Transversus Abdominis Plane Research Articles

Four-point transversus abdominis plane block technique in pigs. A pilot cadaveric study

Four-point transversus abdominis plane block technique in pigs. A pilot cadaveric study

Thoracic Epidural and Analgesic Options After Failed Transversus Abdominus Plane Block With Liposomal Bupivacaine.

A 39 year-old female with a history of Roux-en-Y gastric bypass underwent emergent partial colectomy. Her postoperative analgesic management of a transversus abdominus plane block administered with a combination of bupivacaine and liposomal bupivacaine was ineffective. A bupivacaine thoracic epidural was then placed, which provided significant pain relief. This use of a bupivacaine thoracic epidural infusion following liposomal bupivacaine regional anesthesia demonstrated a case of effective analgesia without the development of local anesthetic systemic toxicity symptoms in a remote hospital setting, where certain laboratory analyses were not readily available.

Innovations in Pain Management for Abdominoplasty Patients: A Systematic Review

Background/Objectives: Abdominoplasties are prevalent surgical procedures for improving lower abdominal contours, necessitating effective pain management. Insufficient management can increase opioid usage, dependency risks, and adverse effects. This review investigates various strategies in abdominoplasty pain management, aiming to reduce opioid dependence and improve patient care. Methods: A comprehensive systematic literature search (MEDLINE, Cochrane, PubMed, Web of Science, EMBASE) was conducted, spanning from their inception to January 2024, using keywords such as ‘abdominoplasty’ and ‘postoperative pain management’. Included studies focused on nonopioid interventions in adults, encompassing various study designs. Non-English publications and those not meeting outcome criteria were excluded. Bias in studies was assessed using specific tools for randomized and non-randomized trials. Results: Thirty-five studies, published between 2005 and 2024, were included, involving 3636 patients with an average age of 41.8. Key findings highlighted the effectiveness of transversus abdominis plane blocks in reducing opioid use and pain. Pain pump catheters also showed promise in improving pain management and reducing opioid dependency. Local anesthetics demonstrated varying degrees of efficacy, while other alternatives like ketamine and NSAIDs successfully reduced postoperative pain and opioid requirements. The bias assessment of the RCTs revealed “low” and “some concerns” ratings, indicating a need for more detailed methodology reporting and management of missing data. The cohort studies generally attained “moderate” risks of bias, primarily due to confounding variables and outcome data reporting. Conclusions: Nonopioid analgesics show potential in postoperative pain management for abdominoplasties, but further research is needed to confirm their effectiveness and optimize patient care.

Comparison of the clinical efficacy on chronic abdominal wall pain between trigger-point electroacupuncture and transversus abdominis plane block

To compare the clinical efficacy between trigger-point (TrP) electroacupuncture and transversus abdominis plane (TAP) block in treatment of chronic abdominal wall pain (CAWP). A total of 62 CAWP patients were randomly divided into a TrP electroacupuncture group (31 cases, 1 case dropped off) and a TAP block group (31 cases, 1 case dropped off). Electroacupuncture at trigger points was delivered in the TrP electroacupuncture group, and TAP block was administered under ultrasonic guidance in the TAP block group. Separately, the score of the numerical pain rating scale (NRS) was observed before treatment and in 1 week, 1 month and 3 months after treatment；the scores of the self-rating anxiety scale (SAS) and the self-rating depressive scale (SDS) observed before treatment and in 1 week and 3 months after treatment；and the score of the short form 36 questionnaire (SF-36) was observed before treatment and in 3 months after treatment. The utilization rate of remedial drugs was recorded during follow-up visit. The clinical efficacy was compared. At each time point after treatment, NRS score decreased in comparison with that before treatment (P<0.05), the scores of SAS and SDS 1 week and 3 months after treatment were reduced (P<0.05) and the each item score of SF-36 increased (P<0.05) 3 months after treatment of each group. Compared with the outcomes in the TAP block group, NRS scores were reduced 1 month and 3 months after treatment respectively (P<0.05), the scores of SAS and SDS decreased (P<0.05) and SF-36 score was elevated (P<0.05) 3 months after treatment in the TrP electroacupuncture group. There was no significant difference in the utilization rate of remedial drugs between the two groups. The clinical efficacy of the TrP electroacupuncture group (96.7%) was superior to that of the TAP block group (83.3%, P<0.05). Both TrP electroacupuncture and TAP block can markedly relieve pain, attenuate the emotional symptoms of anxiety and depression and improve the quality of life in the patients with chronic abdominal wall pain. The clinical efficacy of TrP electroacupuncture is better than that of TAP block 3 months after treatment.

