Ultrasound-guided Subcostal Transversus Abdominis Plane Research Articles

Preoperative Bilateral External Oblique Intercostal Plus Rectus Sheath Block for Postoperative Pain Management following Laparoscopic Cholecystectomy: A Non-inferior 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-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-h sufentanil consumption. A total of 49 patients were included in the final analysis. The postoperative 24-h sufentanil consumption in the EOI group was significantly lower than that in the TAP group (9.79±10.22µg vs. 18.67±12.58µg; p (non-inferiority) <0.01; non-inferiority confirmed). Fewer patients in the EOI versus TAP group had a numerical rating score of >3 during motion. Furthermore, the mean postoperative 48-h sufentanil consumption was lower in the EOI versus TAP group (11.54±11.70µg vs. 23.04±17.10µg; P=0.01). The mean postoperative 24-h 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.

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Comparative study between ultrasound-guided subcostal transversus abdominis plane block and paravertebral block for postoperative analgesia in laparoscopic cholecystectomy

Ultrasound-guided versus laparoscopic-guided subcostal transversus abdominis plane (TAP) block versus No TAP block in laparoscopic cholecystectomy; a randomized double-blind controlled trial

BackgroundTransversus abdominis plane (TAP) block is an effective modality for the control of immediate postoperative pain. The present randomized trial aimed to assess the efficacy of ultrasound-guided subcostal TAP (USTAP) and laparoscopic subcostal TAP (LSTAP) block as compared to standard care without TAP block after laparoscopic cholecystectomy. MethodsThis was a prospective, randomized, controlled trial on patients who underwent laparoscopic cholecystectomy. Patients were equally randomized to one of three groups: USTAP, LSTAP, and control group (no TAP block). The main outcome measures were pain scores and analgesic consumption within the first 24 h postoperatively, postoperative nausea and vomiting (PONV), time to ambulation, time to first flatus, and adverse effects of TAP block. ResultsThe trial included 110 patients (90% females) with a mean age of 40.9 ± 11.7 years. Both USTAP and LSTAP block groups were associated with significantly lower pain scores at 2, 6, 12, and 24 h postoperatively, lower cumulative dose of paracetamol, less PONV, and shorter time to flatus than the control group. USTAP and LSTAP block were associated with similar pain scores at all time points, similar analgesic requirements, a similar incidence of PONV, and comparable time to first ambulation and time to first flatus. No adverse effects related to TAP block were recorded. ConclusionsTAP block is a safe and effective method for pain control and improving recovery after laparoscopic cholecystectomy. Both USTAP and LSTAP blocks were equally effective in terms of pain relief, analgesic requirements, PONV, return of bowel function, and time to ambulation.

Ultrasound-guided subcostal transversus abdominis plane block for pain management in open surgical gastrostomy: A case series

Gastrostomy is needed to provide nutritional support in patients with head and neck cancer surgery. The incision in upper abdomen causes moderate pain. We usually encountered our postoperative patients complaining of significant discomfort that leads us to think about adding some regional anesthesia techniques with conventional pain management. Recently, the role of regional anesthetic techniques for involving anterior abdominal wall has been increased. Ten patients who underwent head and neck cancer surgery requiring open surgical gastrostomy for long-term nutritional support were taken into this descriptive case series. In addition to general anesthetic, intravenous nalbuphine, and paracetamol, ultrasound-guided subcostal transversus abdominal plane (TAP) block was performed 30 min prior to incision of gastrostomy to improve postoperative analgesia. All 10 patients had significant pain relief at gastrostomy incision site which is different from our experience in the same patient population before. The numerical rating score (NRS) was between 0 and 2, and average satisfaction score was 7–8 on a scale of 10. The patients reported a very low level of discomfort. No adverse events were recorded up to patient discharge from the hospital. Subcostal TAP block under ultrasound guidance is a valuable addition to improve postoperative pain management in open surgical gastrostomy. The available case series show encouraging analgesic results with no adverse events recorded. Formal prospective randomized trials are needed to provide further evidence on its efficacy, failure rate, and safety.

