Transversus Abdominis Plane Group Research Articles

A comparative study to access the impact of TAP block with wound infiltration in laparoscopic cholecystectomy

Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure. Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P<0.001). Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia.

Ultrasound-guided transversus abdominis plane block is an effective opioid-sparing alternative to epidural anesthesia in open abdominal aortic aneurysm repair

ObjectiveThis study evaluated the effectiveness of ultrasound-guided transversus abdominis plane (TAP) blocks compared with epidural (EPI) and general anesthesia (GA) in managing postoperative pain following open abdominal aortic aneurysm (AAA) repair. MethodsA retrospective review was conducted on 61 elective open AAA repairs performed between January 2016 and December 2021. Patients were categorized into three groups: GA, GA plus EPI, and GA plus TAP block. The primary outcome measured was opioid requirements, reported as morphine milligram equivalents (MME) at 48, 72, and 120 hours postoperatively. The additional opioid requirements between 48 and 72 hours (ΔMME₁) and between 72 and 120 hours (ΔMME₂) were also evaluated. Secondary outcomes included vasopressor requirements, extubation in the operating room, and length of stay in the intensive care unit and hospital. ResultsThe mean MMEs at 48, 72, and 120 hours were statistically significant across all groups. The mean MME at 48 hours was 51.1 ± 71.9 in the TAP group compared with 140.5 ± 121.7 in the GA group. Pairwise comparisons showed a significant difference between the GA and TAP groups at 48 hours (P = .002), whereas the difference between EPI and TAP at 48 hours was not significant (P = .098). Additional opioid requirements between 48 and 72 hours after surgery (ΔMME₁) showed a significant difference between EPI and TAP (P = .045). All groups had significantly different MMEs at 72 hours, with no significant differences observed at 120 hours. Secondary outcomes were not significantly different across the groups. ConclusionsTAP blocks provide effective postoperative pain control with decreased opioid requirements similar to EPI anesthesia during the first 48 hours postoperatively. This factor makes TAP blocks a viable alternative to EPI anesthesia in open AAA repairs. Further multicenter studies are recommended to validate these findings.

Rectus sheath block results in greater cranial-caudal spread whereas transversus abdominis plane block results in greater lateral spread as assessed by computed tomography in dogs.

To evaluate the in vivo spread of iodinated contrast following injections in the transversus abdominis plane (TAP) and rectus sheath in anesthetized dogs via computed tomography. Secondarily, the time of performing each block was compared. 6 adult, purpose-bred Beagles. In a prospective crossover study, dogs were administered injections either in the rectus sheath or transversus abdominis fascial plane in the same manner as a rectus sheath block (RSB) or TAP block using dilute iodinated contrast. Computed tomography scans were performed immediately following injection (time [T]-0) and at 3, 9, 18, and 30 minutes postinjection. Data regarding the spread in the cranial-caudal and lateral directions and time to perform the injections were compared between the 2 techniques using paired or 2-sample t tests. There was significantly greater spread in the cranial-caudal direction in the RSB group (62.9 ± 6.4 mm vs 54.8 ± 6.8 mm at T30; P = .009), whereas spread in the lateral direction was greater in the TAP group (37.3 ± 3.0 mm vs 48.6 ± 6.1 mm at T30; P < .0001). The RSB injection was performed in a more time-efficient manner than TAP injection (48.2 ± 3.2 seconds vs 82.3 ± 8.7 seconds; P = .03). In living subjects, RSB injections resulted in greater cranial-caudal spread while TAP injections resulted in greater lateral spread. Rectus sheath block injections were performed in a more time efficient manner compared to a single point TAP injection in anesthetized dogs. The RSB was performed in a more time-efficient manner and would likely result in greater coverage of the ventral midline. The TAP block would likely result in more significant regional anesthetic coverage of the lateral abdominal wall. Further studies are required to determine the degree of the clinical significance of these results.