A randomised comparison of transverse abdominal plane block versus thoracic epidural analgesia on postoperative opioid consumption for colorectal enhanced recovery after surgery programme (OPIATE study).

The transverse abdominis plane block is increasingly being used as a less-invasive alternative to thoracic epidural analgesia for effective pain management. This study aimed to compare transverse abdominis plane block with opioid-based thoracic epidural analgesia in terms of postoperative opioid consumption. Patients in the thoracic epidural analgesia group received a continuous infusion of 0.1% levobupivacaine with 2mcg/ml of fentanyl, while those in the transverse abdominis plane group received 6-hourly boluses of 0.4ml/kg of 0.25% levobupivacaine. The primary objective was to compare the average fentanyl consumption, measured as intravenous fentanyl equivalents, over 72 hours. Data of 35 patients were analysed. Fentanyl consumption at the end of 72 hours was significantly lower in the transverse abdominis plane group (median [interquartile range] 495 mcg (255, 750), and mean (95% confidence interval) 717.35mcg (403.54-1031.16)) compared to the thoracic epidural analgesia group (median [interquartile range] 760mcg (750, 760), and mean (95% confidence interval) 787mcg (746.81-827.19)) with a p value of 0.010. Pain scores at rest and during movement were comparable between the groups (p > 0.05). However, the median pain scores during movement were significantly lower in the thoracic epidural analgesia group at 60 and 72 hours (p ⩽ 0.05). Multimodal analgesia with transverse abdominis plane resulted in lower opioid consumption over 72 hours compared to thoracic epidural analgesia.

Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Comparative study between Ultrasound Guided Erector Spinae Plane Block Versus Ultrasound Guided Transversus Abdominis Plane Block with Dexmedetomidine as an adjuvant to local anesthetic in Laparoscopic Upper abdominal Surgery.

Transversus Abdominis plane block to manage post operative pain in canine mastectomy

The aim of this study was to assess effectiveness of transversus abdominis plane block as part of a multimodal anaesthetic protocol in controlling perioperative nociception/ pain in dogs that underwent mammary tumour excision. The study included twelve dogs belonging to different breeds and ages. The dogs were classified according to the American Society of Anaesthetists (ASA) classification of physical status, based on their pre-anaesthetic evaluations and were divided into two groups: I and II, each with six dogs. Dogs in both groups received dexmedetomidine for premedication and diazepam-propofol for induction. Group I dogs were subjected to Transversus abdominis plane (TAP) block and Group II dogs were given butorphanol. Pain score was assessed using the Glasgow Composite Measure Pain Scale (GCMPS-SF) at one hour post-operatively. The pain score was significantly lower in Group I. None of the dogs in Group I required rescue analgesia. TAP block proved beneficial in mitigating nociception and postoperative pain in dogs undergoing mammary tumour excision. Keywords: Mammary tumour resection, TAP block, post-operative pain

Ultrasound-Guided Transversus Abdominis Plane Block as an Effective Path to Reduce Opioid Consumption After Laparoscopic Bariatric Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Effective postoperative pain management is essential to the patient's recovery. The use of opioids as the primary line of pain treatment has been known to increase rates of length of stay, pulmonary complications, paralytic ileus, and nausea and vomiting. Therefore, guidelines strongly recommend alternative paths to reduce opioid consumption through multimodal analgesia, and the transversus abdominis plane block(USG-TAP) has been considered to be one of these optimistic alternatives. A comprehensive systematic search was conducted in four databases until April 2024. We only considered for this analysis randomized controlled trials that assessed the USG-TAP as part of multimodal anesthesia in patients undergoing laparoscopic bariatric surgery. Eleven studies comprising 789 patients were included in the meta-analysis. Our results showed a significant decrease in opioid consumption after the first 24h of surgery (MD - 32.02mg; 95% IC - 51.33, - 12.71; p < 0.01) and fewer patients required extra-dose of opioid (OR 0.20; 95% IC 0.07, 0.62; p < 0.01). The pain score showed to be also improved with the TAP block (MD - 0.69; 95% IC - 1.32, - 0.07; p = 0.03). No difference concerning time to deambulate, nausea and vomiting, and time of surgery was observed among the studies. This study reinforces the benefits of the use of USG-TAP block as part of multimodal analgesia in patients undergoing laparoscopic bariatric surgery.

