Ultrasound-guided Transversus Abdominis Plane Block Research Articles

Postoperative Analgesic Efficiency of Transversus Abdominis Plane Block with and without Magnesium Sulphate after Surgical Repair of Moderate Size Umbilical Hernia

Abstract Background The transversus abdominis plane (TAP) block is a known approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. Different adjuvants have been used to intensify the quality and the duration of local anesthetics. Aim of the Work The aim of this study is to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing surgical repair of moderate sized umilical hernia under general anathesia. As regard postoperative pain and opioid consumption using Visual Analogue scale VAS. Patients and Methods the study was carried out on 40 patients who was undergo surgical hernial repair, after ethical approval of Ain Shams University Hospital and informed consent from patients ,patients assigned in two group ,each group include 20 patients, Group 1: receive TAP block with Bupivacaine 0.25% 20 ml per side. Group 2: receive TAP block with Bupivacaine 0.25% 18 mL+2 ml magnesium sulphate. Results By the end of our study we found that VAS pain score was less in group II than in group I at 0,1,2 and 24 hours postoperatively and most significant at 4,6 and 12 hours the VAS score less in group II than group I (p value <0.05).And the mean time for first rescue analgesic dose was delayed in group II (872.87±265.25mins) compared to group I(466.54±118.29mins) (p value <0.001). Conclusion MgSO4 as an adjuvant to Bupivacaine in Ultra-sounded guided TAP block reduces postoperative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.

A Comparative Study between Ultrasound Guided Bilateral Transversus Abdominis Plane block Versus Opioids (Nalbuphine) Analgesia after Abdominoplasty

Abstract Background Poorly controlled acute pain after abdominoplasty is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, prolonged hospital stay and an increased likelihood of chronic pain. Objectives The aim of this study is to assess the analgesic efficacy and hemodynamic effects of bilateral ultrasound guided single injection Transversus Abdominis Plane (TAP) Block compared with intravenous nalbuphine after abdominoplasty. Each of them combined with general anesthesia in patients undergoing abdominoplasty. Patients and Methods The study was conducted on 70 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 35 patients each: Group TAP: bilateral ultrasound guided TAP block was performed before extubation of patients using 20 ml of 0.25% bupivacaine in each side, Group N: received intravenous nalbuphine as post operative analgesia after abdominoplasty. Results The results of the study revealed that single injection tansversus abdominis plane block has more analgesic efficacy than intravenous nalbuphine. The first call for rescue analgesia (nalbuphine), total nalbuphine consumption and pain scores (visual analog score) indicated that the superiority of the analgesic technique (TAP Block) was attributed to their opioid sparing effect. Conclusion An ultrasound-guided TAP block technique allows for direct visualization of all anatomical structures, the needle, and the spread of local anesthetic, thereby increasing the safety margin, optimizing block qualities, decreasing systemic analgesia requirements and sparing its side effects.

Tranversus Abdominus Plane Block with or without Magnesium Sulphate on Postoperative Pain Control after Open Appendectomy Operation

Abstract Background Patients undergoing Open Appendectomy experience pain postoperatively, requiring a multimodal approach to analgesia. The transversus abdominis plane (TAP) block seems to be an ideal approach. This block may be achieved using bupivacaine with adjuvants such as magnesium sulfate, which we were used in this study. Aim of the Work to detect the efficacy and safety of magnesium sulphate as an adjuvant to the analgesia offered by local anesthetic in ultrasound guided TAP block in patients undergoing open appendectomy. Patients and Methods A prospective double blinded randomized controlled trial was conducted on 60 patients undergoing open appendectomy at Ain Shams University Hospital, Cairo, Egypt. Results Our study concluded that co administration of 500mg MgSo4 to 0.5 % bupivacaine in US guided TAP block lead to: Significant decrease in VAS pain score especially at 4hrs, 6hrs and 12hrs,1st rescue dose of nalbuphine was delayed. And number of patients require rescue doses of nalbuphine in 1st 4 hrs, while only 2 patients require rescue doses of nalbuphine between 4&6 hrs.4 patients require rescue doses of nalbuphine between 6&12 hrs, while 26 patients require rescue doses of nalubuphine between 12&24hrs. we also cocluded that there were a significant decrease in HR and MABP especially at 4hrs and 6 hrs postoperative,. Conclusion MgSO4 as an adjuvant to bupivacaine in Ultra-sounded guided TAP block reduces post-operative pain scores, prolong the duration of analgesia and decreases demand for rescue analgesics.