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

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

Effect of Intraoperative Lung Recruitment and Transversus Abdominis Plane Block in Laparoscopic Bariatric Surgery on Postoperative Lung Functions: A Randomized Controlled Study

Abstract Background Morbid obesity may cause a restrictive condition. general anesthesia (GA) and supine posture both result in a decrease in lung capacity and Functional residual capacity (FRC), encouraging the development of atelectasis, altering the ventilation/perfusion ratio and raising the pulmonary shunt. This study evaluated the impact of recruitment maneuver (RM) and Transversus Abdominis Plane (TAP) block performed during laparoscopic bariatric surgery on spirometry, oxygenation, hemodynamic variables, opioid requirements and pain score assessed after surgery. Methods This pilot prospective randomized controlled study included 80 patients scheduled for elective laparoscopic bariatric surgeries (e.g., laparoscopic sleeve gastrectomy, and laparoscopic gastric bypass) under GA. Patients were divided into four equal groups. All patients had received standardized postoperative analgesia regimen, group I (control group), group II received TAP block after intubation and before surgical incision, group III received RM after intubation and after pneumoperitoneal exsufflation, and group IV received RM after intubation and after pneumoperitoneal exsufflation and TAP block after intubation and before surgical incision. Results Forced Vital Capacity “FVC”, Forced Expiratory Volume “FEV1” were found to be significantly higher after operation in group IV compared to other groups. FEV1/FVC was insignificantly different among the four groups before and after operation. Intraoperative PaO2, PaO2/FiO2 were significantly higher in group III and IV compared to other groups. Numerical rating scale (NRS) at 1, 2, 4, 6 and 12hr had significantly decreased in group II and IV compared to other groups. Heart rate (HR) and mean arterial blood pressure (MAP) were insignificantly different among the four groups. Morphine consumption was significantly lower in group II and IV compared to other groups. Conclusions TAP block combined with RM group exhibited better postoperative pulmonary function tests (PFTs). Intraoperative oxygenation was higher in RM groups. NRS and opioid consumption were lower in TAP groups in postoperative period.

Clinical Effectiveness of Transversus Abdominis Plane (TAP) Block versus Local Anesthesia Wound Infiltration for Postoperative Pain Relief After Laparoscopic Appendicectomy in Children: A Study Protocol for a Multicenter Double-Blind Randomized Controlled Phase III Trial.

Postoperative pain relief after laparoscopic appendicectomy is a key determinant of early rehabilitation in children. Recent guidelines recommend performing either a transversus abdominis plane (TAP) block or local anesthesia (LA) wound infiltration as part of multimodal postoperative analgesia after appendectomy. To date, the clinical effectiveness of TAP block versus LA wound infiltration has never been compared. The hypothesis of this study is that the TAP block may provide a greater opioid-sparing effect after laparoscopic appendicectomy in children than LA wound infiltration. We designed a multicenter double-blind randomized controlled phase III trial and aim to include 110 children who undergo laparoscopic appendicectomy. Children are randomized to receive either TAP block (TAP group) or LA wound infiltration (infiltration group). Multimodal analgesia is standardized in the two groups using the same protocol, which includes the stepwise prescription of paracetamol, phloroglucinol, ketoprofene, and nalbuphine according to the hetero-evaluation of pain performed by the nurses who were blinded to the treatment allocated using the validated FLACC scale. The primary outcome is the total dose of nalbuphine administered within 24 hours after surgery. No study has specifically compared the clinical effectiveness of TAP block versus LA wound infiltration for postoperative pain relief after laparoscopic appendectomy in children. This paper describes the protocol for a randomized trial that addresses this issue. The results of this trial will be useful for editing guidelines with a higher level of evidence on this topic.

Effect of ultrasound-guided transversus abdominis plane block in reducing atelectasis after laparoscopic surgery in children: A randomized clinical trial