Efficacy of Laparoscopic-Assisted Subcostal Transversus Abdominis Plane (TAP) Block: A Double-Blind, Randomized Controlled Trial

Objective: To analyze efficacy of laparoscopic administered Transversus Abdominis Plane (TAP) block on pain scores and opioid consumption in the first 24 hours in patients undergoing laparoscopic cholecystectomy. Study design and setting: The randomized, double-blinded trial was conducted in surgical unit, Shalamar Medical &amp; Dental College Lahore from September 2019 to March 2020. Methodology: 100 patients of either gender scheduled for elective laparoscopic cholecystectomy were included using consecutive probability sampling method. After informed consent, patients were randomized into Intervention TAP GroupA and Control Group-B. Intervention TAP Group-A received laparoscopic aided TAP block with 20ml 0.5% Ropivacaine in subcostal region while Control Group-B received 20ml saline solution which was used as placebo. Both groups received paracetamol 1gm intravenous eight-hourly and Ketorolac 30mg intravenous 12-hourly. Nalbuphine 5mg intravenous was administered as “rescue analgesic” in patients having pain score of four or above. Postoperative pain scores at rest and on coughing were documented using numerical rating scores (VAS) at 2, 4, 6, 12, and 24 hours. Results: There was a significant difference (p-value=0.038, 0.000, 0.025, 0.000, 0.000) in pain scores over the first 24 hours postoperatively in laparoscopically assisted Intervention TAP Group-A. The total nalbuphine consumption was significantly reduced in Intervention TAP Group-A as compared to Control Group-B. Conclusions: Laparoscopic administered TAP block significantly reduced postoperative pain and total opioid consumption following laparoscopic cholecystectomy

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&lt;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 transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section: A randomised clinical trial.

Caesarean section is a widely performed surgical procedure that often results in moderate-to-severe postoperative pain. If left untreated, this pain can lead to short-term and long-term consequences. Transversalis fascia plane (TFP) block and transversus abdominis plane (TAP) block are among the regional anaesthesia techniques employed for managing pain after a caesarean section. We aimed to compare the impact of these two blocks on the quality of recovery in patients undergoing elective caesarean section under spinal anaesthesia. A single-centre, double-blind, randomised trial. Operating room, postanaesthesia recovery unit, and ward in a tertiary hospital. Ninety-three patients (ASA 2 to 3) were recruited. After exclusion, 79 patients were included in the final analysis: 40 in the TFP block group and 39 in the TAP block group. After surgery, participants received either TFP block (20 ml 0.25% bupivacaine for each side) or TAP block (20 ml 0.25% bupivacaine for each side). The primary outcome was the difference in obstetric quality of recovery 11-Turkish (ObsQoR-11T) scores between groups. Secondary outcomes included pain scores, opioid consumption and incidence of opioid-related complications. The mean ObsQoR-11T score was higher in the TFP block group compared with the TAP block group (97.13 ± 6.67 points vs. 87.10 ± 9.84 points, respectively; P < 0.001). The pain scores in the TFP block group were slightly lower between postoperative 4 and 24 h. The mean total morphine consumption was 15.08 ± 2.21 mg in the TFP block group and 22.21 ± 3.04 mg in the TAP block group ( P < 0.001). More patients required rescue analgesia between 4 and 8 h in the TAP block group [2.00 (5.00%) vs. 9.00 (23.08%), P = 0.02]. No significant differences were observed between groups in terms of opioid-related side effects. TFP block used for analgesic purposes yielded a better quality recovery period than TAP block and also reduced opioid consumption. Clinicaltrials.gov (NCT05999981). http://links.lww.com/EJA/B6 .