Ultrasound-Guided Unilateral Posterior TAP Block for Lower Abdominal Surgery in Children

Objectives: This study aimed to evaluate the analgesic effect of ultrasound-guided transversus abdominis plane block in children. Methods: Children between 3-18 years of age on whom lower abdominal surgeries were preformed are included in this random control trial (RCT). The parents signed a written consent form. Patients were randomized into control and study groups. Every group was divided into subgroups either with or without inflammation. Results: There were no differences between the two studied groups regarding demographic and clinical characteristics. Hemodynamics were more stable in the study group than in the control group. After induction, BP decreased in all groups and increased after surgical incision except for the transversus abdominis plane elective (TAP + Elec) group. An elevated white blood cell count was used as the mean indicator of inflammation. The opioid usage during the operation was significantly different in the subgroups (p = 0.000). The relationship between WBC and opioid usage was weak, positive, and statistically significant. Postoperative pain and pain medication requirements were lower in the TAP block group. Conclusion: Transversus abdominis plane block under ultrasound guidance is easy, safe, reliable, and adequate for analgesia in children. This method can decrease surgical and postoperative pain and analgesic requirements.

Analgesic efficacy of dexamethasone versus dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block for post-operative pain relief in caesarean section: A prospective randomised controlled study.

Background and Aims:Transversus abdominis plane (TAP) block is commonly used to treat post-operative pain after lower abdominal surgeries. The aim of this randomised controlled study was to assess the efficacy of addition of dexmedetomidine or dexamethasone to ropivacaine in TAP block and compare the two for post-operative pain relief in caesarean section.Methods:A hundred parturients (18–45 years) undergoing caesarean section under spinal anaesthesia received ultrasound-guided (USG) bilateral TAP block with 50ml of 3mg/kg ropivacaine along with 0.1mg/kg dexamethasone (Group A) or 1μg/kg dexmedetomidine (Group B) in this prospective, randomised, double-blind study. Time to initial self-reporting of post-operative pain, time to first rescue analgesic demand, visual analogue scale (VAS) for pain haemodynamic parameters and adverse effects if any were noted, anda P value < 0.005 was considered as statistically significant.Results:Time to initial self-reporting of post-operative pain (411.35 vs. 338.20 min, P < 0.005) and time to first rescue analgesic (474.30 vs. 407.30 min, P < 0.005) were significantly longer in group B as compared to group A. VAS score at the time of initial self-reporting of pain was significantly lower in group B. No significant haemodynamic changes or side-effects were noted.Conclusion:Addition of dexmedetomidine to ropivacaine as compared with dexamethasone in bilateral TAP block following caesarean section prolongs the time to initial post-operative pain and time to first rescue analgesic consumption.

Comparative study between an ultrasound-guided transversus abdominis plane block and an ultrasound-guided caudal block for postoperative analgesia in children undergoing lower abdominal surgeries – a prospective randomised study