COMPARISON OF SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH PORT SITE INFILTRATION OF LOCAL ANAESTHESIA IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: To compare the efficacy of ultrasound guided subcostaltransversus abdominis plane block and port site infiltration of local anaesthesia in patients undergoing laparoscopic cholecystectomy.&#x0D; Study Design: Comparative cross sectional study.&#x0D; Place and Duration of Study: Anesthesiology department, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jun 2019.&#x0D; Methodology: A sample size of 62 patients calculated by World Health Organization calculator were randomized in a doubleblind study to undergo Sub costal transversus abdominis plane block or port site infiltration by non-probability, consecutive sampling into two equal groups. Group A received sub costal transversus abdominis plane block and group B local anaesthetic. Postoperative pain perception was measured using visual analogue scale.&#x0D; Results: The mean age of patients in group A was 33.39 ± 8.91 years and in group B was 33.77 ± 8.45 years. Out of 62 patients 38 (61.29%) were males and 24 (38.71%) were females. Mean pain score in group A (ultrasound guided sub costal transversus abdominis plane block) was 1.61 ± 0.91 while in group B (port site infiltration of local anaesthetic) was 3.61 ± 1.05 (p-value 0.0001).&#x0D; Conclusion: The mean pain score was less following use of ultrasound guided sub costal transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy as compared to port site infiltration of local anaesthesia.

Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Subcostal Transversus Abdominis Plane Block for Percutaneous Nephrolithotomy: A Prospective, Randomized Trial.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing kidney stones, but patients still suffer from moderate postoperative pain. The aim of this study is to evaluate the perioperative analgesic effect of ultrasound-guided subcostal transversus abdominis plane (TAP) block performed before PCNL procedure. Materials and Methods: Patients scheduled for elective PCNL were randomized into two groups: Group TAP and Group IV. General anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with sevoflurane, fentanyl, and rocuronium. Unilateral ultrasound-guided TAP block was performed with total of 30 mL volume of local anesthetic solution (20 mL bupivacaine 0.125% plus 10 mL lidocaine 1%) after intubation but before surgery to the Group TAP patients. Paracetamol 1 g was given to the Group IV. Tramadol 100 mg and morphine IV-patient-controlled analgesia were applied to both groups. Perioperative fentanyl consumption, postoperative verbal analog scale (VAS), morphine consumption, and additional analgesic drug requirement were assessed. Chi square with Yates correction and Mann-Whitney U tests were used for statistical analysis. Results: Eighty patients were assessed for enrollment. One patient developed septicemia at the recovery room so data of 79 patients were collected for statistical analysis. Total morphine consumption at 48th hour after the surgery was lower at Group TAP (p = 0.022). Perioperative fentanyl consumption was lower at Group TAP (p < 0.001). Additional analgesic requirement and VAS were comparable between groups. Conclusions: Preemptive unilateral ultrasound-guided subcostal TAP block decreases perioperative fentanyl and postoperative total morphine consumption in PCNL patients compared to IV analgesic management.

Ultrasound-Guided Transversus Abdominis Plane Block in Shetland Ponies: A Description of a Three-Point Injection Technique and Evaluation of Potential Analgesic Effects

Colic surgery is one of the most painful procedures carried out in horses. Common strategies to alleviate immediate postsurgical abdominal pain include the administration of potent systemic analgesics; however, these may cause unwanted adverse effects such as cardiovascular depression, ileus, and ataxia. The administration of local anesthetics at the incision site in form of an ultrasound-guided subcostal transversus abdominis plane (TAP) block may therefore be preferred to provide adequate analgesia without significant side effects. To date, no technique for a TAP block in horses undergoing median celiotomy has been described. The objective of the study was to develop a TAP block technique, which will lead to the desensitization of the ventrolateral abdominal wall and adjacent skin area of experimental Shetland Ponies using bupivacaine 0.125%. This is a prospective, blinded, self-controlled trial. A cadaver study was performed to determine the ideal injection points and the volume required to stain the nerves responsible for the sensation of the ventrolateral abdominal wall and skin in Shetland pony cadavers (i.e., T9–L 2). Subsequently, using the ideal injectate volume and the landmarks obtained in the first phase of the study, six Shetland ponies received a bilateral TAP injection, either with a local anesthetic solution (bupivacaine 0.125%) or with saline in a randomized, crossover, blinded fashion. Effectiveness was determined over a 4 hour postinjection time, by using a pinprick technique. Significant differences were found to the responses of the pinprick evaluation between the bupivacaine- and saline-treated sides after 30 minutes of TAP block injection. Reported “learned behavior” could have affected the results of the pinprick testing. The TAP block technique reported in this study using bupivacaine 0.125% appeared effective in desensitizing the lower abdomen of ponies for up to 2 hours. Further research is required to apply this technique in horses undergoing celiotomy. Potentially larger volumes and/or higher concentrations of bupivacaine may be necessary to provide longer duration of action of the block.