Efficacy of dexmedetomidine as an adjuvant in transverse abdominal plane blocks for cesarean section pain management: A systematic review and meta-analysis

Postoperative pain management is a key component of care for women undergoing cesarean section. Although the use of dexmedetomidine (DMD) as an adjuvant to local anesthetics in transverse abdominal plane (TAP) blocks has been investigated, its conclusive evidence on its efficacy and safety remains unclear. A standardized data extraction form, under the guidance of the PRISMA protocol, was devised for selecting relevant studies across eight databases, without restrictions on the publication period. In most of the eight studies reviewed, the group receiving DMD demonstrated a significant extension of the duration of analgesia compared to the control group [mean difference (MD) = -3.37 hours, 95% confidence interval (CI) = -6.10 to -0.65 hours, Z = 2.43, P = 0.02]. The DMD group also showed a significant decrease in Visual Analogue Scale pain scores (MD = -1.38, 95% CI = -2.52 to -0.24, Z = 2.37, P = 0.02) in comparison to the control group. Nevertheless, significant heterogeneity was observed across the studies, potentially due to differences in study design, patient demographics, and dosing protocols, among other factors. The results of this meta-analysis indicate that DMD could be an effective adjuvant to local anesthetics in TAP blocks, potentially improving postoperative pain management and decreasing the need for additional analgesia. Nevertheless, the considerable heterogeneity among the studies warrants cautious interpretation of these results.

Clinical Trial Study Protocol: A Prospective Blinded, Randomized, Controlled Clinical Trial Protocol to Assess the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block on Postoperative Analgesia and Recovery Quality in Laparoscopic Donor Hepatectomy.

Liver transplantation is considered an effective treatment for end-stage liver disease. Laparoscopic donor hepatectomy (LDH) has become a new standard procedure. And it is important to minimize the pain of the donor. Good postoperative analgesia can reduce the occurrence of postoperative complications and promote the early recovery of the donor. Ultrasound-guided transversus abdominis plane (TAP) block can provide effective analgesia for liver donors and reduce postoperative opioid consumption. This study aims to use ultrasound-guided TAP block for LDH to improve postoperative analgesia for donors while reducing opioid consumption and improving patient rehabilitation quality. This study is a prospective blinded, randomized, controlled clinical trial with a concealed allocation of patients (living liver donors) scheduled to receive laparoscopic partial hepatectomy 1:1 to receive local infiltration anesthesia or TAP block. This study will recruit a total of 80 patients. The primary outcome is the dosage of opioids within 24hours after surgery. This trial has been approved by the Institutional Review Board of Beijing Friendship Hospital of China Capital University. This trial study protocol was approved on 8 May 2023. The trial will start recruiting patients after being registered on the Chinese Clinical Trial Registry. ChiCTR2300071694.

Retraction: Adding magnesium sulfate to bupivacaine in transversus abdominis plane block for laparoscopic cholecystectomy: A single blinded randomized controlled trial

Retraction: Adding magnesium sulfate to bupivacaine in transversus abdominis plane block for laparoscopic cholecystectomy: A single blinded randomized controlled trial

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial

BackgroundObesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block.MethodsWe propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups—group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient’s overall postoperative recovery.DiscussionRegional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery.Trial registrationThis trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

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.

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

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

Effectiveness of Liposomal Bupivacaine Transversus Abdominis Plane Block in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial.

