Ultrasound-guided Transversus Abdominis Plane Block Research Articles

Research Article Evaluating the pain relief effects after caesarean delivery by ultrasound-guided transversus abdominis plane (tap) block in Hanoi Obstetrics and Gynecology Hospital, Vietnam

Research Article Evaluating the pain relief effects after caesarean delivery by ultrasound-guided transversus abdominis plane (tap) block in Hanoi Obstetrics and Gynecology Hospital, Vietnam

Quadratus lumborum block versus transversus abdominis plane block for post Caesarean analgesia: A randomized prospective controlled study

BackgroundEffective postoperative analgesia after lower segment caesarean section (LSCS) is very important for early ambulation and early breast feeding and has a role to play in decreasing postpartum depression. Quadratus lumborum (QL) block, a fascial plane block, is gaining popularity for pain management in lower abdominal surgeries. The aim of the present study was to compare the ultrasound-guided (USG) transversus abdominis plane (TAP) block and QL block in patients undergoing LSCS under spinal anaesthesia. MethodsDouble-blinded, randomized, controlled, single-centre study done between Aug 2019 and Oct 2019, randomised 80 patients scheduled for LSCS into two groups, QL (N = 40) and TAP (N = 40), receiving USG TAP or QL block 20 ml of 0.25% bupivacaine with 4 mg dexamethasone bilaterally, postoperatively. ResultsSSPS 20 was used for the statistical analysis Patients were evaluated for 24-h using visual analogue scale (VAS) for pain scores, time to rescue analgesia and the analgesic dose requirement at regular time intervals. Fifteen percent patients in QL block and 75% in TAP block required rescue analgesia (P < 0.001). Significant differences were observed in pain scores at 10 h postoperatively, VAS in QL=1.18 (0.55), TAP=3.08 (1.66) (P < 0.001). By 24 h postoperatively the difference ceased to be statistically significant. Time to rescue analgesia in QL group was 1353 min (+/−224.07) and TAP group 915 min (+/−391.62) (P < 0.001). Average requirement of rescue analgesia (paracetamol) in QL group was 153.84 mg, TAP group 756.09 mg. ConclusionsPatients receiving QL block had prolonged analgesic effects and required less use of rescue analgesia in comparison with TAP group in the first 24 h postoperatively. Trial numberCTRI/2019/07/020475.

Ultrasound-Guided Ilioinguinal/Iliohypogastric Nerve Block versus Ultrasound Guided Transversus Abdominis Plane Block for Lower Abdominal Surgeries: A comparative Clinical Study

Background: Effective pain relief is of utmost importance to anyone undergoing surgery. Postoperative pain relief increases patient comfort and satisfaction. This is best accomplished with a multi-modal approach. Recent trends in minimally invasive surgery and improved recovery protocols have addressed pain treatment in light of these goals. Aim of the work: Comparison between ultrasound-guided Ilioinguinal and Iliohypogastric nerve block with ultrasound-guided transversus abdominis plane block regarding postoperative analgesia in patients scheduled for lower abdominal surgeries. Patients and methods: Seventy patients of ASA I or II, aged 21-50 years, who planned for elective open lower abdominal surgeries were included. They signed an informed consent and were randomly classified into two groups: [Group I] scheduled for Ilioinguinal and Iliohypogastric nerve block, and [Group II] scheduled for transversus abdominis plane block guided by ultrasound. Postoperative pain assessment was conducted by numerical rating score. Results:In inguinal hernia repair, pain score at rest was significantly reduced in the TAP group when compared to Group-I at 30 minutes till the seventh hour postoperatively and at 12 up to 15 hours postoperatively. Also, in the CS group, the pain score was significantly decreased in TAP block when compared to nerve block at 90, 105 minutes, and from 4 up to seventh postoperative hours. With movement, pain scores were significantly lower at the 4, 5, 6, 7, 8, 9, 10, and 11 -hours in group II in inguinal hernia. It was significantly decreased at the 90 minutes to 2 -hours in group II in the CS subgroup. The total analgesic requirements were significantly lower in group II. Conclusion: Ultrasound-guided TAP block tended to be more effective than Ultrasound-guided II/IH nerve block in lowering postoperative pain scores and decreasing the need for rescue analgesia in lower abdominal surgeries.