Comparison of laparoscopy-guided with ultrasound-guided subcostal transversus abdominis plane block in laparoscopic cholecystectomy - A prospective, randomised study.

Background and Aims:Subcostal transversus abdominis plane (TAP) block is usually done under ultrasound guidance in laparoscopic cholecystectomy. Laparoscopic-guided subcostal TAP block is an alternate technique where ultrasound is not available. Our primary objective was to compare the success rate of ultrasound and laparoscopic approaches to the subcostal TAP block. The secondary objectives were to assess the duration of postoperative analgesia and morphine consumption postoperatively for 24 h.Methods:Eighty patients undergoing laparoscopic cholecystectomy were randomly divided into two groups with patients receiving ultrasound-guided (group U) or laparoscopy-guided (group L) subcostal TAP block at the end of surgery. The success rate was assessed by a sensory blockade of T7 and T8 dermatomes 30 min after extubation. The duration of analgesia was taken as time from block administration to the visual analogue scale of ≥3. Morphine was administered in patient-controlled analgesia (PCA) pump with a bolus of 1 mg and a lock-out interval of 10 min. The total morphine consumption was recorded. The statistical analysis was performed with student t-test and Chi-square test.Results:The success rate of group U (100%) was higher than group L (88%) but it was not statistically significant (P = 0.054). The duration of postoperative analgesia was significantly prolonged in group U (867.24 ± 135.83 min) than group L (751.31 ± 311.22 min) (P = 0.033). Morphine consumption was also less in group U (4.72 ± 0.94 mg) than group L (5.57 ± 2.53 mg) (P = 0.049). There was no significant difference in the VAS scores after 4 h postoperatively.Conclusion:Laparoscopy-guided subcostal TAP block is a suitable alternative to ultrasound-guided block and can be utilised in places where an ultrasound machine is not available.

Ultrasound-guided subcostal transversus abdominis plane block with liposomal bupivacaine compared to bupivacaine infiltration for patients undergoing robotic-assisted and laparoscopic hysterectomy: a prospective randomized study.

PurposeTo determine if a transversus abdominis plane (TAP) block with liposomal bupivacaine reduces total postoperative opioid use in the first 72 hrs following laparoscopic or robotic hysterectomy compared to port-site infiltration with 0.25% bupivacaine.MethodsPatients received either a true TAP block procedure with 266 mg liposomal bupivacaine and 50 mg of 0.25% bupivacaine and sham port infiltration or sham TAP block procedure with true port-site infiltration with 100–125 mg of 0.25% bupivacaine. All patients had a standardized, scheduled, non-opioid pain management plan. The primary outcome was total IV morphine equivalents used in the first 72 hrs following surgery. Secondary outcomes included assessment of postoperative pain over the study period and quality of recovery measures.ResultsPatients undergoing TAP blockade required fewer total opioid equivalents during the observation period than patients allocated to infiltration (median 21 versus 25 mg IV Morphine equivalents, P=0.03). Opioid use was highest in the first 24 hrs after surgery, with less difference between the groups during days 2 and 3 postoperatively. There were 5 in the TAP group and 0 in the infiltration group were opioid free at 72 hrs. Those in the TAP group had improved quality of recovery (QoR15) with no change in overall benefit of analgesia score.ConclusionTAP blockade reduced the requirement for opioid pain medication in the first 72 hrs after surgery, had more patients opioid free at 72 hrs, and improved patients’ quality of their recovery.

Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study.

Background The aim of this study was to compare the effectiveness of ultrasound-guided (USG) subcostal transversus abdominis plane (TAP) block and quadratus lumborum (QL) block as preventive analgesia methods after laparoscopic cholecystectomy. Methods A total of 120 patients, 18–75 years of age, were separated into 2 groups preoperatively. Patients in group TAP (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral subcostal TAP block; patients in group QL (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral QL block. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 h were recorded. Results Fifty-three patients in group TAP and 54 in group QL were ultimately evaluated. No statistically significant difference was found in at rest and dynamic visual analog scale scores between the groups. There was also no statistically significant difference between the groups with regard to total analgesia consumption. Although the duration of anesthesia was significantly longer in group QL, no statistically significant difference was found in the duration of surgery between the groups (p < 0.05). Conclusions Results of this study demonstrated that USG subcostal TAP and QL blocks similarly reduced postoperative pain scores and analgesia consumption, with high patient satisfaction. However, subcostal TAP block could be considered preferable to QL block because it can be applied easily and in a shorter time.