Background: Ultrasound imaging techniques have gained great popularity in anaesthesia during the last decade. We aimed to compare an ultrasound-guided transversus abdominis plane (TAP) block and an ultrasound-guided caudal block for postoperative analgesia in children undergoing lower abdominal surgeries. Methods: This study randomly allocated 62 children to two groups of 31 children each. One group received a caudal block with 0.25% bupivacaine 0.5 ml/kg with 1 μg/kg dexmedetomidine while the other group received a TAP block with 0.25% bupivacaine 0.5 ml/kg with 1 μg/kg dexmedetomidine. The parameters that were compared were the duration of postoperative analgesia, cumulative dose of rescue analgesic consumed, FLACC pain scores postoperatively, intraoperative and postoperative haemodynamic changes and incidence of side effects. Results: The duration of analgesia was comparable between the two groups, with 6.61 ± 0.76 hours for the caudal block group and 6.65 ± 0.915 hours for the TAP block group. However, the total amount of cumulative rescue analgesic consumed was significantly higher in the caudal block group (375.8 ± 120.5) compared to the TAP block group (314.5 ± 127.7). The pain scores in 0–6 hours postoperatively were higher in the TAP block group, whereas the caudal block group had higher pain scores 6–24 hours postoperatively with steady rescue analgesic consumption at 8, 12, 16 and 20 hours. Patient-parent satisfaction was better in the TAP block group (7.39 ± 0.76) compared to the caudal block group (6.48 ± 0.811). Conclusion: The TAP block provided superior analgesia compared to the caudal block, as demonstrated by a statistically significant decrease in the required cumulative rescue analgesic and lower pain scores 6–24 hours postoperatively.

Ultrasound-guided transversus Abdominis plane block for postoperative analgesia after abdominal sugery by using bupivacain alone and bupivacain with additive

Background: Caesarean section is often linked with moderate to severe pain, resulting in patient discontent, patient rehabilitation, and lengthy hospitalisation. This research aimed to assess and evaluate the effectiveness and safety of dexmedetomidine and dexamethasone in addition for postoperative analgesia in patients in caesarean section with bupivacaine in the ultrasound guided TAP block. Methods: Random allocation of 90 patients to three equal groups: Group A Transversal Ultrasound Controlled Abdominal Fluke (uTAP):) got bilateral transversal ultrasound guided ultrasound plane block. 20 ml of 0.25 percent bupivacaine and 2 ml of normal saline were administered on both sides. Group B transversal guided ultrasound (UTAP): Bilateral ultrasound guided transversal plane block (UTAP). Dexmedetomidine 1mcg/kg was dissolved into 2 ml of normal saline and 0,25 percent of the amount was added on each side to 20 ml of bupivacaine. Group C Transversal Guided Abdominal Block (uTAP): got the bilateral ultrasound transversal guided plane block of the abdominal abdominal ultrasonography. Dexamethasone 4 mg had been dissolved by adding 20 ml of bupivacaine to 2 ml of normal saline.25 per cent. Results and Conclusion: adding dexmedetomidine to the TAP block for TAP substantially reduces the VAS value, reduces the usage of narcotic in the first 12 hours, increases drowsiness and extends TFA more than dexamethasone.

Comparison of Ultrasound-guided vs Blind Transversus Abdominis Plane Block in Gynecological Abdominal Surgeries for Postoperative Analgesia in Tertiary Care Center: A Randomized Prospective Single-blind Study

Comparison of Ultrasound-guided vs Blind Transversus Abdominis Plane Block in Gynecological Abdominal Surgeries for Postoperative Analgesia in Tertiary Care Center: A Randomized Prospective Single-blind Study

Effect of needle type on plane block spread in a cadaveric porcine model

IntroductionPlane blocks are an increasingly common type of regional anaesthesia technique in the perioperative period. Increased spread of local anaesthesia during plane blocks is thought to be related to an...

Determination of the efficacy of ultrasound-guided bilateral transversus abdominis plane (US-TAP) block in laparoscopic total extraperitoneal (TEP) repair of unilateral hernia surgeries: A randomized controlled trial.

