Ultrasound-guided Transversus Abdominis Plane Block Research Articles

Comparison of Analgesic Effect Between Erector Spinae Plane Block and Transversus Abdominis Plane Block After Elective Cesarean Section: A Prospective Randomized Single-Blind Controlled Study.

BackgroundThis study compared the analgesic efficacy of a bilateral erector spinae plane (ESP) block with that of a bilateral transversus abdominis plane (TAP) block after elective cesarean delivery.MethodsSixty mothers scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive either ESP block or TAP block. The ESP group received ESP block at the level of the ninth thoracic transverse process with 20 mL of 0.25% bupivacaine at the end of surgery. The TAP group received an ultrasound-guided TAP block with 20 mL of 0.25% bupivacaine on completion of delivery. The primary outcome was the duration of analgesia achieved by each block. Secondary outcome measures were the postoperative pain severity, total tramadol consumption, patient satisfaction.ResultsThe median (interquartile range) duration of block was longer in the ESP group than in the TAP group (12 hours [10, 14] vs 8 hours [8, 8], p<0.0001). In the first 24 hours, the mean visual analog pain score at rest was lower by 0.32 units in the ESP group. The median tramadol consumption in the first 24 hours was significantly higher in the TAP group than in the ESP group (125 mg [100, 150] vs 100 mg [75, 100, p=0.003]).ConclusionCompared with the TAP block, the ESP block provides more effective pain relief, has a longer duration of analgesic action, prolongs time to first analgesic requirement, is associated with less tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens after cesarean section.

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.

Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Chronic Post-Operative Surgical Pain: Review of 20 Cases

Abstract Background: Post-operative surgical pain of at least 2- month duration in absence of clear causes was defined as Chronic Post-operative Surgical Pain syndrome (CPSP). Transversus Abdominis Plane (TAP) block is a new imple-mented regional anaesthetic technique included in the analgesic regimen for many abdominal surgeries to reduce immediate post-operative pain and opioid requirements. Aim of Study: To assess the feasibility and efficacy of US guided TAP block in the management of chronic post-operative surgical pain. Patients and Methods: US-guided TAB block done for 20 patients complaining of chronic lower abdominal pain around 3-months to one-year duration after surgical operation with injection of 20ml of bupivacaine 0.25% and 2ml of methyl prednisolone (40mg/ml). Unilateral injection done for 12 patients & bilateral injections done for 8 patients. Second injection done for 6 patients after 3 months (three unilateral & three bilateral). Patient's pain intensity was assessed by Visual Analogue Score (VAS) before procedure & during follow-up visits for the next six months. Results: Three months after US-guided TAP block; 5 patients with mild degree of pain & 2 out of 10 patients with moderate degree of pain became completely pain free, while other 13 patients acquired relative improvement (5 patients with mild degree of pain and 8 patients with moderate degree of pain). Six months after US-guided TAP block; 6 patients (accepted second injection) improved with mild degree of pain while other 2 patients showed little improvement with still moderate degree of pain. Conclusion: Ultrasound guided TAP block is safe and effective method in management of chronic post-operative surgical pain.

Ultrasound-Guided Transversus Abdominis Plane Block for Cesarean Delivery: Injection Site Pain as a New Complication and Dexamethasone Reduced Incidence.

BackgroundAlthough ultrasound-guided transversus abdominis plane block (TAPB) is widely used in multimodal analgesia after cesarean delivery (CD), the complications of TAPB during analgesia after CD have rarely been reported.MethodsA total of 84 cases of CD were randomly assigned to either a ropivacaine group (R group) or ropivacaine + dexamethasone group (RD group) in this double-blind trial. The pain site and pain degree at rest and during activity at 2 h, 6 h, 10 h, 12 h, 14 h, 16 h, 20 h, and 24 h after maternal surgery were recorded. The consumption of opioids at 24h, postoperative nausea, vomiting, exhaustion, and other adverse reactions were recorded.ResultsA total of 80 patients were included in the analysis of results. A total of 19 patients developed ISP, 14 in the R group and 5 in the RD group. The incidence of ISP in the R and RD groups was 35% and 12.5%, respectively. The results described above showed that combining dexamethasone with ropivacaine reduced the incidence of ISP, and the difference was statistically significant (P<0.05). Two groups of women with positive ISP had higher values of opioid consumption than women with negative ISP, but the difference was not significant.ConclusionDexamethasone as an adjuvant for ropivacaine can effectively relieve the ISP of ultrasound-guided TAPB after CD, and can enhance the analgesic effect of ropivacaine.