Transversus abdominis plane (TAP) blocks improve pain control and reduce narcotic medication requirements in various surgical procedures. Liposomal bupivacaine may provide more sustained analgesia. This study compared pain-related outcomes between standard bupivacaine and liposomal bupivacaine TAP blocks after autologous breast reconstruction. The authors conducted a single-center, single-blinded randomized controlled trial between March of 2021 and December of 2022. Patients undergoing deep inferior epigastric perforator flap breast reconstruction in a standardized enhanced recovery after surgery pathway were randomized to receive intraoperative TAP blocks with either bupivacaine and epinephrine (control group) or liposomal bupivacaine, bupivacaine, and epinephrine (experimental group). Primary outcome was postoperative narcotic medication requirements, with secondary outcomes of pain scores, length of stay, and narcotic medication refills. A total of 117 patients met inclusion criteria (59 control patients and 58 experimental patients). Demographic characteristics, comorbidities, breast pathologic variables, surgery laterality, and immediate versus delayed reconstruction status were equivalent between groups. The control group had significantly higher average pain scores postoperatively (4.3 versus 3.6; P = 0.004). However, there were no significant differences in mean narcotic use (66.9 morphine milligram equivalents versus 60.2 morphine milligram equivalents; P = 0.47). Both length of stay and postoperative narcotic prescription refills were equivalent between groups (2.1 days versus 2.2 days, P = 0.55; 22% versus 17.2%, P = 0.52). The addition of liposomal bupivacaine to the standard bupivacaine TAP block mixture in a standardized enhanced recovery after surgery protocol did not demonstrate a significant reduction in postoperative narcotic requirements after deep inferior epigastric perforator flap breast reconstruction compared with standard bupivacaine alone. Patient-reported pain scores, however, were lower among liposomal bupivacaine patients after the initial 24 hours postoperatively and consistent with a longer duration of analgesia. Therapeutic, II.

Discussion: Effectiveness of Liposomal Bupivacaine Transversus Abdominis Plane Block in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial.

Discussion: Effectiveness of Liposomal Bupivacaine Transversus Abdominis Plane Block in DIEP Flap Breast Reconstruction: A Randomized Controlled Trial.

Recovery quality of transversus abdominis plane block with liposomal bupivacaine after cesarean delivery: A randomized trial

Study objectiveThis study aimed to investigate the effect of liposomal bupivacaine in transversus abdominis plane block (TAP) on recovery quality after cesarean delivery. DesignA randomized trial. SettingAn operating room, a post-anesthesia care unit, and a hospital ward. PatientsA total of 147 women scheduled for cesarean delivery under spinal anesthesia were enrolled and randomized to receive a TAP block with plain bupivacaine (bupivacaine group), liposomal bupivacaine (liposomal group), or a mixture of plain bupivacaine and liposomal bupivacaine (mixture group). InterventionsThe bupivacaine group received bilateral TAP blocks with plain bupivacaine 50 mg alone. The liposomal group received bilateral TAP blocks with liposomal bupivacaine 266 mg alone. The mixture group received bilateral TAP blocks with plain bupivacaine 50 mg followed by liposomal bupivacaine 266 mg. MeasurementsThe primary outcome was the Quality of Recovery−15 (QoR − 15) score assessed 24 h postoperatively. Secondary outcomes encompassed the QoR − 15 score at 48 h post-surgery, the VAS pain score at rest and with movement at 24, 48, and 72 h postoperatively, opioid consumption within the 0–24 h and 24–48 h periods following surgery, as well as patient's satisfaction with analgesic. Main resultsThe QoR − 15 score at 24 h postoperatively was significantly higher in both the liposomal group and the mixture group compared to the bupivacaine group. Specifically, the QoR − 15 score for the liposomal group versus the bupivacaine group (median [IQR]: 120 [107, 128] vs. 109 [104, 120]; median difference, 7; 95 % CI, 2 to 13; P = 0.011) and for the mixture group versus the bupivacaine group (median [IQR]: 122 [112, 128] vs. 109 [104, 120]; median difference, 9; 95 % CI, 4 to 14; P = 0.001). The QoR − 15 score in both the liposomal group and the mixture group were also higher than those in the bupivacaine group at 48 h postoperatively, though the difference was not clinically meaningful. Additionally, both the liposomal and mixture groups exhibited lower pain score at 24 h and 48 h postoperatively compared to the bupivacaine group, but no significant clinical differences were achieved in either pain scores or opioid consumption. Patients in both the liposomal and mixture groups reported higher satisfaction score with analgesia than those in the bupivacaine group. ConclusionsTAP block using either liposomal bupivacaine or a mixture of plain bupivacaine and liposomal bupivacaine provided superior quality of recovery at 24 h after cesarean delivery compared to using plain bupivacaine alone.