BackgroundAtelectasis is a commonly observed postoperative complication of general anesthesia in children. Pulmonary protective ventilation strategies have been reported to have a beneficial effect on postoperative atelectasis in children. Therefore, the present study aimed to evaluate the efficacy of the ultrasound-guided transversus abdominis plane (TAP) block technique in preventing the incidence of postoperative atelectasis in children. Materials and methodsThis study enrolled 100 consecutive children undergoing elective laparoscopic bilateral hernia repair and randomly divided them into the control and TAP groups. Conventional lung-protective ventilation was initiated in both groups after the induction of general anesthesia. The children in the TAP group received an ultrasound-guided TAP block with 0.3 mL/kg of 0.5% ropivacaine after the induction of anesthesia. ResultsAnesthesia-induced atelectasis was observed in 24% and 84% of patients in the TAP (n = 50) and control (n = 50) groups, respectively, before discharge from the post-anesthetic care unit (T3; PACU) (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.019–0.179; P < 0.001). No significant difference was observed between the control and TAP groups in terms of the lung ultrasonography (LUS) scores 5 min after endotracheal intubation (T1). However, the LUS scores were lower in the TAP group than those in the control group at the end of surgery (T2, P < 0.01) and before discharge from the PACU (T3, P < 0.001). Moreover, the ace, legs, activity, cry and consolability (FLACC) pain scores in the TAP group were lower than those in the control group at each postoperative time point. ConclusionUltrasound-guided TAP block effectively reduced the incidence of postoperative atelectasis and alleviated pain in children undergoing laparoscopic surgery.

Spinal Anestezi Altında Sezaryen Doğumda Postoperatif Analjezi için Transversalis Fasya Plan Bloğunun Transversus Abdominis Plan Bloğuyla Karşılaştırılması: Retrospektif Bir Çalışma

Objective: Transversalis fascia plane (TFP) and transversus abdominis plane (TAP) blocks are used for postoperative analgesia in many lower abdominal procedures such as cesarean section. This study aimed to retrospectively compare the postoperative effects of TFP and TAP blocks for postoperative multimodal analgesia in patients who underwent cesarean section under spinal anesthesia. Methods: We retrospectively searched electronic medical records to identify patients who underwent cesarean section under spinal anesthesia between November 2021 and June 2022. A total of 497 patients were identified, and 120 patients were included that meet our criteria in our analysis. The patients were divided into three groups: TFP, TAP, and control. Data were obtained from the files of the patients. Results: The block groups had significantly lower numeric rating scale (NRS) scores, less non-steroidal anti-inflammatory drug consumption, and lower complications than the control group. No opioid consumption was observed in the block groups. Although no non-steroidal anti-inflammatory drug consumption until the 4th hour and no opioid consumption until the 8th hour were observed in the control group, the need for additional analgesics increased as time passed. While the TFP group needed analgesics later than the TAP group, the NRS scores and total analgesic consumption were lower (p&lt;0.001). Patient satisfaction was higher in the block groups than in the control group (p&lt;0.001). Conclusion: Transversalis fascia plane and TAP blocks are effective as part of multimodal analgesia in cesarean section. The TFP block is superior to the TAP block in terms of pain scores, additional analgesic requirements, and patient satisfaction. Keywords: Cesarean section, postoperative pain, ultrasound-guided regional anesthesia, transversus abdominis plane block, transversalis fascia plane block

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

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

Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Pain Management after Total Abdominal Hysterectomy

Background: Post-operative analgesia is of vital importance to prevent various undesirable side effects such as respiratory complications, venous thromboembolism, and increased hospital stay. The transversus abdominis plane (TAP) block and Quadratus lumborum (QL) block has been used for post-operative pain relief in various abdominal surgeries as part of the multimodal analgesic approach. Therefore, this randomized, prospective study was conducted to compare the post-operative analgesic efficacy of QL block and TAP block in patients undergoing abdominal hysterectomy.Methods: This study was carried out in the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine, Dhaka Medical College Hospital, Dhaka. Patients of ASA status I and II, planned for total abdominal hysterectomy under spinal anaesthesia were selected and randomly allocated into two groups (Group A – TAP Block and Group B – QL Block). Hemodynamic status, time of onset of sensory block, mean duration of postoperative analgesia, the amount of rescue analgesic requirements as well as intensity of post-operative pain were assessed at different point of time. Visual analog scale (VAS) was used to assess the postoperative pain. Total morphine consumption in 24 hours and time required for 1st postoperative analgesic were recorded.Results: A total of 60 patients were included in this study. The onset of sensory block was faster in Group B than A (22.6±6.5 min &amp; 16.3±5.2 min). VAS score was higher among group A at 10th hours and 18th hours. In case of group B, VAS score was more at 14th hour. Post operatively 1st demand of analgesia was earlier in Group-A (10.4±1.5 vs 14.1±1.7) (p&lt; 0.001). Total analgesic requirement was higher in Group- A than Group B (18.7±4.6 vs11.2±3.8) (p&lt; 0.001).Conclusion: Quadratus Lumborum Block produces longer duration of analgesia, provides optimum post-operative pain control and maintain an excellent hemodynamics than TAP block in patients undergoing abdominal hysterectomy.