Efficacy of ultrasound-guided subcostal transversus abdominis plane block for analgesia after laparoscopic cholecystectomy

Introduction: Subcostal transversus abdominis plane (TAP) block involves nerves of anterior abdominal wall. In the present study, the primary objective was to find out whether subcostal TAP block reduces the requirement of rescue analgesics following laparoscopic cholecystectomy.Materials and Methods: Fifty patients scheduled for laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups. Twenty-five patients in Group B received subcostal TAP block with 0.25% bupivacaine 20 mL on each side and 25 patients in Group A received 0.9% normal saline 20 mL on each side after completion of surgery. Each patient's pain was assessed using visual analog scale (VAS) score at 0, 2, 4, 8, 16, and 24 h. The primary outcome measure was to compare the requirement of rescue analgesia, whereas secondary outcome measure was to compare satisfaction grades between the two groups. Comparison of quantitative and qualitative variables between groups was done using unpaired student's t-test and Chi-square test, respectively, using Statistical Package for the Social Sciences.Results: Percentage of patients who required paracetamol (P < 0.002) and nalbuphine (P < 0.001) as rescue analgesic was significantly less in Group B as compared to Group A. In all, 92% of Group B and 4% of Group A patients had a satisfactory overall quality of postoperative analgesia which was statistically significant (P < 0.002).Conclusion: Subcostal TAP block is an effective method of providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

Anesthetic management of a hydrocephalus patient with inclusion body myositis

Inclusion body myositis (IBM) is an inflammatory muscle disease characterized by slowly progressive muscle weakness and wasting, especially affecting proximal leg and distal arm. We report a successful anesthetic management of a 68-year-old male patient with IBM undergoing ventriculoperitoneal shunt. Anesthesia was induced and maintained with total intravenous anesthesia using propofol, remifentanil, and ketamine. The trachea was uneventfully intubated without muscle relaxants. Ultrasound-guided subcostal transversus abdominis plane block and rectus sheath block were performed with 0.25% levobupivacaine 45 ml that could provide good surgical condition without muscle relaxants. Intravenous flurbiprofen 50 mg and morphine 2 mg were used for postoperative analgesia. The patient’s emergence from general anesthesia and the postoperative course was uneventful.

Analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block

Background:To evaluate the analgesic efficacy on defined areas of the abdomen and back after ultrasound-guided subcostal transversus abdominis plane (TAP) block using 0.25% levobupivacaine 0.5 mL/kg.Methods:Twenty patients undergoing elective laparoscopic cholecystectomy, between 20 and 60 years of age with operative time <1 hour, received subcostal TAP block using 0.25% levobupivacaine 0.5 mL/kg on the left side. Surgery started after 1 hour of observation. Sensory assessment was undertaken using pinprick and 75% ethyl alcohol at 10, 20, 30 minutes, 1, 3, and 12 hours after TAP block at 19 testing zones that were divided by anatomic landmark lines on the abdomen and the back. Efficacy of zone was defined as loss of cold temperature sensation or loss of pinprick pain sensation in more than 50% patients in that testing zone. Duration was determined by analgesia and loss of temperature sensation beginning within 30 minutes of TAP block placement lasting until time points of 1, 3, and 12 hours. All of the testing zones were divided as Group I effective at 20 minutes in less than 50% patients (0%–50%), Group II 50% to 70% patients, Group III 70% to 90% patients, and Group IV 90% to 100% patients.Results:Twenty patients meeting the study requirements were included. At each time point, the efficacies among 4 groups were significantly different. Subcostal TAP had good efficacy and stable duration in zones 1, 2, 3, 5, and 6.Conclusion:Subcostal TAP block with 0.25% levobupivacaine 0.5 mL/kg dose provided effective analgesia in the anterior abdominal wall between medioventral line to anterior axillary line except the lateral upper abdominal region.