Anesthesia for open inguinal hernia repair with ultrasound-guided transversus abdominis plane block in a high-risk elderly patient: Case report

Anesthesia for open inguinal hernia repair with ultrasound-guided transversus abdominis plane block in a high-risk elderly patient: Case report

Management of cesarean delivery in a parturient with osteogenesis imperfecta：A case report

Osteogenesis imperfecta (OI) is characterized by bone fragility, defects in the teeth, blue sclera, and deficits in hearing and vision [1,2]. Because of an anticipated difficult airway and back anatomy, there is a high risk of choosing either general or spinal anesthesia, especially in critically ill obstetric patients. It is still controversy about the anesthesia method in patients with OI. Ultrasound-guided transversus abdominis plane block (TAPB) has been used for analgesia after cesarean section, but rarely for anesthesia in this operation [3-5]. We describe a critically parturient with OI who underwent cesarean section under ultrasound guided TAPB with spontaneous breathing general anesthesia. The patient's vital signs have remained stable during the operation, and a live female infant was delivered successfully by cesarean section. The mother and daughter were safe at last. Written informed consent was provided by the patient for publication of this report with photos.created.

EARLY RECOVERY FOLLOWING ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK (TAP) IN ABDOMINAL CONTOURING SURGERIES

Background:The transversus abdominis plane (TAP) block is a well-known regional nerve block that is used for the pain control after various inguinal andabdominal surgeries. The most effective and well known method of administering the TAP block is under ultrasound guidance.Till now only few studies have evaluated analgesic efficacy of TAP block in Abdominoplastysurgical procedure, in which post-operative pain is a major concern for both surgeon as well for the patient. Objectives:We conducted retrospective cohort study to assess efficacy of ultrasound-guided bilateral TAP block, in controlling post-operative pain in abdominoplasty patients. Methods:Sixty Patients who had undergone Lipoabdominoplasty procedurewere studied retrospectively. The patients who had received TAP block were assigned as groups A and those patients who had not received any TAP block were assigned as group B, with thirty Patients in each group.The patients in two groups were compared for their demographic characteristics, pain intensity on mobilization, time to first rescue analgesic dose (visual analog scale (VAS) score ≥ 5 or on demand), opioid consumptionand incidence of nausea-vomitingepisodes during first post-operative 24 hours. Results:The patients in two groups were similar in demographic characteristics. Patients in group A (TAP block group) had required significantly smaller mean dose of postoperative opioids (Group A: 5mg Group B: 75 mg P = &lt;0.000) and hadsignificantly longer mean time of first request for analgesic medication (Group A: 8 hours 11 minutes Group B: 1 hours 20 minutes P = &lt;0.000).Median VAS score on mobilization was significantly lower in Group A(group A: 1 Group B: 5).Only Three patients in group A as compared to 18 patients in group B had experienced nausea and vomiting in post-operative period. Conclusions:The ultrasound guided TAP block provide more effective analgesia after Lipoabdominoplasty, which allows more comfortable early post-operative mobilization, decreases opioid requirement as well as opioid related side-effects, Therefore ultrasound guided TAP block should be considered in most of lipoabdominoplasty patients for better patient experience and outcome.

Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials

PurposePain after bariatric surgery can prolong recovery. This patient group is highly susceptible to opioid-related side effects. Enhanced Recovery After Surgery guidelines strongly recommend the administration of multimodal medications to reduce narcotic consumption. However, the role of ultrasound-guided transversus abdominis plane (USG-TAP) block in multimodal analgesia of weight loss surgeries remains controversial.Materials and MethodsA systematic search was performed in four databases for studies published up to September 2019. We considered randomized controlled trials that assessed the efficacy of perioperative USG-TAP block as a part of multimodal analgesia in patients with laparoscopic bariatric surgery.ResultsEight studies (525 patients) were included in the meta-analysis. Pooled analysis showed lower pain scores with USG-TAP block at every evaluated time point and lower opioid requirement in the USG-TAP block group (weighted mean difference (WMD) = − 7.59 mg; 95% CI − 9.86, − 5.39; p < 0.001). Time to ambulate was shorter with USG-TAP block (WMD = − 2.22 h; 95% CI − 3.89, − 0.56; p = 0.009). This intervention also seemed to be safe: only three non-severe complications with USG-TAP block were reported in the included studies.ConclusionOur results may support the incorporation of USG-TAP block into multimodal analgesia regimens of ERAS protocols for bariatric surgery.

Safety and efficacy of dexamethasone as an adjuvant to bupivacaine in bilateral transversus abdominis plane block in children undergoing major abdominal surgery

BackgroundThis prospective randomized controlled double-blind clinical study was conducted on 52 patients of both genders divided into two groups (26 patients each). Local anaesthetic solution of isobaric bupivacaine 0.25% (0.3 ml/kg) was prepared. Group A received bilateral transversus abdominis plane (TAP) block with bupivacaine and dexamethasone (0.3 mg/kg) while group B received bilateral TAP block with bupivacaine and volume of saline equal to the amount of dexamethasone given in group A. Patients were observed for FLACC pain scale at the time of discharge from the post-anaesthesia care unit and then every 2 h for 36 h after the operation. This study was conducted to assess the safety and efficacy of adding dexamethasone to bupivacaine on the quality of bilateral US-guided transversus abdominis plane (TAP) block in children undergoing major abdominal surgeryResultsDexamethasone added to local anaesthetic in ultrasound-guided TAP block significantly decreased FLACC score at 8, 10, and 12 up to 24 h postoperatively, The time to the first requested analgesia was prolonged in the dexamethasone group (P = 0.000). The total dose of acetaminophen consumption over 36 h after surgery was also reduced (P = 0.000), but no difference was found regarding the total dose of rectal diclofenac (P = 0.068).ConclusionAdding dexamethasone to isobaric bupivacaine TAP block reduces postoperative pain and analgesic requirements compared to isobaric bupivacaine TAP block alone in children undergoing major abdominal surgery.

Evaluation of injection volumes for the transversus abdominis plane block in dog cadavers: a preliminary trial

ObjectiveTo evaluate staining of nerve branches after the injection of different volumes during ultrasound-guided transversus abdominis plane (TAP) block in dog cadavers. Study designProspective randomized study. AnimalsA total of 15 frozen/thawed adult dog cadavers. MethodsHemiabdomens were randomly allocated to one of four groups. In groups G0.3, G0.6 and G1.0, ropivacaine–methylene blue solution (0.3, 0.6 and 1.0 mL kg–1 in seven, eight and eight hemiabdomens, respectively) was injected at the midpoint between the iliac crest and the last rib at the height of the shoulder. In group G0.3×2 (seven hemiabdomens), two injections (0.3 mL kg–1) were performed, caudal to the last rib and cranial to the iliac crest at the same height. Total time for injection was recorded; after 30 minutes, cadavers were dissected and spread of dye was evaluated. ResultsAccuracy of injection site was 80% and injection time was 71 (48–120) seconds for all groups together. Craniocaudal spread was 6.4 ± 1.6, 9.1 ± 2.6, 11.4 ± 2.3 and 11.2 ± 3.8 cm for G0.3, G0.6, G1.0 and G0.3×2, respectively [G0.3 to G0.3×2 (p = 0.044) and G1.0 (p = 0.034)]. There was no difference in dorsoventral spread among groups. Number of ventral nerve branches stained was 3 (2–4), 3 (2–4), 3 (3–4) and 3 (2–4) for G0.3, G0.6, G1.0 and G0.3×2, respectively, including nerve branches from twelfth thoracic to third lumbar (L3) in different proportions among groups. Conclusions and clinical relevanceResults suggest that a single-injection TAP block, using 0.3 mL kg–1, stains comparable number of nerve branches as higher volumes or two-point injection. Despite the volume or technique, consistent staining of the innervation of the caudal abdomen (L1–L3) was observed. Additional cadaveric studies are necessary to identify the optimal technique for complete abdominal wall staining.

