Transversus Abdominis Plane Research Articles

Combining Transversus Abdominis Plane and Rectus Sheath Blocks in Open Inguinal Hernia Surgery Anesthesia: A Retrospective Cohort Analysis.

Lichtenstein hernia repair is a common surgical procedure. Previously, combined rectus sheath (RS) and transversus abdominis plane (TAP) blocks have been shown to be beneficial in laparoscopic inguinal hernia surgery. Our hypothesis is that combining the two blocks will also be beneficial in open Lichtenstein hernioplasty day-case procedures. This retrospective study analyzed data from 186 patients undergoing inguinal hernia surgery chosen using the propensity score matching. Primary endpoint was intraoperative and postoperative opioid consumption. Secondary endpoints were conversion of the anesthetic method, postoperative nausea and vomiting (PONV), unscheduled hospitalization or emergency room visits, perioperative duration, analysis of the patient flow, and surgical complications. Ninety-three patients treated with the blocks (study group) and 93 controls were analyzed. The study group had significantly lower opioid use in the operating room (2.5-7.5mg vs. 5.0-7.5mg and p<0.01) and in the recovery room (0.0-2.0mg vs. 1.0-10.6mg and p<0.0001). There was no difference in postoperative recovery room times nor in the patient flow. Postoperative hospitalization due to pain was 9.1% in the control group, whereas no patients in the study group were hospitalized (p<0.01). RS and TAP blocks reduce postoperative pain in inguinal hernia surgery, resulting in significantly lower postoperative opioid use and hospitalization rates. The blocks are technically easy and quick to perform and should be considered for pain management in inguinal hernia day-case surgery.

Transversus abdominis plane block combined with intrathecal fentanyl versus intrathecal morphine for post-cesarean analgesia: a randomized non-inferiority clinical trial

BackgroundIntrathecal morphine is the standard for post-cesarean analgesia but often causes pruritus and may be unavailable in resource-limited settings. This study assessed whether a combination of bilateral transversus abdominis plane...

Effects of combined transversus abdominis plane block under direct vision and acupoint injection on promoting rapid recovery after laparoscopic cholecystectomy

ObjectiveTo study the effect of transversus abdominis plane (TAP) block under direct vision with acupoint injection on the rapid recovery of patients after laparoscopic cholecystectomy.MethodsNinety-three patients undergoing laparoscopic cholecystectomy at Hangzhou Hospital of Traditional Chinese Medicine from January 2023 to December 2023 were selected and divided into control, TAP block under direct vision (TAP-DV), and TAP-DV with acupoint injection (TAP-DVA) groups using a random number table method. Postoperative VAS, Ramsay score, IL-6, CRP, and postoperative rehabilitation indices were compared among the three groups.ResultsThe VAS pain score at 6 h after surgery was significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05). The VAS pain score at 24 h after surgery was significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05) and was significantly lower in the TAP-DVA group than in the TAP-DV group (P < 0.05). The VAS pain score 48 h after surgery was significantly lower in the TAP-DVA group than in the control and TAP-DV groups (P < 0.05). The mean IL-6 level was significantly lower in the TAP-DVA and TAP-DV groups than in the control group (P < 0.05). The postoperative nausea and vomiting rate was significantly lower in the TAP-DVA group than in the control group (P < 0.05). The postoperative exhaust time was earlier in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05) and was earlier in the TAP-DVA group than in the TAP group (P < 0.05). The postoperative hospitalization days and total cost were significantly lower in the TAP-DV and TAP-DVA groups than in the control group (P < 0.05).ConclusionTAP-DVA has a stable and good analgesic effect and can promote rapid recovery after laparoscopic cholecystectomy.

Pain control and analgesic requirements following laparoscopy-assisted transversus abdominus plane (TAP) block compared to port site infiltration post-paediatric laparoscopic appendicectomy. A Randomised controlled trial.