Comparative assessment of efficacy of various anesthesia options after cesarean section

The article describes the comparative assessment of efficacy of transversus abdominis plane block as a component of multimodal analgesia during cesarean section.Subjects and methods. 165 primiparous women were enrolled into the study, their average age made 30.5 years. Operative delivery was performed under spinal anesthesia. All patients were divided into five groups. In the patients in Groups 1 and 3, postoperative analgesia was performed using transversus abdominis plane (TAP) block without ultrasound guidance, while in Groups 2 and 4, TAP block was guided by ultrasound. In Groups 1 and 2, ropivacaine hydrochloride was used at a concentration of 0.2%, in Groups 3 and 4 - 0.375%. In Group 5, paracetamol in combination with narcotic analgesics was used for analgesia. Pain intensity was assessed every hour using a visual analogue pain scale at rest and during movement during the 1st day after delivery. To assess the severity of the stress response and metabolic status of patients, concentrations of cortisol, prolactin and glucose in blood plasma was tested. The levels of cortisol and prolactin were tested in 4 stages: before surgery, 1 hour after surgery, 6 and 24 hours after delivery. Plasma glucose was tested in 3 stages: before surgery, 1 hour and 6 hours after surgery.Results. TAP block in combination with paracetamol provided adequate postoperative analgesia, reduced the consumption of analgesics, and also contributed to the earliest activation of new mothers after cesarean section. The use of 0.2% ropivacaine hydrochloride solution with TAP block was equally effective as the use of 0.375% solution of ropivacaine hydrochloride. Ultrasound guided TAP block significantly improved the quality of postoperative pain management. TAP block reduced the level of stress hormones in patients but in 24 hours, the levels of stress hormones in all groups of patients receiving and not receiving TAP block did not differ.

Analgesia for postoperative myomectomy pain: A comparison of ultrasound-guided transversus abdominis plane block and wound infiltration.

Acute postoperative pain after myomectomy can impair patient function. Like all other postoperative pain, it is a challenge requiring solution, particularly in developing countries. Ultrasound-guided transversus abdominis plane (TAP) block and wound infiltration (WI) are both known to be effective in managing postoperative pain. It is not certain if transversus abdominis plain block would be superior to wound infiltration. Aims: It was hypothesized that the TAP block has similar analgesic effectiveness to wound infiltration. This study was a randomized controlled trial involving, seventy-four (74) patients scheduled for myomectomy at the University of Benin Teaching Hospital Benin City, Nigeria under the subarachnoid block, which were randomized into TAP and WI group preoperatively. The ultrasound-guided bilateral TAP block group and wound infiltration group (subfascial and subcutaneous infiltration) each used 40 mL of 0.25% of plain bupivacaine to achieve postoperative analgesia. The time to first analgesic request, numerical pain rating scale (NRS) score at rest, and movement were assessed. Data were analyzed using SPSS version 16 (Chicago Il, USA). The time to first analgesic request was significantly delayed in the TAP block group compared to the wound infiltration group [240 (131, 375) min vs 170 (128, 187) minutes. P = 0.006]. The proportions of patients with NRS score ≤3 at the time of first analgesic requests were significantly more in the TAP block group (P < 0.001). The analgesic consumed by the TAP block group was significantly low compared to the WI group. There were no incidences of complications due to TAP block or wound infiltration. TAP block provided a longer duration of analgesia and a clinically superior quality of analgesia to wound infiltration.