Efficacy of Dexmedetomidine as an Adjuvant to Bupivacaine in Ultrasound-Guided Transverse Abdominis plane Block for Laparoscopic appendicectomy: A Randomised Controlled Study.

ObjectiveDexmedetomidine is an alpha 2-adrenergic agonist that prolongs analgesia as an adjuvant when added in neuraxial and peripheral nerve blocks. The aim of the present study was to evaluate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ultrasound (USG)-guided transverse abdominis plane (TAP) block for postoperative analgesia in laparoscopic appendicectomy.MethodsA total of 60 American Society of Anesthesiologists I and II adult patients aged between 16 and 60 years planned for laparoscopic appendicectomy were randomised into two groups (A and B). Group A patients received 20 mL of 0.125% bupivacaine+1 μg kg−1 dexmedetomidine, whereas group B patients received 20 mL of 0.125% bupivacaine alone on both sides at the time of USG-guided TAP block. Haemodynamic variables, pain scores, sedation scores, time to first dose of rescue analgesic and side effects, if any, were assessed and compared between the groups.ResultsDemographic and operative characteristics were comparable in both groups. The mean duration of analgesia was more in group A (7.33 h) than in group B (4.8 h). The requirement of rescue analgesics was more in group B (80%) than in group A (56.7%). The sedation and pain scores at 2, 4 and 6 h were better in group A than in group B (p<0.05). The heart rate, systolic blood pressure and diastolic blood pressure were lower in group A during the postoperative period than in group B.ConclusionThe addition of dexmedetomidine as an adjuvant to bupivacaine in TAP block provides prolonged postoperative analgesia and better pain control with reduced need for rescue analgesics than bupivacaine alone in patients undergoing laparoscopic appendicectomy.

Does Ultrasound-Guided Transversus Abdominis Plane Block Reduce Donor Site Pain After Harvesting Anterior Iliac Crest Bone Grafts

The most common side-effect of anterior iliac crest (AIC) bone grafting is postoperative pain. The purpose of this study was to investigate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block for reducing donor site pain after harvesting AIC bone graft. Patients scheduled for unilateral alveolar cleft repair with AIC bone grafting, regardless of age, were enrolled in this prospective, randomized controlled trial study, divided into 2 groups: group T (performing TAP block) and group C (without TAP block). Postoperative pain at the alveolar cleft and AIC site were assessed using a visual analog scale (VAS) at the immediate postoperative time, 6, 12, and 24 hours after surgery. Morphine consumption during operation, postoperatively in the first 24 hours and total dosage until discharge and its side effects were also observed. Patients' satisfaction was accessed. MANOVA was used to evaluate the effects of treatment on those outcome variables. The P value <.05 was considered statistically significant. Eighteen patients, with a mean age of 14.39±3.70 years, were enrolled in this study. Pain scores at the AIC site in group T were statistically less significant than in group C for all times with P value <.001, <0.001, 0.002, and 0.004 consequently. Pain scores at the AIC site at 24 hours had no statistically significant difference after Bonferroni correction. There was statistically significant greater patients' satisfaction in pain control at the AIC site in group T than in group C with P value <.001. Group T revealed, statistically significant, less morphine consumption than group C at both the first 24 hours and postoperatively, totally until discharge with P value <.001. No complications of TAP block were reported in this study. There was a statistically significant lower incidence of nausea in group T than in group C with Pvalue 0.029. The ultrasound-guided TAP block is an effective postoperative pain controller and can decrease postoperative morphine consumption at AIC bone harvesting.

