fentanyl-based patient-controlled analgesia (PCA). The primary outcome was the ObsQoR-10T score which was assessed at 24h postoperatively. Secondary outcomes included opioid consumption, pain scores at rest and movement, adverse effects, and patient satisfaction. There was no significant difference between the groups regarding the total ObsQoR-10T scores (91.72 ± 6.46 vs. 91.56 ± 5.54, p = 0.895). The TAP + TFP group had significantly higher fentanyl consumption at 24h compared to the ITM group (187.50µg vs. 87.50µg, p = 0.005). No significant differences were found in pain scores at rest or during movement. The incidence of adverse effects and patient satisfaction rates were comparable between groups. The TAP + TFP block combination yielded a similar overall ObsQoR-10T recovery profile to ITM. Both strategies provided satisfactory analgesia and high maternal satisfaction. ClinicalTrials.gov ID: NCT06944912 retrospectively registered at clinicaltrials, principal investigator: Ali Ahiskalioglu (registration date: April 18, 2025).