Appendicectomy is a common procedure in children. Regional anaesthesia helps reduce requirements for opioids and hospital stay and enhances recovery. Laparoscopic-assisted Transversus Abdominus Plane block (L-TAP) was shown to be efficient and potentially superior to port site infiltration (PSI); however, this was not previously studied in paediatric appendicitis. This study aimed to evaluate the effectiveness of L-TAP compared to PSI in children undergoing laparoscopic appendicectomy (LA). A single-blinded RCT was performed to compare L-TAP to PSI with 0.25% plain bupivacaine at the end of an LA. Patients aged 6-16 years diagnosed with uncomplicated acute appendicitis (AAST grade 1) were randomised to either group in a 1:1 fashion. Complicated appendicitis, open or Lap-converted to open appendicectomies, were excluded. Outcome measures included the total amount and number of doses of opiates and clonidine required, length of stay (LOS), and visual analogue score (VAS) of pain. 49 patients in the PSI group and 41 in the L-TAP group were included; the mean age was 11.3 ± 2.4 years. There was no significant difference in age and weight between the groups. One patient in each group required opioid-based patient-controlled analgesia (PCA) in the theatre recovery room; however, on retrospective review, this was not clinically warranted. Seven patients in each group required morphine while in recovery (p = 0.4). There was no significant difference in total morphine (PSI 0.12 vs L-TAP 0.04 mg/kg body weight, p = 0.1) and clonidine (PSI 0.57 vs L-TAP 0.59 micro gm/kg body weight, p = 0.5) requirement during the hospital stay. Patients in the L-TAP group had two hours shorter LOS than the PSI group (38.0 ± 3.9 vs 39.7 ± 4.1, p = 0.38). There was no significant difference in VAS scores. There was no difference between L-TAP and PSI. L-TAP was feasible, easy to earn, and safe. We recommend that it be considered in clinical protocols and local guidelines as part of the peri-operative analgesia regimen, especially when ultra-sound guided blocks are unavailable. Overall, patients with uncomplicated appendicitis who undergo LA have low VAS scores and require mostly simple analgesia.

Do transversus abdominis plane (TAP) blocks improve pain after laparoscopic bilateral inguinal hernia repairs beyond the recovery unit? A randomized control trial.

While surgeons agree that perioperative field blocks should be performed for open inguinal hernia surgery, there lacks consensus in the minimally invasive context. Prior small-scale randomized trials study pain scores only up to 24h postoperatively. Thus, we sought to investigate the analgesic benefits of a bupivacaine transversus abdominis plane (TAP) block in the first 4 postoperative days. This is a prospective single-institution randomized control trial involving patients undergoing elective totally extraperitoneal inguinal hernia repairs, who received either a TAP block with bupivacaine 0.25% or saline placebo. Postoperatively, patients completed a pain survey (based on a 0-10 visual analog score) and an opioid/non-opioid pain medication log. Differences were detected using a Wilcoxon rank sum test for continuous variables, and a Fisher's exact test or chi-squared for categorical variables. A total n = 90 patients were included in the per-protocol analysis, of which n = 46 received TAP blocks with bupivacaine versus n = 44 placebo. Patient characteristics were similar between the groups, including recurrent hernias and number of tacks placed (p > 0.05). All cases were bilateral. Postoperatively, pain scores (at rest and with movement) and pain medication use were similar for all postoperative days 1-4. Our study shows no significant difference in pain or opioid requirement within the first 4days postoperatively, suggesting that the analgesic benefits of plain bupivacaine TAP blocks in totally extraperitoneal inguinal hernia repairs do not exist beyond the recovery unit. This will help inform anesthesiologists and patients in discussing risks and benefits of a TAP block in their surgical context.

COMPARE THE ANALGESIC EFFICACY OF 0.25% BUPIVACAINE AND 0.25% BUPIVACAINE WITH 0.9 μG/KG DEXMEDETOMIDINE IN TAP BLOCK

Objectives: The transversus abdominis plane (TAP) block is a relatively new regional anesthesia technique that provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall. Despite a relatively low risk of complications and a high success rate using modern techniques, TAP blocks remain overwhelmingly underutilized. The objective is to compare the analgesic efficacy of 0.25% bupivacaine and 0.25% bupivacaine with 0.9 μg/kg dexmedetomidine in TAP block as a part of a multimodal analgesia regimen for post-cesarean delivery pain management. Methods: Patients more than 18 years old posted for elective/emergency caesarean section in ABVGMC, Vidisha, Madhya Pradesh. After approval from the institutional ethical committee and written informed patients consent, 20 each pregnant women were included in the both study group. Group A: TAP block with 0.25% bupivacaine 20 mL each side Group B: TAP block with 0.25% bupivacaine with 0.9 μg/kg dexmedetomidine 20 mL each side. We studied TAP block in patients posted for elective caesarean section. Results: The women received 0.25% bupivacaine or 0.25% bupivacaine with 0.9 μg/kg dexmedetomidine. The median visual analogue scale (VAS) for pain was significantly higher in the bupivacaine Group A at 12 h with compare to Group B. Overall, there was no difference in VAS score at 0.5, 2, 4, 6, and 24 h demands between the two groups. The mean time to first rescue analgesia in Group A was 14.6±5.5 h and in Group B was 16.8±4.2 h. Conclusion: We conclude that the using dexmedetomidine as an additive to bupivacaine in ultrasound-guided TAP block for elective/emergency caesarean section provides prolonged duration of post-operative analgesia, and lowered VAS pain scores. The addition of dexmedetomidine to bupivacaine also reduced the total dose of opioid requirement in the first 24 h after caesarean section.