Evaluation of magnesium sulfate as an adjuvant to bupivacaine for postoperative analgesia in ultrasound-guided transversus abdominis plane block in patients scheduled for lower segment caesarean section under subarachnoid block – A prospective, randomized, double-blind study

Background and Aims: Various adjuvants such as magnesium sulfate (MgSO4), dexamethasone, and clonidine have been used in transversus abdominis plane (TAP) block to prolong the duration analgesia. MgSO4 is N-methyl D-aspartate receptor antagonist (NMDA) and presence of NMDA receptors in skin and muscle can prolong the duration of postoperative analgesia. We aimed to evaluate the effects of MgSO4 as an adjuvant to bupivacaine in ultrasound-guided (USG) TAP block for prolongation of duration of postoperative analgesia. Materials and Methods: Sixty pregnant patients of the American Society of Anesthesiologists physical Status I and II between age group of 18–35 years, scheduled for elective cesarean section under subarachnoid block were allocated randomly into two groups:- Group BM (bupivacaine + MgSO4) and Group B (bupivacaine + Normal saline). All patients received USG bilateral TAP block after caesarean section using either 25 ml of 0.25% bupivacaine and 0.3 ml (75 mg) of 25% injection MgSO4 or 25 ml of 0.25% Bupivacaine and 0.3 ml of normal saline on each side. All patients were evaluated for dynamic pain at 0, 30 min, 1, 2, 4, 6, 12, and 24 h, for postoperative analgesia and adverse effects. The normally and nonnormally distributed data were analyzed using unpaired t-test and Mann–Whitney U-test, respectively. P < 0.05 was considered statistically significant. Results: Duration of analgesia in Group BM (12.3 h. ±0.83666 h) and Group B (12.0333 h. ±1.24522 h) were comparable (P = 0.3348). The average pain scores at different time points did not differ significantly between the two groups (P > 0.05). Conclusion: MgSO4 as an adjuvant to bupivacaine in USG TAP block does not prolong duration of postoperative analgesia.

Ultrasound-guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing inguinal hernia surgery: A comparative study.

Background and Aims:Ultrasound-guided (USG) transversus abdominis plane (TAP) block has emerged as a safe and effective regional anesthesia technique as it provides adequate postoperative pain relief for lower abdominal surgeries. Caudal block is a gold standard technique in pediatric surgeries. Our aim was to compare the duration of postoperative analgesia between TAP block and caudal block in children undergoing inguinal hernia surgeries.Material and Methods:In a prospective, randomized, controlled study, 112 children of age 2-8 years and ASA grade I and II, undergoing elective inguinal hernia surgery were randomly allocated into two groups: Group T (n = 56) received USG-guided TAP block with 0.5mL/kg of 0.2% ropivacaine and Group C (n = 56) received caudal block with 1mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of postoperative analgesia and the secondary outcome variables included variation in hemodynamic parameters and adverse effects, if any.Results:There was no significant difference in median of CHEOPS score till 5 postoperative hours, thereafter till 24 postoperative hours, significantly lower CHEOPS score were found in Group T. Mean duration of analgesia was 523.44 ± 61.30 min in Group T, whereas in Group C, it was 352.59 ± 32.54 min. No significant difference was observed in hemodynamic variations and adverse effects.Conclusion:TAP block and caudal block both are effective in providing postoperative analgesia in children undergoing inguinal herniotomy. USG-guided TAP block was found to be superior as it provided longer duration of analgesia and reduced rescue analgesic dose without any significant adverse effects as compared with caudal block after inguinal herniotomy.