Perineural dexamethasone does not enhance the analgesic efficacy of ultrasound-guided subcostal transversus abdominis plane block during laparoscopic cholecystectomy

Ultrasound-guided transversus abdominis plane (TAP) block is an adjunct therapy to provide effective postoperative analgesia in abdominal surgical procedures. Dexamethasone is a supplement agent that can improve the efficacy of local anesthesia. However, information about its additive effect is limited. This study aimed to compare the analgesic efficiency using ultrasound-guided TAP block with and without perineural dexamethasone for patients who underwent laparoscopic cholecystectomy. Sixty patients who underwent laparoscopic cholecystectomy were randomly divided into three groups: group I, controls; group II, TAP; and group III, TAP+perineural dexamethasone supplement. The requirement of additional analgesia and the first-time request of rescue-analgesia were recorded after operation and the numerical rating scale was evaluated at specific intervals. Compared to group I, the first-time requirement of rescue-analgesia in groups II and III was significantly delayed (403.0+/-230.9, 436.0+/-225.3 vs 152.3+/-124.7, P<0.01). Compared with those in group I, patients in groups II and III were associated with lower numerical rating scale pain scores (P<0.01) and less postoperative analgesic consumption (P<0.01). There was no significant difference in the variables mentioned above between groups II and III (P>0.05). Perineural dexamethasone has no additive/synergistic effect with subcostal TAP block on analgesic efficacy for the patients undergoing laparoscopic cholecystectomy.

Abstract PR502

Background & Objectives: To evaluate the analgesic efficacy on different area on abdomen and back after ultrasound-guided subcostal transversus abdominis plane (TAP) block using 0.25% levobupivacaine 0.5 ml/kg. Materials & Methods: Twenty patients undergoing elective laparoscopic cholecystectomy, American Society of Anesthesiologists (ASA) I orII, between 20 and60 years of age, operative time <1h, received subcostal TAP block using 0.25% bupivacaine 0.5ml/kg on the left side. Surgery started after one hour of observation. Sensory assessment was undertaken using pinprick and 75% ethyl alcohol at 10 min, 20 min, 30 min, 1 hour, 3 hours, and 12 hours after TAP block at 19 testing zones which were divided by anatomic landmarks lines on abdomen and back. Effectiveness of zone was determined by effectiveness in more than 50% patients in that testing zone, stability was determined by effectiveness of at least two time points of 10, 20, 30 min and at least two time points of 1, 3, 12h. All of the testing zones were divided as 0-50% positive group (effective in less than 50% patient), 50-70% group, 70-90% group, and 90-100%. Results: 20 cases of adult patients who met the requirements were included in the study, the average time of their block level appeared was 1.01 ± 0.02min. Twenty patients met the study requirements were included. At each time points, the effectiveness between groups were significant different (P<0.0083). The testing zones 1, 2, 3, 5, and 6 were effectively and stably blocked.Conclusion: Subcostal TAP block with 0.25% levobupivacaine with 0.5ml/kg dose, provided effective and stable analgesia in the anterior abdominal wall between medioventral line to anterior axillary line of the anterior abdominal wall, except the upper lateral abdominal area. Disclosure of Interest: None declared

Plasma ropivacaine concentration following ultrasound-guided subcostal transversus abdominis plane block in adults.

Ultrasound-guided subcostal transversus abdominis plane block (TAPB) is widely used for abdominal surgery; however, arterial plasma concentration of the anesthetic ropivacaine after the blockade is still unclear. We evaluated ropivacaine concentration after subcostal TAPB in adult patients undergoing upper abdominal surgery. Twelve patients with American Society of Anesthesiologists physical status 1-2 were enrolled. They received ultrasound-guided subcostal TAPB with 0.45 % ropivacaine at 3 mg/kg. Arterial plasma samples were collected at 15, 30, 45, 60, 90, and 120 min after the blockade and analyzed for total ropivacaine concentration using liquid chromatography and mass spectrometry. At every time point, the maximum concentrations (C(max)), and time to the C max (T(max)) were recorded. The mean C(max) and T(max) were 1.87 (0.78) µg/ml and 31.3 (16.7) min, respectively. No adverse events or clinical symptoms indicating systemic toxicity were observed during this study. The study demonstrated that administration of ropivacaine at 3 mg/kg during subcostal TAPB led to rapid increases in plasma concentration of the anesthetic during the first 2 h after the blockade. C(max) nearly reached the threshold for systemic toxicity.

Ultrasound-guided Subcostal Transversus Abdominis Plane Block

Ultrasound-guided subcostal transversus abdominis plane block is a recently described regional anaesthetic technique for providing postoperative analgesia after upper abdominal surgery. Use of subcostal TAP catheters holds considerable promise on account of its relative simplicity, efficacy and safety profile. This article reviews the current literature on this technique and reflects on personal experience.