Combined use of transversus abdominis plane block and laryngeal mask airway during implementing ERAS programs for patients with primary liver cancer: a randomized controlled trial

The incidence and mortality of primary liver cancer are very high and resection of tumor is the most crucial treatment for it. We aimed to assess the efficacy and safety of combined use of transversus abdominis plane (TAP) block and laryngeal mask airway (LMA) during implementing Enhanced Recovery After Surgery (ERAS) programs for patients with primary liver cancer. This was a prospective, evaluator-blinded, randomized, controlled parallel-arm trial. A total of 96 patients were enrolled (48 in each group). Patients in the control group received general anesthesia with endotracheal intubation, while patients in the TAP + LMA group received general anesthesia with LMA and an ultrasound-guided subcostal TAP block. The primary end-point was postoperative time of readiness for discharge. The secondary end-points were postoperative pain intensity, time to first flatus, quality of recovery (QoR), complications and overall medical cost. Postoperative time of readiness for discharge in the TAP + LMA group [7 (5–11) days] was shorter than that of the control group [8 (5–13) days, P = 0.004]. The postoperative apioid requirement and time to first flatus was lower in the TAP + LMA group [(102.8 ± 12.4) µg, (32.7 ± 5.8) h, respectively] than the control group [(135.7 ± 20.1) µg, P = 0.000; (47.2 ± 7.6) h, P = 0.000; respectively]. The QoR scores were significantly higher in the TAP + LMA group than the control group. The total cost for treatment in the TAP + LMA group [(66,608.4 ± 6,268.4) CNY] was lower than that of the control group [(84,434.0 ± 9,436.2) CNY, P = 0.000]. There was no difference in complications between these two groups. The combined usage of a TAP block and LMA is a simple, safe anesthesia method during implementing ERAS programs for patients with primary liver cancer. It can alleviate surgical stress, accelerate recovery and reduce medical cost.

Ultrasound-guided Hydro-dissection Facilitates Tissue Expander Placement and Components Separation in Complex Ventral Hernia Repair

Summary:Tissue expanders are known adjuncts in ventral hernia repair, used in a staged approach where tissue closure or coverage of the defect is preferred but inadequate. Placement of tissue expanders in the correct tissue plane can be difficult, especially in thin patients or with loss of domain. This case series describes a technique in which tissue expander placement is facilitated by ultrasound-guided hydro-dissection, following the placement of a transversus abdominis plane (TAP) block. In short, after induction of anesthesia, the same needle used for the ultrasound-guided TAP block can be repositioned by the anesthesiologist to instill tumescent solution into the fascial plane between the internal and external oblique muscles. This allows for identification of the fascial planes in the ensuing operation. Our technique may prove to be an alternative tool in the placement of tissue expanders for ventral hernia repair, or in other procedures requiring device placement.

COMPARATIVE STUDY OF ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK USING BUPIVACAINE WITH AND WITHOUT HYALURONIDASE IN LAPAROSCOPIC BARIATRIC SURGERY

