Ultrasound-guided Transversus Abdominis Plane Block Research Articles

Evaluation of the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block for chronic pain after lower abdominal surgery

Aim: This study aimed to evaluate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block in patients diagnosed with chronic pain after undergoing lower abdominal surgery.
 Methods: Patients who were admitted to the pain medicine clinic between January 1, 2016, and January 1, 2020, and underwent TAP block with the diagnosis of chronic pain after undergoing lower abdominal surgery were retrospectively analyzed. The visual analog scale (VAS) score was measured before the procedure and at the 1-month and 3-month follow-ups.
 Results: The proportion of patients with a reduction in VAS scores of >50% after TAP block application was 50% at the 1-month follow-up and 72.5% at the 3-month follow-up. The changes in the VAS score was found to be statistically significant (p < 0.05).
 Conclusion: Although ultrasound-guided TAP block seems to be an effective treatment method for chronic pain after lower abdominal surgery, further studies and clinical trials investigating different types of surgeries and including a larger number of patients are warranted.

The effect of ultrasound-guided transversus abdominis plane block on pulmonary function in patients undergoing laparoscopic cholecystectomy: a prospective randomized study.

Transversus abdominis plane block (TAPB) is commonly used for postoperative pain control after laparoscopic cholecystectomy. However, few studies have analyzed its effect on pulmonary function. The goal of this study was to elucidate the effect of ultrasound-guided bilateral TAPB on pulmonary function preservation and analgesia after laparoscopic cholecystectomy. We enrolled 58 patients who underwent laparoscopic cholecystectomy. Among them, 53 were randomized to group T (n = 27) and group C (n = 26). Group T and group C received ultrasound-guided bilateral TAPB with 40ml of 0.375% ropivacaine and 40ml of 0.9% normal saline, respectively. Visual analog scale (VAS) scores, patient-controlled analgesia (PCA) consumption, forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and modified Borg scale scores were measured until 24h post-surgery. The VAS scores were significantly lower in group T than in group C at 1 and 8h after the surgery. PCA consumption was significantly lower in group T than in group C at all postoperative time points. FEV1, PEF, and FEV1/FVC were more preserved in group T than in group C at 1h. Group T had significantly lower modified Borg scale scores than did group C at 1 and 8h. Ultrasound-guided TAPB is effective in pulmonary function preservation and pain control after laparoscopic cholecystectomy. Therefore, it could be a great option for multimodal analgesia, preservation of pulmonary function, prevention of pulmonary complications including atelectasis, and promotion of postoperative recovery after laparoscopic cholecystectomy. This study was enrolled in the Clinical Research Information Service (Clinical Research Information Service, KCT0004435, Hwa Yong Shin, 2019-08-19).

Effectiveness of Ultrasound Guided Trans-versus Abdominis Plane (TAP) Block with Landmark Technique Guided TAP Block for Open Appendectomy

Objective: To compare the analgesic efficacy of ultrasound (US) guided TAP block with landmark technique guided TAP block for management of post-op pain after open appendectomy in patients of acute appendicitis. Methods: In this study, we include 80 patients of acute appendicitis who were planned for open appendectomy were included. The study was conducted from June-2021 to Jan-2022 in Nishtar Hospital Multan. In Landmark TAP group; TAP block was given using bupivacaine (0.25%) after completion of surgical procedure using blind landmark technique. In US TAP group; TAP block was administered under US supervision. VAS Score and time of first rescue analgesia were main study outcomes. Results: Mean age was 33.5±9.9 years in landmark TAP group and 32.8±10.4 years in US TAP group (p-value 0.75). There was no significant difference in mean VAS score at 1, 6, 12 and 18 hours after surgery between the groups, However, after 24 hours of surgery mean VAS score was higher in landmark TAP group; 3.5±1.2 versus 2.9±1.0 in TAP group (p-value 0.02). Time of first rescue analgesia was significantly prolonged in US TAP group; 1320.7±275.9 minutes versus 1180.4±320.7 minutes in landmark TAP group (p-value 0.04). Conclusion: Ultrasound guided TAP block is superior to landmark guided TAP block, as it provides better analgesic outcomes in comparison of landmark guided TAP block. Keywords: Ultrasonography, landmark technique, transversus abdominus plane block.

Transversus Abdominis Plane Block Versus Local Anesthetic Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Hernia Repair in Daycare Procedure: A Randomized Control Trial.

Introduction: Various modalities are now being used to manage postoperative pain, such as regional nerve blocks techniques, continuous epidural analgesia, patient-controlled analgesia, opioids, and systemic non-steroidal anti-inflammatory drugs. This study compared the mean postoperative pain score between ultrasound-guided transversus abdominis plane (TAP) block and a local anesthetic wound infiltration at the surgical incision site.Methodology: A prospective, comparative, randomized controlled trial (RCT) was carried out from February 2021 to September 2021. The study was conducted in the anesthesia department of Dow University of Health Sciences, Karachi, Pakistan. Patients aged 18-80 years presenting with elective surgery of (both direct and indirect) inguinal hernia repair were enrolled in the study. Participants were randomly assigned into one of the two groups that are local anesthetic wound infiltration (Group A) and TAP block (Group B). The mean pain score was assessed using a visual analog scale and compared between the two groups.Results: The study included 168 patients grouped in two different groups. The mean age in Group A was 43.87 (+17.21), and Group B was 47.01 (±15.37). Mean pain scores in groups A and B were 6.36±1.94 vs 4.51 ± 1.99 (p-value=0.001). The pain rescue medications were given to 57.14% of patients in Group A and 34.52% of patients in Group B, and it was significantly different in the two groups (p-value=0.003). It was found that patients in Group A reported more severe pain (41.67%) than patients in Group B (10.71%).Conclusion: When compared to local anesthetic wound infiltration, ultrasound-guided TAP block had better analgesic activity compared to local anesthetic wound infiltration.