The Efficacy of the Transversus Abdominis Plane Block in Abdominoplasty: A Systematic Review and Meta-Analysis.

The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. Its use in cosmetic abdominoplasty procedures is less frequently documented. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery. The authors aimed to conduct the first meta-analysis within the literature to evaluate this technique's effectiveness in abdominoplasties. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay. Random effect modelling was used for the analysis. The time taken to the first analgesic was significantly lower in the TAP cohort (p <0.05). In addition, there was a lower incidence of postoperative nausea/vomiting(OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group. The authors report the first meta-analysis within the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.

The impact of the transversus abdominis plane block (TAP) on stress response measured through the complete blood– derived inflammatory markers

This study aims to evaluate the effect of the transversus abdominis plane (TAP) block on the blood cells and the inflammatory markers neutrophil– to– lymphocyte ratio (NLR), platelet– to– lymphocyte ratio (PLR), and systemic immune– inflammation index (SII) after the laparoscopic ovariectomy (LapOV) in dogs. 72 healthy bitches undergoing LapOV were randomly allocated to the no– TAP group of dogs under inhaled anesthesia (IA), the TAP– S group (IA and TAP with saline), and the TAP– B group (IA and TAP with bupivacaine). The NLR, PLR, and SII were calculated 1 h before ovariectomy (T0) and at 2−3 h (T1), 6−8 h (T2), and 20−24 h (T3) post– surgery. The number of dogs requiring postoperative analgesic rescue with buprenorphine and the doses administered in each group were recorded. Significant changes were observed in all groups’ postoperative NLR, PLR, and SII over time. Between groups, no differences were observed in any of the ratios at any control point (NLR at T0−T3: p = 0.17, 0.36, 0.80, and 0.95; PLR at T0−T3: p = 0.70, 0.62, 0.21, 0.87; SII at T0−T3: p = 0.29, 0.65, 0.09, and 0.34). A significantly lower number of dogs required analgesic rescue in the TAP-B group (p = 0.0001) and a lower number of doses were administered (p = 0.001). There is no difference in the inflammatory response measured through the complete blood– derived inflammatory markers after the LapOV in dogs when the postoperative pain is managed entirely with opioids or with the TAP block with bupivacaine. The hydrodissection associated with the TAP block technique does not increase the inflammatory response.

Effect of Ultrasound-Guided Transversus Abdominal Plane Block on Postoperative Pain After Laparotomy Abdominal Surgery

Background: Transversus abdominis plane (TAP) block is used to manage pain in patients undergoing laparotomy abdominal surgery. This study aimed to investigate the effect of ultrasound-guided TAP block on postoperative pain and complications in patients undergoing laparotomy abdominal surgery. Materials and Methods: In this randomized double-blinded prospective clinical trial, 64 patients undergoing laparotomy surgery were selected based on inclusion and exclusion criteria and were randomly divided into two groups with 32 patients in each group. General anesthesia was induced in all patients. At the end of the surgery, a TAP block was performed under ultrasound guidance in the intervention group, and the control group received no intervention. The severity of pain was assessed 2, 6, 12, 18, and 24 hours after surgery using visual analogue scale (VAS) criteria. Patients who scored their pain more than 4 on the VAS for pain relief received 25 mg of intravenous (IV) pethidine. Furthermore, potential complications, including nausea, vomiting, and dizziness were assessed and recorded in both groups. Results: Mean pain severity 2, 4, 6, 12, 18, and 18 hours after surgery was significantly lower in the TAP-block group than in the control group (P=0.001). The mean dose of pethidine received in TAP block patients was 28.90±19.16 and 60.93±14.11 in the control group, which showed a significant difference (P=0.001). Moreover, the mean time to the first dose of pethidine in patients in the TAP block group and the control group was 15.36±3.56 and 8.43±4.28 hours after surgery (P=0.001). In addition, the incidence of nausea and vomiting was lower in the TAP group than in the control group. Conclusion: Ultrasound-guided TAP block can control post-laparotomy pain and reduce opioid use during hospitalization.