Background and Aims:Bilateral ultrasound-guided transversus abdominis plane (US-TAP) block has been successfully used to provide analgesia for most lower abdominal procedures. Our aim was to determine the efficacy of US-TAP block with levobupivacaine in laparoscopic total extraperitoneal (TEP) repair of unilateral hernia surgeries under general anaesthesia (GA) as compared to no block.Material and Methods:It is prospective randomised controlled study done in a tertiary care centre in South-East Asia. After obtaining Institute Ethics Committee approval and consent, 60 patients of ASA I-II aged between 18 to 80 years were randomized into two groups.After receiving GA, Group TAP - received bilateral US-TAP block with levobupivacaine 0.25% 0.3ml kg-1 on either side whereas, the control group did not receive any block.The time taken to first request for rescue analgesic (T Rescue) by the patient and the Numeric Rating Scale (NRS) at that time point were noted and tramadol 50mg i.v. was administered, followed by 50mg i.m. PRN for 24 h from the time of extubation. The 24 h analgesic requirement was noted in mg kg-1.Results:Results were analysed using SPSS 16 and P < 0.05 was considered significant. T Rescue was significantly longer in the TAP Group (P = 0.02) with lower NRS at time points 24 h (P = 0.02) and 12 h (P = 0.004). Postoperative nausea and vomiting were significantly less in TAP Group (P < 0.001).Conclusion:Bilateral US-TAP block provided better analgesia and side effect profile as compared to no block when administered in laparoscopic TEP repair of hernia surgeries.

An Image Study on Local Anesthetic Spread in Healthy Volunteers Receiving Subcostal Exterior Semilunaris Transversus Abdominis Plane (SE-TAP) Block.

BackgroundDespite the popularity of the ultrasound-guided transversus abdominis plane (TAP) block and the diversity of advancing approaches, the extent of injectate spread limits its clinical benefits. This study used three-dimensional computed tomography (3D-CT) imaging and a cold stimulus to evaluate the spread of a local anesthetic injected through the subcostal exterior semilunaris to transversus abdominis plane (SE-TAP) block in healthy volunteers.MethodsEight healthy volunteers received a right-side ultrasound-guided SE-TAP block with 25 mL of 0.3% ropivacaine. The sensory block was assessed by a cold stimulus at 30 min, 2 h, 4 h, and 8 h following the SE-TAP block according to the 18-zone division method. A CT scan and 3D imaging were performed after the first sensory assessment.ResultsThe injectate spread into the transversus abdominis space in all eight volunteers. 3D imaging confirmed that the injectate spread extensively along the costal margin in the plane of the transverse abdominis muscle and that it surpassed the semilunaris. Regarding the assessment using cold stimulus, five of six anterior zones and three of six lateral zones obtained successful rates of cutaneous sensory block higher than 75% 30 min after SE-TAP. Sensory block was achieved in the ventral dermatomes of all volunteers.ConclusionOur study showed that the SE-TAP injectate, which was administered using simple anatomical landmarks to provide reliable analgesia for abdominal surgery, consistently spread along the costal margin and extensively blocked cutaneous sensitivity in the anterior and lateral abdominal walls.

Analgesic efficacy of ultrasound‐guided transversus abdominis plane block after cesarean delivery: A systematic review and meta‐analysis

The meta-analysis is aimed to further access the analgesic efficacy of ultrasound-guided transversus abdominis plane (USG-TAP) block after cesarean section (CS). Electronic databases were searched for eligible studies. Primary objectives were pain-related outcomes. Weighted mean differences (WMDs) or standardized mean differences (SMDs), as well as risk ratios (RRs) with 95% confidence intervals (CIs), were used to calculate estimates. Subgroup analyses were done based on whether USG-TAP blocks were performed with long-acting intrathecal opioids (ITO). A total of 17 studies were included. When compared with control groups (placebo or no blocks), USG-TAP block resulted in lower cumulative opioid consumption at 6h (WMD: -8.32; 95% CI: -14.86, -1.79), 12 h (WMD: -10.75; 95% CI: -20.93, -0.57), and 24 h (WMD: -12.71, 95% CI: -21.28, -4.14). No significant differences were demonstrated among dynamic or resting pain scores. Patients in USG-TAP groups needed longer time to request first analgesic (WMD: 3.56; 95% CI: 1.43, 5.68) and showed a lower requirement of opioid rescue analgesia for breakthrough severe pain during 24 h (RR: 0.40; 95% CI: 0.18, 0.86). Subgroup analyses showed USG-TAP blocks did not afford additional benefit in the presence of intrathecal morphine. Also, reduced need for antiemetics after CS and higher maternal satisfaction were provided by USG-TAP blocks. USG-TAP block can provide significantly effective analgesia for patients who underwent CS in the absence of long-acting ITO and therefore are worth promoting in the setting of long-acting ITO being unfeasible.