Background: Transversus abdominis plane (TAP) block is atechnique of regional anesthesia, which reduces the pain derived from abdominal wall incisions, decreases general anesthesia requirements, and increases hemodynamic stability. Hyaluronidase is an enzyme considered as the “spreading factor”, facilitating the spread of local anesthetic solutions. It has been shown to produce reliable blockade with better spread and therefore better quality of block when used with local anesthetics.Aim of the work: The aim of this study is to compare the efficacy of Injection of Bupivacaine 0.25% and Injection of Bupivacaine 0.25% with Hyaluronidase 1500 Uin ultrasound guided transversus abdominis plane block.Patients and methods: This double blinded randomized controlled clinical trial study was conducted in the Department of anesthesia, Faculty of Medicine, Ain Shams University and general hospitals during the period from 1st January 2018 to 31stDecember 2018 after being approved by the department ethical Committee. The study population included 60 bariatric patients which were randomly divided into 2 groups (30 patients in each group);Group A: TAP block with Bupivacaine 0.25% 19 ml+1 ml normal saline (loading dose) followed by continuous infusion of Bupivacaine 0.25% at a rate of 4ml/hr.; i.e., 96 ml/24hrs.Group B: TAP block with Bupivacaine 0.25% 19 ml+ Hyaluronidase 1500 U 1ml (loading dose) followed by continuous infusion of Bupivacaine 0.25%+ Hyaluronidase 50 U at a rate of 4ml/hr.; i.e., 96 ml/24hrs.Results: the group of TAP block with Bupivacaine and Hyaluronidase (Group B) had statistically lower NRS 2nd, 4th, 6th, 8th,16th, 22ndand 24th postsurgical day (p=0.28, 0.42,0.018, 0.003, 0.003, 0.004 and 0.041 respectively). Also Group B had statistically lower mean of opioid consumption in 2nd, 4th, 6th, 8th,16th, 22th and 24th postsurgical day with overall lower mean of opioid consumption among group B (p=0.002).Regarding vital data among both groups was non-significant (p≥ 0.2).Conclusion: Our findings support the use of ultrasound guided TAP block using liposomal bupivacaine with hyaluronidase as part of multimodal analgesia for bariatric surgery based on decreased postoperative opioid requirements.

Better timing of ultrasound-guided transversus abdominis plane block for early recovery after open inguinal herniorrhaphy: A prospective randomised controlled study

BackgroundThis study investigated the optimal timing of analgesic transversus abdominis plane (TAP) block in the operating room for better recovery quality using the Korean version of the Quality of Recovery-40 (QoR-40K) questionnaire in patients who had undergone open inguinal herniorrhaphy. MethodsThis single-centre, prospective randomised controlled study included adult male patients who had an ASA physical status of I–II. A total of 80 patients were analysed. The patients were randomly assigned and classified into pre-incisional TAP (pre-TAP) block (n = 40) and post-incisional TAP (post-TAP) block (n = 40) groups. The quality of postoperative functional recovery and complications were compared between the two groups during 24 h postoperatively. ResultsPreoperative findings of the two groups were comparable. The global QoR-40K score was higher in the pre-TAP group than in the post-TAP group. Among sub-dimensions, scores of physical comfort and pain were higher in the pre-TAP group than in the post-TAP group. In the post-anaesthesia care unit, the pre-TAP group showed lower pain scores than the post-TAP block group. There was no severe pain in the pre-TAP group, but two patients (5.0%) in the post-TAP block group suffered severe pain. The pre-TAP group required lower doses of IV rescue opioid in the PACU than the post-TAP group. All patients were discharged from hospital on postoperative day 1 without surgical complications. ConclusionsThe timing of analgesic TAP block may be of clinical importance to prevent postoperative pain and to improve the quality of early patient recovery following open inguinal herniorrhaphy.

The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study.