Transversus Abdominis Plane Block VS. Local Wound Infiltration for Elective Minimally Invasive Cholecystectomy in Children: A Prospective Randomized Trial

BackgroundThe efficacy of transversus abdominis plane (TAP) block versus local anesthetic wound infiltration (LWI) in pediatric laparoscopic surgery is largely unknown. The objective of this study was to prospectively analyze this in minimally invasive cholecystectomy. We hypothesized that TAP block would be superior to LWI in terms of pain control and post-operative complications. MethodsWe conducted a prospective, randomized, single-blinded, controlled trial between 2017 and 2022 after obtaining Institutional Review Board (IRB) approval. After randomization, patients received a standard amount of ropivacaine via either 1) ultrasound-guided TAP block after general anesthesia induction or 2) local injection at port insertion by the operating surgeon. We collected data including operative time, pain scores, and medication usage post-operatively. We used descriptive statistics to report all endpoints and compared data with t-tests and Fisher's exact tests. A p-value less than 0.05 was considered statistically significant. ResultsWe enrolled 85 patients (43 LWI, 42 TAP). Mean [standard deviation] age and body mass index (BMI) in the LWI and TAP groups were 14.8 [1.9] and 14.7 [2] years and 29.9 [7.2] and 27.4 [8.2] kilogram/meter2 (kg/m2) respectively. We did not find any significant differences in postoperative opioid use, pain scores, and gastrointestinal symptoms. TAP patients had significantly longer time between anesthesia-start and procedure-start (p < 0.001), although total time under anesthesia was not significantly different (p = 0.540). ConclusionThere are no significant differences between equal administration of local anesthetic by TAP block and surgeon administered LWI during minimally invasive cholecystectomy. Type of StudyRandomized clinical trial. Level of EvidenceLevel II.

A randomized clinical study to compare postoperative pain relief in ilioinguinal nerve block versus transversus abdominis plane block following inguinal hernia repair surgery

Background: Inguinal hernia surgeries are associated with postoperative pain and discomfort. Transversus abdominis plane (TAP) block and Ilioinguinal/Iliohypogastric (IIIH) nerve blocks are widely used to control postoperative pain. In this study we have compared postoperative pain relief between TAP block and IIIH nerve block in the patients undergoing inguinal hernia surgery under spinal anesthesia. Aims and Objectives: The primary aim of this study was to compare postoperative pain relief of TAP block and IIIH block in patients undergoing inguinal hernia surgery. Secondary objectives were to observe hemodynamic parameters and to observe for postoperative side effects if any. Materials and Methods: Sixty patients of age group 18–65-year-old males, ASA grade I, II, were randomised into two groups TAP group (n=30) and IIIH group (n=30). TAP group received 30 mL of 0.25% ropivacaine TAP block and group IIIH received 20 mL, and wound infiltration with 10 mL of 0.25% ropivacaine. Duration of analgesia was recorded, visual analogue scale (VAS) score compared in first 24h postoperatively. Perioperative haemodynamic parameters were recorded. Results: VAS score was found significant at 1, 2, 3, 4, 5, 8, 10, 16 h (P&lt;0.001). The mean duration of analgesia was found to be 4.64±1.16 h and 6.3±1.84 h for IIIH group and TAP group respectively which was statistically significant (P&lt;0.001). Haemodynamic were stable and no complication was there in both the groups. Conclusion: As a part of multimodal analgesia regimen both TAP block and IIIH block provided good pain relief postoperatively in patients undergoing inguinal hernia. In this study TAP block provided prolonged pain relief than IIIH block after inguinal hernia repair.

Comparison between peripheral nerve stimulator-guided serratus anterior plane block versus transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy under general anaesthesia: A double-blind randomised controlled trial.