Transversus abdominis plane block in oncourology: a narrative review

Transversus abdominis plane block (TAP block) is a regional anesthesia technique used as part of multimodal postoperative analgesia for a wide range of abdominal surgical procedures. However, the use and effectiveness of this technique in urological surgeries are not well documented in Russian literature. We conducted a literature search in PubMed, EMBASE, Web of Knowledge, and Cochrane Library databases to evaluate the effectiveness of using transversus abdominis plane blocks compared to other anesthesia techniques in oncourological surgery. It has been determined that transversus abdominis plane block, serving as an integral component of multimodal anesthesia in patients undergoing oncourological procedures, significantly curtails the reliance on opiates both during and following surgery. Moreover, it mitigates the intensity of pain syndrome in the postoperative phase and fosters a swifter and more comprehensive recovery process for patients.

A Randomized Comparative Study of Transversus Abdominis Plane Block with or without Intravenous Diclofenac Sodium as A Component of Multimodal Regimen for Post-Operative Analgesia Following Caesarean Section

A Randomized Comparative Study of Transversus Abdominis Plane Block with or without Intravenous Diclofenac Sodium as A Component of Multimodal Regimen for Post-Operative Analgesia Following Caesarean Section

Efficacy of Intraoperative Paracetamol and Nefopam Infusions in Addition to Transversus Abdominis Plane Block in Kidney Transplant Recipients.

Background and Objectives: Kidney transplantation (KT) is an important treatment modality for renal failure. However, moderate-to-severe pain often occurs in KT recipients. Multimodal analgesia using combined analgesic measures has been recommended to enhance postoperative recovery. This retrospective study explored the additional analgesic efficacy of paracetamol and nefopam infusions in living-donor KT recipients who received a transversus abdominis plane (TAP) block. Materials and Methods: Consecutive living-donor KT recipients at our institute between January 2020 and March 2022 were divided into groups that received a TAP block with paracetamol and nefopam infusions (Group TA) or a TAP block without analgesics (Group T) during surgery. Following propensity-score (PS) matching, 103 patients were included in each group. Postoperative pain intensity assessed using the visual analog scale (VAS), opioid consumption via patient-controlled analgesia (PCA) devices over 24 h, and postoperative outcomes were compared between the two groups. Results: VAS pain intensity at rest was lower in group TA than in group T at 1 and 6 h after surgery [1 h: 29 (15-41) vs. 41 (29-51) mm, p < 0.001; 6 h: 32 (23-43) vs. 40 (32-54) mm, p < 0.001]. The VAS pain intensity during coughing was lower in group TA [1 h: 46 (30-58) vs. 59 (48-69) mm, p < 0.001; 6 h: 51 (40-63) vs. 60 (45-71) mm, p < 0.001]. Moreover, PCA consumptions during the first 6 h and between 6-24 h post-surgery was significantly lower in group TA. Other postoperative outcomes did not differ between the two groups. Conclusions: Multimodal analgesia with intraoperative paracetamol and nefopam infusions improved postoperative pain control in living-donor KT recipients who received a preoperative TAP block. Our findings demonstrate the efficacy of paracetamol and nefopam infusions in KT recipients.

Comparison of perioperative analgesic effectiveness of ultrasound-guided erector spinae plane block and transversus abdominis plane block in patients undergoing laparoscopic nephrectomy.