Comparison of ropivacaine and bupivacaine in ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing elective lower abdominal surgeries - A randomized double-blind trial

Ultrasound-guided Transversus Abdominal Plane (TAP) block is an effective and safe regional anaesthesia technique. Our study is aimed to draw a comparison between the analgesic efficacy of Ropivacaine and Bupivacaine using ultrasound-guided TAP block. After approval from our Institutional Ethical Committee, 100 ASA I and II patients were recruited. Patients of either sex in age group of 18–65 years, undergoing elective lower abdominal surgeries were included in this prospective double-blind study. Patients were randomized into two groups, A and B. Group A (n=50) patients received ultrasound-guided TAP block with 20 ml 0.5% Ropivacaine and those in group B (n =50) received 20 ml 0.25% Bupivacaine at the end of surgery. The postoperative pain score (Numeric Rating Scale, NRS), patient satisfaction score, total requirement of analgesics in the first 24 hours, and the side effects were observed. Statistical tests were conducted using student's t-test, chi-square test, or fisher's exact test whichever was applicable. P &amp;#60; 0.05 was considered statistically significant. Statistically significant difference in the pain scores were observed between the two groups at different time intervals. The mean NRS score was higher for group B at 2, 4, 6 and 14 hour following the block. The duration of analgesia was longer and the total requirement of analgesic was lesser in group A as compared to group B.(p&amp;#60;0.001)Ultrasound-guided TAP block with 0.5% Ropivacaine provides effective analgesia for longer duration and decreases the total analgesic consumption as compared to 0.25% Bupivacaine in lower abdominal surgeries.

A COMPARATIVE STUDY OF CAUDAL BLOCK AND ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK WITH LEVOBUPIVACAINE AND DEXAMETHASONE AS ADDITIVE IN EXTRAPERITONEAL LOWER ABDOMINAL SURGERIES IN PEDIATRICS

Objective: The objective of the study was to evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus caudal block for post-operative analgesia with levobupivacaine and dexamethasone as additive in extraperitoneal lower abdominal surgeries in pediatrics as there is no available literature showing the same.&#x0D; Methods: This is a randomized control study carried out between two groups among 50 children (1–8 years of age), both sexes, posted for elective extraperitoneal lower abdominal surgeries after taking informed consent from parents. Fifty children were randomly allocated into two groups, 25 in each group. Caudal epidural (CE) group received general anesthesia and caudal block with 1 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. TAP group received general anesthesia and ultrasound-guided TAP block with 0.5 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. Data were collected by means of pre-designed format with pre-/post-operative assessment with standardized scores.&#x0D; Results: The mean age of the patients was 4.84 (SD=2.29). Mean face, legs, activity, cry, and consolability score was low and non-significant before shifting the patient (&lt;2 h post-operative [post-op]) in both the groups. Thereafter from 2 to 12 h, the mean score increased to 4.92 (SD=2.72) in the CE group and 2.92 (SD=2.17) in the TAP group and the difference was statistically significant at 2 h, 4 h, 6 h, and 12 h postoperatively. Mean time to rescue analgesia in the CE group was 4.96 h (SD=4.32) and 5.52 h (SD=7.53) in the TAP group and difference was statistically significant (p=0.000). Mean total rescue analgesic requirement for the CE and TAP groups was 298.40 mg (SD=170.70) and 111.40 mg (SD=138.81) and the difference was also significant. Post-operative complications such as urinary retention and motor blockade were seen in 28% of CE patients, while none of the patients experienced post-operative nausea/vomiting.&#x0D; Conclusions: Our study showed significant increase in duration of post-operative analgesia among TAP patients with reduced requirement of rescue analgesics and lesser post-operative complications as compared to CE patients

Comparison of Three Different Doses of Dexmedetomidine Added to Bupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block; A Randomized Clinical Trial.