Laparoscopic cholecystectomy (LC) is a widely accepted surgical procedure associated with postoperative pain. This study was done to compare peripheral nerve stimulator (PNS)-guided serratus anterior plane block (SAP) and transversus abdominis plane (TAP) block for postoperative analgesia for patients undergoing LC. Following approval from the ethical committee, 70 patients for LC were randomly assigned to Group S: SAP block and Group T: TAP block. The blocks were performed under PNS guidance, and 20 ml of 0.375% ropivacaine was administered. The severity of pain was measured using a visual analogue scale (VAS). The study's primary objective was the evaluation of the postoperative VAS score. The time of the first dose of rescue analgesia and total tramadol consumption for 24 h postoperatively were secondary objectives. All the statistical calculation was done using statistical analyses for Social Sciences for Windows version 23.0 (IBM Corp, NY, USA). Lower VAS score was seen in patients of TAP block at rest as well as movement at 6 h (P = 0.001), 12 h (P = 0.001) and 18 h (P = 0.001) postoperatively compared with SAP. The TAP group showed a significantly increased time of first rescue analgesic compared to the SAP group (7.97 ± 0.51 vs. 5.89 ± 1.45, P = 0.001). Tramadol usage was significantly higher in the SAP group than in the TAP group (128.9 ± 36.22 vs. 72.43 ± 44.80, P = 0.001). TAP block guided by the PNS improves postoperative pain with less tramadol consumption and during the postoperative period without significant complications.

Transversus abdominis plane block improves postoperative recovery following cesarean delivery under general anesthesia: A propensity score matched retrospective cohort study.

To evaluate the effects of transversus abdominis plane (TAP) block on postoperative recovery 24 h after cesarean delivery under general anesthesia. A propensity-score-matched, retrospective cohort study was used. A total of 173 pregnancies resulting in elective cesarean delivery under general anesthesia between March 2021 and March 2022 were analyzed retrospectively. Patients receiving TAP block were compared with those receiving only intravenous analgesia. The Quality of Recovery 15 (QoR-15) score, assessed 24 h postoperatively using a 15-item questionnaire, was the primary outcome. Secondary outcomes included time to first ambulation, time to first flatus postoperatively, ability to tolerate ambulation, visual analog scale (VAS) score, hospitalization cost, and postoperative nausea and/or vomiting. The total QoR-15 score 24 h postoperatively in the TAP group was significantly higher than in the Control group (P < 0.001). Patients in the TAP group had higher Bruggemann comfort scale scores (P < 0.001), could better tolerate early postoperative ambulation (P < 0.001), and had shorter time to first ambulation (P < 0.001) and flatus (P < 0.001). Correlation analysis demonstrated an inverse relationship between the cumulative VAS pain scores, time to first postoperative ambulation, time to first flatus, and total QoR-15 score 24 h postoperatively. Following cesarean delivery under general anesthesia, TAP block combined with intravenous analgesia can improve postoperative recovery and shorten the time to postoperative ambulation and recovery of intestinal function.

Posterior transversus abdominis plane block versus lateral quadratus lumborum block in children undergoing open orchiopexy: a randomized clinical trial☆

BackgroundDue to the complex innervation of the testicle and spermatic cord, analgesic management can be challenging in orchiopexy. We aimed to compare the effects of posterior Transversus Abdominis Plane (TAP) and lateral Quadratus Lumborum Block (QLB) on analgesic use, pain, and parent satisfaction in unilateral orchiopexy. MethodsASA I–III, aged 6 months –to 12 years children undergoing unilateral orchiopexy were included to this double-blinded randomized trial. Patients were randomized into two groups with the closed envelope method before the surgery. Lateral QLB or posterior TAP block was applied under ultrasonography with 0.4 ml.kg−1 0.25% bupivacaine for both groups. The primary outcome was the assessment of additional analgesic usage in the peri-postoperative period. Evaluation of postoperative pain until 24 hours after surgery and parental satisfaction were also assessed as secondary outcomes. ResultsA total of 90 patients were included in the analysis (45 patients in each group). The number of patients needing remifentanil was significantly higher in the TAP group (p < 0.001). The average FLACC (TAP: 2.74 ± 1.8, QLB: 0.7 ± 0.84) and Wong-Baker scores (TAP: 3.13 ± 2.42, QLB: 0.53 ± 1.12) were significantly higher for TAP (p < 0.001). Additional analgesic consumption at the 10th, 20th minutes, 6th, 16th, and 24th hours, especially after the 6th hour, were significantly higher for TAP. Parent satisfaction was significantly higher in the QLB group (p < 0.001). ConclusionLateral QLB provided more effective analgesia than posterior TAP block in children undergoing elective open unilateral orchiopexy. Clinical Trials RegistryNCT03969316.