In this study, we aimed to compare the efficacy of two regional anesthesia methods, transversus abdominis plane (TAP) block and erector spinae plane (ESP) block, for intraoperative and postoperative pain relief in patients undergoing laparoscopic nephrectomy. Fifty patients aged 18-80 years with American Society of Anesthesiologists (ASA) classification I-II scheduled for elective laparoscopic nephrectomy were included after ethical approval and informed consent. Patients were randomly assigned to either Group TAP (receiving TAP block) or Group ESP (receiving ESP block). Postoperatively, all patients received patient-controlled analgesia (PCA) with morphine. We evaluated intraoperative hemodynamics, additional opioid use, resting and coughing pain scores (Visual Analog Scales - VAS), time to first PCA dose, postoperative opioid consumption, rescue analgesic needs, opioid side effects, and patient and surgeon satisfaction. In Group ESP, postoperative VAS scores at 8 hours and during the first mobilization were significantly lower (p=0.019, p=0.004, respectively) compared to Group TAP. Patient satisfaction was notably higher in Group ESP (p=0.014). However, other postoperative parameters were similar between the groups (p>0.05). These findings held true when considering only radical nephrectomies, with no differences in the assessed parameters between simple and partial nephrectomies. In conclusion, both TAP and ESP blocks demonstrated comparable effectiveness in postoperative pain management for laparoscopic nephrectomies. Nevertheless, due to lower VAS scores during mobilization and higher patient satisfaction, the ESP block appears to be more effective for multimodal analgesia. Further research is required to comprehensively assess their efficacy in laparoscopic radical nephrectomies.

Efficacy of transversus abdominis plane block in postoperative pain management of laparoscopic totally extraperitoneal inguinal hernia repair: a propensity score-matched analysis.

Transversus abdominis plane (TAP) block is a promising technique for postoperative pain control. In this study, we aimed to evaluate the efficacy of the TAP block in managing postoperative pain after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. In this retrospective study, medical records of patients who had received ultrasonography-guided TAP blocks after surgery from January 2019 to August 2023 were reviewed and compared with those of patients who had not received. Propensity score matching was controlled for age as a confounder. Postoperative pain levels were measured using the numeric rating scale (NRS). After matching, 95 patients were included in each group. The TAP block group (2.7 vs. 4.0, P < 0.001) had significantly lower NRS scores immediately and early postoperative pain than the control group (1.9 vs. 2.5, P < 0.001). However, there was no significant difference between the 2 groups in terms of postoperative complications (P > 0.05). TAP block is effective and safe for managing immediate and early postoperative pain in laparoscopic TEP inguinal hernia repair and does not increase the risk of complications.

Dexmedetomidine versus Dexamethasone as an Adjuvant to Ropivacaine in Transversus Abdominis Plane Block in Infraumbilical Surgeries for Postoperative Analgesia: A Randomised Clinical Study

Introduction: Postoperative pain due to abdominal wall incision in infraumbilical surgeries can negatively impact surgical outcomes and increase the risk of complications. Effective postoperative analgesia facilitates rehabilitation and recovery. The Transversus Abdominis Plane (TAP) block is a regional analgesic technique that blocks the nerves supplying the anterolateral abdominal wall (T7-L1). Adjuvants like dexamethasone and dexmedetomidine added to local anaesthetics can prolong the duration of the block. Aim: To compare the duration of analgesia (the time of first rescue analgesia) and the quality of pain relief, as assessed by the Visual Analogue Scale (VAS), between dexmedetomidine and dexamethasone as adjuvants to ropivacaine in the TAP block for infraumbilical surgeries. The secondary objective was to compare postoperative haemodynamic changes and side effects. Materials and Methods: In this randomised double-blinded prospective clinical study, conducted in the Department of Anaesthesia, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS MIRC), Piparia, Vadodara, Gujarat, India from March 2023 to September 2024. 80 patients of American Society of Anaesthesiologists (ASA) I and II, aged 18-60 years, undergoing elective infraumbilical surgeries (open abdominal hysterectomy and open bilateral inguinal hernia repair) under spinal anaesthesia were randomly allocated into two groups of 40 patients each. Group-R1 received 0.2% ropivacaine 3 mg/kg plus dexamethasone 0.1 mg/kg, while Group-R2 received 0.2% ropivacaine 3 mg/kg plus dexmedetomidine 1 μg/kg in a bilateral TAP block. The total volume was made up to 50 mL with normal saline. Postoperative pain was assessed using VAS scores. The time to first rescue analgesia demand and haemodynamic parameters were recorded. Results: The mean age of the study participants was 40.15±7.46 years (Group-R1) and 39.5±5.59 years (Group-R2). Demographic data, type of surgery, and duration of surgery were comparable between the two groups. VAS scores were significantly lower in Group-R2 compared to Group-R1 at all time points up to six hours postoperatively (p&lt;0.0001). The mean duration of analgesia was significantly longer in Group-R2 (308.18±12.3 minutes) compared to Group-R1 (239.78±14.23 minutes) (p&lt;0.0001). Haemodynamic parameters were comparable between the groups, with no significant side effects observed. Conclusion: Dexmedetomidine 1 μg/kg as an adjuvant to 0.2% ropivacaine in the TAP block provided a longer duration of analgesia and better quality of pain relief compared to dexamethasone 0.1 mg/kg for postoperative analgesia in infraumbilical surgeries.