BackgroundAdding dexmedetomidine to bupivacaine has been shown to prolong the analgesic effects of the transversus abdominis plane (TAP) block. However, the optimal dose of this adjuvant drug is unclear.ObjectivesIdentifying optimal doses of dexmedetomidine added to bupivacaine in the TAP block.MethodsIn this randomized controlled trial, 86 patients candidate for elective open inguinal herniorrhaphy under spinal anesthesia were divided randomly into three groups; low (L), medium (M), and high (H) dose of dexmedetomidine, that finally 80 cases ended the study and were analyzed. At the end of the surgery, the patients underwent ultrasound-guided TAP block. In all patients of the three groups, the analgesic base of the block was 20 mL bupivacaine 0.125% that was supplemented with 0.5, 1, or 1.5 µ/kg of dexmedetomidine in groups L, M, and H, respectively.ResultsThe maximum duration of the block was 4 hours in group L and 8 hours in groups M and H. None of the patients needed to receive analgesic at 0, 2, and 24 hours after the block. The dose of analgesic required in the first 8 hours of the block in groups M and H was less than in group L (P < 0.02). Patients in groups H and M were more satisfied with the block (P < 0.01) and experienced less pain compared with group L (P < 0.01). Drowsiness and sedation were observed in patients up to 4 hours after the TAP block, which was dependent on the dexmedetomidine dose (P < 0.01).ConclusionsBased on our results, the optimal dose of supplemental dexmedetomidine could be 1 µ/kg in the TAP block.

Evaluation of Analgesic Effect of Transversus Abdominis Plane Block after Emergency Cesarean Section

Background: Adequate postoperative analgesia is crucial after a caesarean section (CS) to facilitate early ambulation and newborn care (breast feeding, maternal-fetal bonding), as well as to reduce morbidity. As part of a multimodal analgesic strategy, the transversus abdominis plane (TAP) block is used in CS postoperative analgesia. The goal of our study is to see how effective TAP block is as an analgesic in the first 48 hours following emergency CS by Pfannenstiel incision. n Methodologies: A total of 100 pregnant women receiving emergency CS were enrolled in this prospective double-blind trial. They were divided into two groups at random. Group A: Bupivacaine was used to inhibit TAP in 50 women. Group B (control group): 50 women were given TAP block with 0.9 percent saline. Results: At rest and during movement, VAS in group B was substantially lower than in group A, although there was no significant difference between the two groups at baseline. When compared to group A, the time to the first morphine request was greatly delayed, and the overall dosage of morphine was greatly reduced. At 12 hours and 1 day, group B had much less nausea and sedation than group A, but at 0 and 2 days, there was no significant difference between the two groups. Final Thoughts: The use of an ultrasound-guided TAP block following emergency CS lowers the need for analgesics in the first 48 hours following surgery. It reduces pain intensity, lengthens the time to initial rescue analgesia, and lowers overall morphine, sedation, and nausea scores.