Ergonomic Consideration of Ultrasound-guided Transversus Abdominis Plane Block between Experienced and Novice Anaesthesiologists

Introduction: Ergonomics is the science of interaction between human and working environment. The growing use of Ultrasound (US) in regional anaesthesia has created the need to consider ergonomic aspects relevant to regional anaesthesia. Aim: To analyse ergonomic consideration of Ultrasound-guided (USG) Transversus Abdominis Plane block (TAP) between experienced and novice anaesthesiologists for Inguinal Hernia Repair. Materials and Methods: A prospective observational study was conducted where 10 experienced (E) (performed &gt;20 TAP block procedures) and 11 novice (N) (performed at least 5 TAP block procedures) anaesthesiologists participated. The study included 21 patients of ASA I and II posted for inguinal hernia repair under spinal anaesthesia. USG TAP block was given after the completion of surgical procedure. Patient, operator and environmental factors were observed and measured using a measuring scale and photographs and goniometer. Results: Performance of USG TAP block was ergonomically suboptimal and varied among the operators. A 7E and 2N performed the procedure in sitting position and others in standing position, which was statistically significant (p=0.03) adjustment of tables were done by 7E and 2N operators, the difference statistically significant (p=0.03). A 2E and 8N flexed their back and 7E kept their neck flexed less than 20° and 9N kept their neck flexed more than 20° which was statistically significant (p=0.001). Only 10E and 5N kept Ultrasound machine in front in line and others were not, which was statistically significant (p=0.012). There was no significant difference between the groups in terms of side of the block performed, location of the procedure, position of assistants and trolleys in relation to operator during the procedure. Conclusion: It was found that the performance of USG TAP block was ergonomically sub-optimal in the setting described. compared to novice, experienced operators performed better. Inclusion of ergonomic concepts in academic training

Systemic lidocaine versus ultrasound-guided transversus abdominis plane block for postoperative analgesia: A comparative randomised study in bariatric surgical patients.

Background and Aims:The multimodal analgesia strategies to minimise opioid-related side effects are highly desirable in bariatric surgical procedures. We evaluated the efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block and intravenous lidocaine for postoperative analgesia in obese patients undergoing laparoscopic bariatric surgery.Methods:We studied 56 patients with body mass index >35 kg/m2. They were randomly allocated to Lidocaine group (Group A) and USG-TAP group (Group B). Group A patients were given intravenous Lidocaine (1.5 mg/kg) bolus followed by (1.5 mg/kg/h) infusion. Group B patients were given ultrasound-guided bilateral TAP block using 20 cc of 0.375% ropivacaine each side. Postoperative numeric rating pain scale score (NRS) hours were compared. Other parameters compared were total fentanyl requirement, sedation score, postoperative nausea vomiting (PONV) score and patient satisfaction score. A P value < 0.05 was considered statistically significant.Results:The patient in the Group A had lower resting NRS score (P < 0.05) postoperatively and less fentanyl consumption (P < 0.001) than in Group B. The difference in the sedation scores (P = 0.161) and PONV (P = 0.293) score was found to be statistically insignificant between Group A and B. The difference between the two groups was statistically significant with respect to patient satisfaction score with majority of patients having an excellent patient satisfaction score in Group A as compared to Group B.Conclusion:Intravenous Lidocaine as part of multimodal analgesic technique in obese patients undergoing laparoscopic bariatric surgery improves pain score and reduces opioid requirement as compared to USG-TAP Block.

Comparison of analgesic efficacy of ropivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block and port site infiltration in laparoscopic live-donor nephrectomy, a double-blind randomized parallel group trial