The effects of abdominal nerve block techniques as preventive analgesia on pediatric laparoscopic procedures: A randomized controlled trial

ABSTRACT Background The current study compared the effect of ultrasound-guided quadratus lumborum block (QLB) to transversus abdominis plane block (TAPB) on post-operative pain in children undergoing lower abdominal laparoscopy. Methods Ninety male and female patients (ASA I to II), ages (1–7), performing elective laparoscopic lower abdomen surgery randomly allocated into three equal groups of 30 patients each. Group (C) received conventional analgesics. In addition to conventional analgesics, 0.5 ml/kg of bupivacaine 0.25% was injected under US-guidance on both abdominal sides, into transversal plane at subcostal level in group (TAP) or into the facial plane between the PM and QL muscles in group (QL). Our primary outcome was the measuring FLACC scale immediately following surgery, every 30 minutes in the PACU, and then at 4, 6, 8, 10, 12, 18, and 24 hours after surgery. Our secondary outcomes were the first analgesic request, the dosage of analgesics, the postoperative complications, and parents’ satisfaction during the first 24 hours. Results When comparing the FLACC pain scores, the QL group showed a significant reduction in pain for the whole postoperative period in comparison to C group (p < 0.001) and up to 12 h in TAP group (p < 0.001). Patients in QL group got the longest time to the first analgesic requirement (p < 0.001). The C group required more analgesics overall than the other groups. Conclusions Ultrasound-guided QLB after induction of general anesthesia in comparison to TAP block provides better postoperative pain, prolonged analgesia, and less postoperative analgesic consumption after lower abdominal laparoscopic surgery in pediatrics.

Modified thoracoabdominal nerves block through perichondrial approach for surgical patients: a scoping review

BackgroundModified thoracoabdominal nerves block through perichondrial approach (M-TAPA) is a trunk block that has been gaining attention for managing postoperative pain following abdominal surgeries since its first report in 2019. We conducted a scoping review on M-TAPA, aiming to comprehensively evaluate existing research, identify the gaps in knowledge, and understand the implications of M-TAPA.MethodsThis scoping review was conducted using databases including PubMed, Embase, Cochrane, and CINAHL to evaluate the clinical efficacy of M-TAPA on April 19, 2024. Background and outcomes including anesthetized dermatomes, postoperative pain, opioid consumption, quality of recovery, duration to perform, and plasma local anesthetic concentrations were assessed. All reports involving patients, including randomized controlled trials, observational studies, case series, and case reports regarding M-TAPA, were included without language or age restrictions. The included studies were analyzed based on their methodology and clinical relevance.ResultsAnesthetized dermatomes were mainly observed in anterior cutaneous branch T7–11. Lateral cutaneous branch T8–10 also anesthetized; however, the probability was lower than anterior cutaneous branch area. M-TAPA has been investigated mostly in laparoscopic cholecystectomy; although its potential to outperform non-block and wound infiltration has been suggested, it did not clearly outperform the transversus abdominis plane block.ConclusionsM-TAPA may be considered a promising technique for postoperative pain management in upper abdominal laparoscopic surgeries. Further studies are warranted to elucidate the precise mechanisms and broader surgical applications.