PurposePostoperative pain management for patients undergoing hepatic resection is still a challenge due to the risk of perioperative liver dysfunction. The transversus abdominis plane (TAP) block is a promising regional analgesic technique. However, the correct guidelines regarding the dose and regimen of local anesthetics in patients undergoing hepatic resection have yet to be established completely. This study aimed to evaluate the safety and efficacy of ultrasound-guided BD-TAP block with a large dose of ropivacaine in laparoscopic hepatectomy.Patients and MethodsThis prospective, blinded, randomized, controlled study was conducted with 50 patients who were scheduled for selective laparoscopic hepatectomy. Patients who received a BD-TAP block (3 mg/kg of ropivacaine diluted to 60 mL) with general anesthesia were categorized into the BD-TAP block group (n = 25), and those who received general anesthesia were categorized into the control group (n = 25). The primary outcomes were consumption of sufentanil within 48 hours post-operation and plasma ropivacaine concentration. The secondary outcomes were the severity of pain (at rest and upon coughing), nausea and/or vomiting, and quality of recovery.ResultsCompared with the control group, the patients in BD-TAP block group had a significant reduction of postoperative sufentanil consumption at 2 hours (P = 0.019), 24 hours (P = 0.001), and 48 hours (P = 0.001), and the visual analog scale (VAS) scores on coughing were significantly lower at postoperative 2 hours (P = 0.004). There were no statistically significant differences in postoperative nausea and/or vomiting, flatus, catheter removal, off-bed activity, liver function, or postoperative hospital stay. The mean peak total ropivacaine concentration was 1,067.85 ng/mL, which occurred 1 hour after administering the block, and mean free ropivacaine concentration was 52.32 ng/mL. The highest individual peak plasma concentration was 2,360.90 ng/mL at 45 min postinjection, and the free ropivacaine concentration was 139.29 ng/mL.ConclusionUltrasound-guided BD-TAP block provides effective postoperative analgesia after laparoscopic hepatectomy. This study also confirms that ultrasound-guided BD-TAP blocks with 3 mg/kg ropivacaine during laparoscopic hepatectomy almost never results in the plasma ropivacaine concentrations associated with neurotoxicity.

Determine the effectiveness of post-operative pain management of ultrasound guided transversus abdominis plane block vs open internal transversus abdominis plane block following abdominal hysterectomy a randomized controlled study

<strong>Introduction:</strong> Abdominal hysterectomy is a common surgical procedure associated with considerable post-operative pain. The surgical outcomes are generally improved when pain control is optimized in the postoperative period. The transversus abdominis plane (TAP) block is an evolving regional anesthetic technique which provides analgesia to the skin, muscle and parietal peritoneal layers of anterior abdominal wall leading to reduction of post-operative pain. Objectives: To compare the effectiveness in reducing postoperative pain between ultrasound guided TAP block, open internal TAP block and without TAP block in patients undergoing abdominal hysterectomy under general anaethesia. <strong>Methods:</strong> Three-armed randomized case control prospective study conducted in Teaching Hospital Kandy from August 2016 to May 2017. Sixty six (66) patients scheduled and admitted for abdominal hysterectomy via supra- pubic transverse incision under general anaesthesia, aged between 40-60 years were included. Block randomization technique was applied to achieve the allocation concealment. There were 22 participants in each group of each arm. The Group 1 received USS guided TAP block, Group 2 open TAP block and Group 3 neither TAP block administered. The key data collected by a blinded observer at 12, 24 and 48 post-operative points were analgesic requirements and the analogue pain scale measurements of post-operative pain. These were compared in three groups. 95% confidence interval and 0.05 probability cut off were used to determine statistical significance. <strong>Results:</strong> The Mean age of the all participants was 51.98 years (SD=8.36) and length of the surgical incision ranged from 10cm to 13cm. Mean weight of participants was 60.69kg (SD - 7.0kg). Majority of the surgeries were completed in less than 45 minutes (n=42:63.6%). There was no significant difference in above three measurements in the three groups. The difference in mean pain score in all 3 study groups were statistically significant at time points of 12, 24 and 48 hours (F=15.45-12H: F=12.63-24H: F=7.67-48H). The difference in mean Pethidine requirement in all 3 study groups were statistically significant at 3 time points of 12, 24 and 48 hours (F=20.71-12H: F=14.4-24H:F=10.52-48H). The difference in mean NSAID requirement in all 3 study groups at 24- and 48-hour study points studied were statistically significant (F=5.98-24H: F=8.07-48H). <strong>Conclusions: </strong>In abdominal hysterectomy the pain score, Pethidine and NSAID requirement was less, in participants who received an USS TAP block and an Open TAP block as a post-operative pain relief method when compared with participants who did not receive either. However, the data did not confirm that one TAP block is statistically superior to other. More detail experimental studies should be planned to evaluate the effectiveness of post-operative pain relief of TAP blocks during open abdominal hysterectomy and TAP blocks compared with existing post-operative pain relief protocols.