Background: Laparoscopic live-donor nephrectomy (LLDN) produces reduced donor's pain, early recovery, and a better cosmetic compared to open surgeries. We compared the analgesic efficacy of ropivacaine and levobupivacaine in unilateral ultrasound-guided transversus abdominis plane block (UTAPB) and port-site infiltration (PSI) in LLDN. Patients and Methods: The 120 donors, American Society of Anesthesiologists I-II, of either sex were randomly divided into two groups. The ropivacaine (Group-R = 60 patients given 20 ml of 0.2%) or levobupivacaine (Group-L = 60 patients, 20 ml, 0.25%) in unilateral UTAPB and 10 ml of either drug for PSI at the end of the surgery. All patients received intravenous (IV) patient-controlled analgesia pump (fentanyl) and IV paracetamol 1 g up to 48 h of study duration. Seventy-five milligram IV diclofenac was used as rescue analgesia. The duration of analgesia, time to the first requirement, and number of times rescue analgesia, total amount of fentanyl consumed and pain score Visual Analog Scale noted. Results: In UTAPB, the duration of sensory block in the levobupivacaine group was significantly longer to the ropivacaine group, 12.70 + 7.12 versus 10.55 + 6.64 h (P = 0.090), with lesser rescue analgesic requirement 37 versus 49 (of 60 patients) and lesser total fentanyl consumption 57.50 ± 53.54 mg versus 82.50 ± 65.63 mg. The first-time rescue analgesic delayed, 80.25 ± 137.78 versus 53.67 ± 79.85 min and a number of times rescue analgesic used significantly lesser in the levobupivacaine group 0.87 ± 0.84 versus 1.15 ± 0.92, with better patient satisfaction. Conclusion: Both the levobupivacaine and ropivacaine are effective in UTAPB for the management of postoperative pain after LLDN. The duration of sensory block was longer, total opioid consumption, and rescue analgesic requirement use were significantly lesser in the levobupivacaine group.

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.

The comparison of effects of fentanyl and dexmedetomidine as adjuvants to ropivacaine for ultrasound-guided transversus abdominis plane block for postoperative pain in cesarean section under spinal anesthesia -A randomized controlled trial.

Background and Aims:Transversus abdominis plane (TAP) block has been effectively used for anterior abdominal wall analgesia. The aim of the study was to compare the duration of analgesia produced by two drugs fentanyl and dexmedetomidine as adjuvants to ropivacaine in TAP block under ultrasound-guidance after lower segment cesarean section in a randomized controlled trial.Material and Methods:Sixty-four women of American Society of Anaesthesiologists (ASA) physical status II coming for cesarean sections were randomized to receive TAP blocks on each side of the abdomen using the local anesthetic drug 20 ml of 0.5% ropivacaine with either fentanyl 25 mcg or dexmedetomidine 25 mcg. A ten point numerical pain score was done at baseline, at 1 h and then at intervals of 4 h postoperatively. The hemodynamic parameters such as heart rate, blood pressure, and pulse oximetry were also monitored as above. The time to first analgesia demand from the time of the block and the total analgesic consumption were recorded. The statistical analysis was done by Mann-Whitney U test and the analgesics consumption by using Chi-square test with R software.Results:Our primary end-point was to assess the duration of analgesia produced by fentanyl added to ropivacaine for ultrasound-guided TAP block, which were 125 min with Q1–Q3 as 110–180 and dexmedetomidine 130 min with Q1–Q3 as 105–161 (P value = 0.47). The amount of analgesics used in the postoperative period in both the groups were analyzed using the Chi-square test not found to have any significant difference between both the groups (P-value = 0.512).Conclusion:Fentanyl and dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided TAP block were equally effective in both prolongation of analgesia and reducing the total consumption of analgesics.

Analgesic efficacy and safety of ultrasound guided transverse abdominis plane block in postcesarean section patients—A randomized control trial

Context: Following cesarean section, pain is anticipated. An important component of pain after cesarean section is from abdominal wall incision. Transverse abdominis plane (TAP) block can be used as a part of multimodal analgesia for cesarean section. Aims: To assess the analgesic efficacy and safety of ultrasound-guided TAP block in postcesarean section patients. Methods: Sixty patients undergoing cesarean section under spinal anesthesia were included in this randomized control study. They were divided into three equal groups, A, B, and C. All patients received diclofenac suppository 100 mg 12th hourly and intravenous paracetamol 1g 8th hourly after surgery. Group A patients underwent TAP block after the surgery using a total of 40 ml of 0.25% bupivacaine bilaterally. Group B patients underwent TAP block using 20 ml of 0.25% bupivacaine with clonidine 2 μg/kg. Group C patients did not undergo any block. Postoperative blood pressure, heart rate, nausea, vomiting, sedation, and pain score were noted. Kruskal–Wallis test, Chi-square test, and Mann–Whitney test were used for statistical analysis. Results: Patients who received TAP block had prolonged analgesia. The mean time to rescue analgesia was 8.6 ± 2.8, 7.9 ± 3.8, and 3.5 ± 3.1h for groups A, B, and C, respectively. The pain scores in group A and B were less than group C. Comparison of pain score between group A and B did not show any statistical difference. Conclusion: Ultrasound-guided TAP block is a safe and effective method of providing postoperative analgesia in caesarean patients. Addition of clonidine does not provide any additional benefit.