TECHNICAL AND QUANTITATIVE ANALYSIS OF PAIN MANAGEMENT IN MAJOR SURGERIES USING REGIONAL ANESTHESIA WITH OPIOID-SPARING DRUGS

The management of acute postoperative pain (APP) in major abdominal surgeries remains a critical challenge due to the adverse effects associated with opioid use, such as respiratory depression, nausea, vomiting, and decreased gastrointestinal motility. These complications underscore the need for alternative pain management strategies that minimize opioid dependence while ensuring effective analgesia. This study systematically reviews the opioid-sparing effects of regional anesthesia techniques, with a specific focus on the transversus abdominis plane (TAP) block and quadratus lumborum block (QLB). Both techniques are increasingly recognized as essential components of multimodal analgesia strategies, which aim to optimize postoperative recovery and reduce opioid-related complications. The findings reveal that TAP and QLB are highly effective in controlling postoperative pain, significantly decreasing opioid requirements and enhancing recovery outcomes. TAP block has demonstrated particular efficacy in reducing pain and opioid consumption in colorectal and bariatric surgeries, while QLB has shown promise in managing pain for more extensive abdominal procedures, offering prolonged analgesic effects. Despite their shared benefits, each technique presents unique efficacy profiles, which are influenced by factors such as surgical type, patient characteristics, and the choice of local anesthetic. These distinctions highlight the importance of tailoring regional anesthesia techniques to individual patient needs. This study also emphasizes the role of multimodal analgesic approaches that combine regional anesthesia with other non-opioid analgesics, such as ketamine and lidocaine, to further enhance pain control and minimize opioid use. Such approaches not only improve pain management but also contribute to faster recovery and fewer complications, such as postoperative nausea and delayed gastrointestinal transit. In conclusion, integrating regional anesthesia techniques like TAP and QLB into multimodal pain management protocols offers substantial benefits in reducing opioid consumption and enhancing postoperative recovery. Future research should focus on direct comparisons between regional techniques, their long-term effects, and their potential to reduce chronic pain recurrence, ensuring continued advancements in perioperative care.

A Comparison between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Inguinal Hernia Repair

A Comparison between Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Inguinal Hernia Repair

Regional nerve block in postoperative analgesia after cesarean section: A narrative review

Of all obstetric operations, cesarean section is one of the most common. The impact of postoperative pain on physical and mental health in women cannot be ignored. Moreover, effective postoperative analgesia is essential in women who have given birth. Traditional systemic analgesic methods (intravenous analgesia, oral analgesics, etc) are often accompanied by adverse reactions that are positively correlated with the drug dosage. Regional nerve block is an analgesic and anesthetic technique that temporarily blocks nerve conduction by injecting local anesthetics around the nerve roots, nerve trunks, nerve plexus, ganglia, or surgical area, thereby alleviating or eliminating pain. Currently, the regional block techniques used for postoperative analgesia following cesarean section include paravertebral nerve block, transversus abdominis plane block, rectus sheath block, quadratus lumborum block, ilioinguinal-iliohypogastric nerve block, erector spinae block, wound infiltration analgesia, and intraperitoneal infusion of local anesthetics. These regional block techniques hold great promise for providing effective postoperative analgesia after cesarean section, each with unique advantages. Moreover, regional blocks have a unique place in multimodal analgesia protocols following cesarean section and are increasingly used in clinical practice for analgesia after cesarean section. This review provides an overview of the regional nerve block techniques used for postoperative analgesia following cesarean section, discusses their benefits and drawbacks, and provides a reference for choosing postoperative pain management following cesarean delivery, offering a hopeful outlook for improved patient care.

The use of interfascial blocks for complex analgesia in the surgical resicrion of soft tissue tumors in the chest area in kompanion animals

Achieving satisfactory results of surgical treatment of cancer patients is impossible without pain control both intraoperatively and in the early postoperative period. The inclusion of regional anesthesia in multimodal pain control protocols can significantly improve the quality of analgesia and accelerate patient recovery after surgery. Nevertheless, each method of interfascial plane block has its own indications, contraindications, and complications. The purpose of our study was to show the validity and effectiveness of the use of regional anesthesia in the form of interfascial plane blocks during surgical resection of soft tissue tumors in the chest area in companion animals. The study were included 49 animals (30 dogs and 19 cats) who underwent surgery resection of soft tissue tumors in the chest area. The criterion for the inclusion of animals in the study was the use of regional anesthesia in the form of interfascial plane blocks in the anesthesia protocol. As a result of the study, it was revealed that the combination of several interfascial blocks provides a significantly better level of analgesia in resection of volumetric formations in the early postoperative period, however, when performing a unilateral mastectomy, the combination of a transversus abdominis plane block with a erector spinae plane block does not reduce the postoperative pain level. In mastectomies involving the cranial mammary glands, the best result for postoperative anesthesia is shown by the use of serratus anterior plane block. The inclusion of interfascial plane blocks in the anesthesia protocol for oncological patients makes it possible to significantly reduce or eliminate the use of narcotic analgesics in the perioperative period and, accordingly, avoid side effects and complications associated with the use of narcotic drugs, which is especially important for debilitated and geriatric patients.