Potential Advantages of Wireless Ultrasound-Guided Transversus Abdominis Plane Block for Pain Control Post-Abdominoplasty

Transversus abdominis plane (TAP) block is a relatively new technique used to provide analgesia to the anterolateral abdominal wall following abdominal procedures. Transversus abdominis plane blocks can be performed using a blind/landmark technique or with ultrasound guidance. We report a 49-year-old woman who received a successful wireless ultrasound-guided TAP block during an abdominoplasty. Our case illustrates the potential advantages of a wireless ultrasound-guided TAP block versus a landmark-guided TAP block during an abdominoplasty. It also serves to promote the use of wireless ultrasound imaging when performing a TAP block to minimize risks of the procedure and achieve better pain control postoperatively. Further studies are needed to confirm the added value that ultrasound provides.

Population Pharmacokinetics of Levobupivacaine During Transversus Abdominis Plane Block in Children.

Levobupivacaine is commonly used during transversus abdominis plane (TAP) block in pediatric patients. However, the dosing regimen is still empirical, and the pharmacokinetic properties of levobupivacaine are not considered. Here, the pharmacokinetics of levobupivacaine during an ultrasound-guided TAP block were evaluated to optimize dosing regimen, regarding the between-subject variability (BSV) and the volume of levobupivacaine injected. The clinical trial (prospective, randomized, double-blind study protocol) was conducted in 40 children aged 1-5 years, who were scheduled for inguinal surgery. Each patient received 0.4 mg/kg of levobupivacaine with a volume of local anesthesia solution adjusted to 0.2 mL/kg of 0.2% or 0.4 mL/kg of 0.1% levobupivacaine. Blood samples were collected at 5, 15, 20, 25, 30, 45, 60, and 75 minutes after the block injection. The population pharmacokinetic analysis was performed using the NONMEM software. From the pharmacokinetic parameters obtained, median Cmax, tmax,, and area under the concentration versus time curve were 0.315 mg/L, 17 minutes, and 41 mg/L·min, respectively. BSV of clearance was explained by weight. At the dose regimen of 0.4 mg/kg, none of the infants showed signs of toxicity, but in 13 patients, TAP block failed. After analysis, BSV for absorption rate constant, distribution volume, and clearance were 81%, 47%, and 41%, respectively. Residual unexplained variability was estimated to be 14%. For improved efficiency in the pediatric population, the dose of levobupivacaine should be greater than 0.4 mg/kg. Children's weight should be considered to anticipate any risk of toxicity.

A Comparative Study of Effectiveness of Ultrasound-Guided Transversus Abdominis Plane (TAP) Block vs Epidural Analgesia for Post-Operative Pain Relief in Lower Abdominal Surgeries

Background: An increase in the use of regional anesthesia techniques for postoperative pain relief for analgesia following lower abdominal surgeries. Epidural anesthesia considered as the "gold standard" has been established to provide excellent analgesia as well as attenuation of neurogenic contribution to inflammation. The TAP block provides reliable somatic analgesia in lower abdominal incision surgeries. Use of ultrasound helps incorrect localization of the plane and accurate placement of the needle and catheter.Subjects and Methods:In TAP group under USG guidance 20 ml 0.2% Inj. Ropivacaine was deposited on each side of the abdominal wall. In Epidural group 10 ml of 0.2% Inj. Ropivacaine was administered at skin closure.Results:Systolic and diastolic blood pressure levels were significantly lower in group B as compared to group A (p&lt;0.05). . VAS score was significantly higher in group B as compared to group A (P&lt;0.05). It was observed that a significantly higher number of patients in epidural group required rescue analgesia and at higher dosages (p&lt;0.05).Conclusion:TAP block has almost no complications, keeps the patient hemodynamically stable and offers a good early postoperative analgesia (till 24 hours) when compared to a more accepted modality like epidural analgesia.