Comparison of transversus abdominis plane block and intrathecal morphine for laparoscopic donor nephrectomy: Randomised controlled trial.

Background and Aims:Postoperative pain following laparoscopic donor nephrectomy (LDN) is significant and no suitable analgesic technique is described. Opioid analgesia in standard doses is often suboptimal and associated with numerous adverse effects. Transversus abdominis plane (TAP) block has been evaluated in various laparoscopic procedures. Intrathecal morphine (ITM) has been seen to provide long-lasting analgesia of superior quality in laparoscopic colorectal procedures.Methods:The present study was undertaken to evaluate the analgesic efficacy of single-dose ITM 5 μg/kg for LDN. After ethics approval, 60 adult patients scheduled for LDN were randomised to receive intravenous fentanyl, ultrasound-guided TAP block or ITM for postoperative analgesia. Postoperative 24-h patient-controlled analgesia (PCA) fentanyl consumption, visual analogue scale (VAS) score and intraoperative fentanyl and muscle relaxant requirements were compared. Statistical analysis was performed using appropriate statistical tests by using Stata 11.1 software.Results:Haemodynamic stability at pneumoperitoneum and in the post anaesthesia care unit was significantly better in patients receiving ITM. Intraoperative rescue fentanyl requirement (P = 0.01) and postoperative fentanyl requirement until 24 h (P = 0.000) were significantly lower in the morphine group. Postoperative VAS at rest and on movement was significantly lower in the morphine group at all points of assessment (P = 0.000).Conclusion:ITM 5 μg/kg provides better intraoperative and postoperative analgesia and reduces postoperative PCA fentanyl requirement in laparoscopic donor nephrectomy compared to TAP block or intravenous fentanyl.

A randomized controlled trial to study the effect of hyaluronidase as adjuvant in ultrasound-guided transversus abdominis plane block for postoperative analgesia in total abdominal hysterectomy

Background: Transversus abdominis plane (TAP) block is a regional anesthesia technique for postoperative analgesia. Since multiple nerves are to be blocked in a single prick, mucolytic enzyme hyaluronidase is being used to improve the spread of the local anesthetic. The present study was conducted to evaluate the effect of adding hyaluronidase as an adjuvant to local anesthetic in ultrasound (US)-guided TAP block. Materials and Methods: Eighty patients were randomly divided into two groups, Group B and Group BH. Group B patients received US-guided bilateral TAP block with 38 ml of 0.25% bupivacaine (heavy) and 2 ml of NS. Group BH patients received 38 ml of 0.25% bupivacaine (heavy) with 3000 IU hyaluronidase (2 ml) after completion of surgery under spinal anesthesia. Visual analog score (VAS) and heart rate were noted periodically. Time of demand of the first rescue analgesia and total analgesic consumption in 24 h were noted. Patient satisfaction survey was done at the end of 24 h. Results: Group BH patients had lower mean VAS scores at 6 and 8 h postoperatively as compared to Group B. The mean time of demand for the first rescue analgesia was longer in Group BH (351 ± 16 min) as compared to Group B (307 ± 13 min). The cumulative dose of rescue analgesic needed was more in Group B (370 ± 9 min) as compared to Group BH (343 ± 8 min). Patient satisfaction score was 3.3 ± 0.5 in Group BH and 2.3 ± 0.5 in Group B. All the differences were statistically significant. Conclusion: Addition of hyaluronidase improved quality of postoperative analgesia which can be due to the enzymatic action of hyaluronidase which hydrolyses the hyaluronic acid in the connective tissue and facilitates the spread of local anesthetic solution.