Comparing Intravenous Single Low Doses of Magnesium Sulphate versus Dexamethasone as Adjuvants to Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Prolongation of Postcesarean Analgesia

Introduction: The TAP block is a regional anesthetic technique, which blocks neural afferents between T6 and L1, which provide anterior abdominal walls and therefore help to alleviate postoperative pain. Aim: The aim is to compare the efficacy of preoperative single low dose of intravenous MgSO4 versus intravenous dexamethasone as adjuvants to ultrasound guided TAP block for prolongation of postcesaren analgesia. Materials and Methods: A total 60 pregnant females were selected undergoing elective caesarean sections under general anesthesia with ultrasound-guided transversus abdominis plane (TAP) block done at the end of surgery. Patients were randomly and equally allocated into three groups of 20 patients each. The first group of patients were classified as magnesium sulphate group (M)who received 50 mg/Kg IV, the second group of patients were classified as dexamethasone group (D) who received 2 mg IV and the third group was classified as the placebo group (C) who received IV saline. Results: Comparison of the VAS at 6 and 12 hours postoperatively showed statistically significantly lower values in group (M) and group (D) compared to group (C) and also group (M) was significantly lower than group (D) as well. The time interval until first rescue analgesia (Nalbuphine) needed by the patients (VAS ≥ 50) was significantly longer in group (M) compared to group (D) and group (C) consecutively. Additionally, it was significantly longer in group (D) than in the control group(C). The total dose of rescue analgesia consumed during the first 24 hours postoperatively was significantly lower in groups (M) than in group (D) and both groups showed lesser doses compared to group (C) Conclusion: We concluded that both MgSO4 and dexamethasone could prolong the postoperative duration and analgesic efficiency provided by the TAP block in cesarean sections. This further reduced the demands for postoperative rescue analgesia, with MgSO4 found to be more efficient than IV dexamethasone. Clinical Trial Registration Number: NCT04223128

P28: LAPAROSCOPIC VERSUS ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK IN LAPAROSCOPIC COLORECTAL SURGERY - A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Introduction A multimodal approach to peri-operative analgesia represents a cornerstone of enhanced recovery programmes in minimally invasive colorectal surgery. Transversus abdominis plane (TAP) block is an emerging anaesthetic technique that may reduce postoperative opiod analgesic requirements. It can be performed laparoscopically or percutaneously. We performed a systematic review and meta-analysis to compare the effectiveness of laparoscopic versus ultrasound-guided TAP block in laparoscopic colorectal surgery. Method PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All studies that compared laparoscopic (LTB) versus ultrasound-guided (UTB) TAP blocks in laparoscopic colorectal resections were included. The primary outcome measure was narcotic consumption at 24 hours postoperatively, while secondary outcomes included pain scores, operative time, postoperative nausea and vomitting (PONV) and complication rates. Random effects models were used to calculate pooled effect size estimates. Result Three randomised controlled trials and one retrospective study were included capturing 309 patients. On random effects analysis, there were no significant differences in narcotic consumption between LTB and UTB (Mean difference -8.12 mg, 95% CI=-22.13 to 5.89, p=0.26). LTB was associated with significantly lower pain scores (Mean difference -0.49, 95% CI=-0.96 to -0.02, p=0.04). There were no differences in operative time (Mean difference -6.67 mins, 95% CI=-29.4 to 16.06, p=0.57), PONV (OR=0.97, 95% CI=0.36 to 2.65, p=0.96) or complication (OR=1.30, 95% CI=0.64 to 2.64, p=0.47) rates. Conclusion LTB is associated with significantly less pain at 24 hours postoperatively but similar narcotic usage, PONV, operative time and complication rates, compared to UTB. Take-home message Laparoscopic transversus abdominis plane block is shown to leave patients with less pain at 24 hours post-op compared to ultrasound guided methods in colorectal patients.