The Efficacy of Transversus Abdominis Plane (TAP) Blocks When Completed by Anesthesiologists Versus by Surgeons: A Systematic Review and Meta-Analysis.

Background/Objectives: Current literature has demonstrated the benefits of transversus abdominis plane (TAP) blocks for reducing postoperative pain and opioid consumption for an array of surgical procedures. Some randomized controlled trials and retrospective studies have compared ultrasound guidance TAP blocks completed by anesthesiologists (US-TAP) to laparoscopic guidance TAP blocks completed by surgeons (LAP-TAP). However, the findings of these studies have not been consolidated to improve recommendations and patient outcomes. Our objective is to consolidate and summarize current literature regarding the efficacy of TAP blocks for postoperative pain control and opioid consumption when performed with ultrasound guidance (US-TAP, compared to laparoscopic guidance (LAP-TAP). Methods: We performed a systematic review and meta-analysis of RCTs and retrospective studies to evaluate US-TAP versus LAP-TAP blocks for postoperative pain control and opioid consumption. We searched PubMed/MEDLINE, CINAHL, Cochrane, and Web of Science databases for all articles meeting the search criteria until the time of article extraction in February 2024. The primary outcome variables were postoperative pain scores and opioid consumption. The secondary outcome variables were complications, time taken to perform the block, length of stay (LOS) in the hospital, and cost of performing the block. Results: Of the 1673 articles initially identified, 18 studies met the inclusion criteria for evaluation. Of the included studies, 88.9% and 77.8% found no significant difference in postoperative pain scores or opioid consumption, respectively, between US-TAP and LAP-TAP groups. Six studies (33.3%) found that LAP-TAP was faster to perform than US-TAP. Meta-analysis demonstrated no statistically significant differences in postoperative pain scores or opioid consumption between groups but showed that block times were significantly longer in the US-TAP group. Conclusions: US-TAP and LAP-TAP blocks may be equivocal in terms of reducing postoperative pain and opioid consumption. LAP-TAPs may be less time-consuming and more cost-effective and viable alternatives to US-TAP blocks in the perioperative setting.

Continuous Epidural Versus Non-Epidural Pain Management After Minimally Invasive Esophagectomy: A Real-Life, High-Case-Load Center Experience.

Background/Objectives: Esophagectomy is a key component of esophageal cancer treatment, with minimally invasive esophagectomy (MIE) increasingly replacing open esophagectomy (OE). Effective postoperative pain management can be achieved through various analgesic modalities. This study compares the efficacy of thoracic epidural anesthesia (TEA) with non-TEA methods in managing postoperative pain following MIE. Methods: A retrospective review was conducted on 110 patients who underwent MIE between 2018 and 2023. 1. TEA vs. 2. intravenous patient-controlled analgesia (PCA) alone vs. 3. transversus abdominis plane (TAP) catheter with PCA vs. 4. single-shot TAP block with paravertebral catheter (PVB) in combination with PCA were compared. The primary outcome was postoperative pain within the first 72 h, assessed using the numeric rating scale. Secondary outcomes included postoperative surgical complications (Clavien-Dindo classification (CDC)), patient satisfaction, and duration of induction and emergence, among others. Results: The incidence of an NRS > 3 during movement was 47.1%, 51%, 60.1%, and 48.3% for TEA, PCA alone, TAP + PCA, and PVB + PCA, respectively. For pain at rest, the rates were 8.3%, 4.3%, 11.2%, and 5%, respectively. High surgical complication rates were observed across all groups (CDC IIIa-V 31.6% overall), with patient satisfaction similarly high, regardless of the analgesic modality used (85% satisfied or very satisfied). No differences in the other secondary outcomes were observed. Conclusions: PVB combined with PCA offered analgesic efficacy and patient satisfaction comparable to TEA in managing postoperative pain following MIE.