Ultrasound-guided transversus abdominis plane block in high-risk infants, better option than opioids: A series of five cases

Perioperative analgesia poses specific problems, especially when it comes to neonates and infants. The use of opioid in neonates is usually associated with the risk of delayed extubation and postoperative mechanical ventilation. Regional analgesia including epidural and caudal may be technically challenging or has limitations in a certain group of patients. Ultrasound (US)-guided transversus abdominis plane block (TAP) is gaining popularity as a new technique of regional anesthesia applicable to infants and children. Precise drug administration is a major concern with TAP blocks in pediatric patients, especially infants and neonates. The application of US has enhanced the accuracy of local anesthetic deposition and hence the efficacy of analgesia in TAP block. We, hereby, report a series of five high-risk infants and neonates posted for abdominal surgeries wherein an ultrasonography-guided TAP resulted in satisfactory perioperative analgesia obviating the need of systemic opioids.

Ultrasound-Guided Transversus Abdominis Plane block versus Ultrasound-Guided Caudal Block for Pain Relief in Children Undergoing Lower Abdominal Surgeries

Background: Transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain intensity. Also, Caudal analgesia with local analgesics is effective but is often short-lived and associated with an undesired motor blockade and other complications. Objective: This prospective, randomized, controlled clinical study aimed to compare the effectiveness of analgesia by using ultrasound guidance for TAP block and caudal analgesia in children undergoing lower abdominal surgery. Patients and Methods: This prospective, randomized, controlled study included 60 children aged between 2 to 6 years, scheduled for elective lower abdominal surgery. Group A (n=20) received an ultrasound TAB block. Group B (n=20) received ultrasound-guided caudal block Group C (n=20) who was the controlled group received conventional analgesia. The intraoperative assessment included HR, systolic, diastolic and mean BP, need for rescue analgesia postoperative pain scores and parent satisfaction Results: No significant difference between all groups regarding demographic data, type and duration of surgery and intraoperative hemodynamic values. The control group had the highest number of patients and doses needed for rescue analgesia while TAB showed the lowest. The TAB group patient showed the highest degree of parent satisfaction than the other two groups. Conclusions: The study showed that TAB and Caudal block effective in postoperative pain-relieving in lower abdominal surgery in children however patients who received TAB block required less postoperative rescue analgesia with a better impact on pain scores than caudal block TAB show better parent satisfaction and earlier home discharge.

Ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in children undergoing laparoscopic appendectomy: a randomized controlled study

Context Ultrasound (US)-guided quadratus lumborum block (QLB) is a new abdominal truncal block used for perioperative pain management of both upper and lower abdominal surgeries. Aims To compare the analgesic efficacy of US-guided QLB with transversus abdominis plane (TAP) block. Settings Approval of Zagazig Institutional Review Board (IRB) was obtained (ZU-IRB # 5504/16-9-2018) before the study, and patient’s informed written consent was also obtained. Our clinical study was registered with ClinicalTrials.gov (NCT04031196). A total of 34 pediatric patients scheduled for elective laparoscopic appendectomy were randomly allocated in two equal groups: QLB and TAP block groups. Patients and methods All patients received general anesthesia using intravenous 2 mg/kg propofol, 1 µg/kg fentanyl, and atracurium 0.5 mg/kg. After induction of anesthesia, QLB group received bilateral US-guided QLB type 2, using 0.5 ml/kg of 0.25% levobupivacaine, whereas TAP block group received bilateral US-guided TAP block using 0.5 ml/kg of 0.25% levobupivacaine. The primary outcomes were changes of intraoperative hemodynamics and postoperative pain assessment. Secondary outcomes were total intraoperative fentanyl consumption, the first time of rescue analgesics, total rescue analgesic consumption in the first postoperative 24 h, and degree of parent satisfaction. Results QLB group had statistically significant lower hemodynamic changes 15 min after performing the block to the end of surgery (P Conclusion This study revealed that QLB provides longer and more effective postoperative analgesia compared with TAP block in pediatric patients undergoing laparoscopic appendectomy.