English

BACKGROUND Regional anaesthesia is an armamentarium in the hands of the anaesthesiologist to provide swift, effective and safe condition for surgery. However, local anaesthetics are characterised by slower onset and shorter duration of action, when used in larger doses can cause systemic toxicity. Hence, adjuvants are used to better the quality of blocks. Here, I have used dexmedetomidine as an adjuvant in transversus abdominis plane (TAP) block to assess duration of action, hemodynamic effects and side-effects. METHODS Our study is randomised double blinded comparative study, in which we have compared two groups, one received ropivacaine alone and another received ropivacaine with dexmedetomidine as an adjuvant. Assessment was done for duration of action, visual analog scale (VAS) scores, analgesic drug usage, sedation scoring and incidence of side-effects and complications. This study was conducted on 94 parturients with 47 patients in each group. RESULTS Dexmedetomidine has a statistically significant prolonged action and has given excellent analgesia post-operatively. Additional analgesics were required in a lesser number than the control group. There were no hemodynamic disturbances and complications. CONCLUSIONS Dexmedetomidine added to ropivacaine for ultra-sound guided TAP block is associated with prolonged and excellent analgesia with lesser requirement for additional analgesic usage, lower VAS scores, hemodynamic stability, and minimal sedation. KEYWORDS Caesarean Section, Dexmedetomidine, Analgesia, Post-Operative, Ropivacaine, Transversus Abdominis Plane Block

Comparison of Ultrasound-Guided Transversus Abdominis Plane Block with Sub-Arachnoid Block for Open Inguinal Hernia Repair.

Background:Open inguinal hernia repair is one of the routine day-care procedures performed across the world. A multitude of anesthetic techniques have been outlined for painless inguinal hernia repair, comprising general anesthesia and regional anesthesia such as spinal, epidural, and nerve blocks; with regional anesthetic techniques often favored for uncomplicated open inguinal hernia repair. Ultrasound-guided peripheral nerve blocks have made rapid strides and are gaining popularity because of the reduced incidence of adverse events.Aims:We aim to compare the efficacy of two regional anesthesia techniques to compare the adequacy of surgical anesthesia and their efficacy to ease postoperative pain with least potential side effects.Settings and Design:This prospective, interventional, single-centric, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was registered with the Clinical Trial Registry of India (CTRI/2021/04/033109). It was conducted after obtaining written informed consent from all patients and approval from the institutional review board.Materials and Methods:Sixty patients of American Society of Anesthesiologists physical status classes I/II, in the age group of 18–60 years of either sex, scheduled for elective open inguinal hernia repair, were enrolled into two groups of 30 patients each according to the anesthetic technique used. Group T comprised patients receiving ultrasound-guided transversus abdominis plane block (TAP block), whereas the Group S comprised patients administered spinal anesthesia for elective open inguinal hernia repair. The primary end points of this study were to assess the adequacy of surgical anesthesia and duration of postoperative analgesia, whereas the secondary end points included assessment of patients’ hemodynamic profile post institution of the block and comparing the incidence of adverse events associated with the two techniques.Statistical Analysis:SPSS version 20.0 was used for analysis. Frequency, mean distribution, standard deviation, Chi Square test and student t Test were calculated to p value. P < 0.05 was considered statistically significant. Continuous variables were expressed as mean + SD, whereas categorical variables were expressed as absolute numbers and percentages. Intergroup nominal categorical data were compared by Chi-square test.Results:The visual analog scale score was found significantly lower in Group T at all time points except immediate postsurgery (3, 6, 12, 24, and 48 h) as compared to Group S (0.357 ± 0.4880 vs. 1.393 ± 1.8527; P = 0.006, 1.393 ± 0.4973 vs. 2.893 ± 2.3148; P = 0.001, 2.429 ± 0.9201 vs. 3.321 ± 2.0377; P = 0.039, 1.214 ± 0.4179 vs. 2.286 ± 1.9217; P = 0.006, and 1.143 ± 0.3563 vs. 1.643 ± 1.5685; P = 0.106, respectively), and the duration of postoperative analgesia was highly significant (P < 0.001) in Group T (724.00 ± 103.2914 min) as compared to Group S (256.643 ± 73.4218 min). Difference in the number of rescue analgesics administered over the first 24 and 24–48 h was significantly higher in the spinal group which comprised patients administered with the TAP block.Conclusion:Ultrasound-guided TAP block provides better intra-operative and postoperative analgesia as compared to subarachnoid block especially in respiratory and cardiovascular cripples without any significant adverse events and hemodynamic changes.