Long-Acting Bupivacaine for Pain Control After Cesarean Birth

ObjectiveTo evaluate women’s postcesarean pain levels and total opioid use for standard opioid pain management compared with local anesthetic with patient-requested opioids. DesignRetrospective cohort study. Setting/Local ProblemRural southeast Ohio. Ohio had a higher rate of opioid use disorder (1.4%) than both the regional average (0.8%) and the national average (0.7%). ParticipantsWe performed a retrospective study of 402 medical records of women who gave birth by cesarean. InterventionWomen were provided one of three types of perioperative anesthesia: routine spinal (standard of care group), wound infiltration with liposomal bupivacaine (LB INF), and transversus abdominis plane (TAP) block with liposomal bupivacaine (LB TAP). Data were collected on the amount of opioids taken postoperatively (measured as morphine milligram equivalents [MME]), pain scores, and history of opioid use. ResultsThe LB INF and LB TAP groups had significantly lower total and average MME per day than the standard of care group (p < .001). Pain scores for the LB INF group were lower on postoperative day (POD) 0 and POD1, whereas LB TAP pain scores were lower than standard of care pain scores on POD1 (p < .004). Women with a prior history of substance use disorders reported higher pain scores, took more total opioids. and stayed in the hospital longer regardless of type of anesthesia received (p < .001). ConclusionLB INF and LB TAP were associated with lower amounts of opioids used and with lower postcesarean pain scores compared with the standard of care.

Randomized single blind trial to compare the short term post-operative outcome and cost analysis of laparoscopic versus ultrasound guided transversus abdominis plane block in patients undergoing bariatric surgery.

Laparoscopic Bariatric surgery despite being minimally invasive can cause moderate to severe pain in the immediate postoperative period. Adequate pain management remains a major challenge. Transversus Abdominis Plane (TAP) block is a regional anesthesia technique which blocks the sensory nerve supply of anterior-lateral abdominal wall. Primary: evaluate Laparoscopic versus ultrasound (USG)-guided TAP block on immediate post-operative analgesia after undergoing laparoscopic bariatric surgery. Secondary: compare cost effectiveness of Laparoscopic versus ultrasound-guided TAP block after undergoing bariatric surgery. Randomized Single blind study undertaken after sample size was calculated by (N) = 2(Zα + Z1-β)2σ2/δ2 which proposed 60 patients in each group. Block randomization was done after excluding redo/revision surgeries and patients were alloted Group I: Laparoscopic-guided TAP block & Group II: USG-guided TAP block. In both groups, Bilaterally, 20ml (0.25%) bupivacaine was injected immediately after completion of bariatric surgery. SPSS v23 (IBM Corp.) was used for analysis. Group I (N = 61 53F/8M) & Group II (N = 60 42F/18M) were demographically comparable. Group I (3.58 ± 0.67) had significantly lower procedure time compared to Group II (12.47 ± 1.61) (p-Value < 0.001). First rescue analgesia was administered at 7.07 ± 2.61h in Group I vs 7.21 ± 2.39h in Group II (p-Value 0.659). In first 24h rescue analgesic dose requirement in Group I was 1.29 ± 0.53 vs 1.39 ± 0.50 in Group II (p-Value 0.487). VAS scores during rest and movement till 24h post-operative were statistically similar. Procedural cost was more in group II. Laparoscopic-guided TAP block is a safe and cost-effective approach for postoperative pain management after bariatric surgery and provides similar comparable analgesic effect as the USG-TAP block. Laparoscopic TAP is a surgeon delivered, easy to administer and significantly less time-consuming procedure which is feasible even when an ultrasound machine is not available.