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Background and objectivesUltrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks and transverse abdominis plane (TAP) blocks are widely used for postoperative analgesia in children undergoing inguinal hernia repair (IHR). Quadratus lumborum block (QLB)...

TRANSVERSES ABDOMINIS PLANE BLOCK VERSUS QUADRATUS LUMBORUM BLOCK FOR POSTOPERATIVE ANALGESIA AFTER CAESAREAN SECTION.

BACKGROUND- Caesarean section for baby delivery is one of the most common surgical procedures being performed worldwide. Effective early postoperative analgesia remains priority and it can improve maternal outcome. Multimodal analgesia remains standard for post operative analgesia following caesarean section. Truncal block, including transversus abdominis plane (TAP) block and quadratus lumborum block play an important roles in multimodal analgesia. Aim of this study was to compare TAP block versus QL block for analgesic efciency after cesarean section under general anaesthesia. METHODS – This prospective randomized control study was done in tertiary care hospital from June 2021 to December 202, 80 patients were enrolled and randomized into two groups TAPB and QLB group with 40 patients each. Ultrasound guided TAP block and QL block with 20 ml of 0.2% Ropivacaine was given on each side was given postoperatively before extubation. Patients were observed for 24 hours, Inj Tramadol intravenous was given as rescue analgesia. Patients were evaluated for analgesic efciency, time to rescue analgesia, number of doses, average analgesic dose were noted along with median VAS score.RESULTS- Average dose requirement for rescue analgesia was higher in TAPB group than QLB group. Number of patients requiring analgesia was 80% in TAPB and 27.5% in QLB group. Time to rescue analgesia was 820 minutes in TAPB group and 1414 minutes in QLB group. Median VAS scores were comparable between two groups initially; signicant difference was seen at 6 hours postoperatively, with maximum difference seen at 12 hours interval. Beyond 18 hours difference in median VAS scores between two groups was insignicant. No complications with either of procedures were noted.CONCLUSIONS - Analgesic efcacy of QL block is better than TAP block. Median VAS scores were lower and time to rst analgesic demand was prolonged, with reduced total analgesic consumption in 24 hours.

A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

Nowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial.

BackgroundThis study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries.MethodsEighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP block. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric rating scale (NRS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded.ResultsSeventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NRS than those in group C (P < 0.05). The highest difference in the postoperative NRS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores.ConclusionsIn patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NRS and reduced analgesic requirements than port site LAI.

Analgesic Efficacy of Dexamethasone and Dexmedetomidine as an Adjuvant to 2% Lignocaine Adrenaline and 0.5% Bupivacaine in Transversus Abdominis Plane Block after Caesarean Delivery

Introduction: The ultrasound-guided Transversus Abdominis Plane (TAP) block is an analgesic technique which involves injection of a local anesthetic between the internal oblique abdominal and the transversus abdominis muscle planes. It provides analgesia to the cranial branches of T10-L1 nerve roots. It has been a practice to provide analgesia in patients following various surgical procedures including the gynecological procedures like hysterectomy and caesarean section. Aim: To assess the analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine in TAP block following caesarean delivery. Materials and Methods: This was a cross-sectional study conducted at Konaseema Institute of Medical Sciences and Research Foundation (KIMS&amp;RF), Amalapuram, Andhra Pradesh, India for a period of one year from January 2021 to December 2021. One hundred patients with an American Society of Anaesthesiologists (ASA) physical scores of I-II, who underwent caesarean section under the Pfannenstiel incision method under subarachnoid anaesthesia with 0.5% heavy bupivacaine, were enrolled in the study. Group I consisted of patients that received an ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 20 mcg dexmedetomidine. Group II included patients who received ultrasound-guided bilateral TAP block immediately following surgery with 10 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine adrenaline, and 8 mg dexamethasone. The Electrocardiogram (ECG) recordings and blood pressure were recorded during the block in each patient. This approach enabled a more precise analgesic approach for each individual patient. The patients were assessed for pain up to 12 hours of surgery based on a Visual Analog Scale (VAS), where 0 represented no pain and 10 represented ‘the worst pain ever possible. Results: The patients who received ultrasound-guided TAP block with dexmedetomidine were significantly less on-demand of tramadol (p-value=0.005) and had significantly lower VAS scores at 3 hours (p-value=0,000014), 6 hours (p=0.015) and 12 hours (p-value=0.006), postoperatively. Conclusion: This study proved that dexmedetomidine was more effective when compared to dexamethasone, when added as an adjuvant to 2% lignocaine adrenaline and 0.5% bupivacaine. Ultrasound guided TAP block was a safe and effective postoperative analgesia in cesarean section.

Comparison of ultrasound-guided transversus abdominis plane block and quadratus lumborum block for postoperative analgesia following laparoscopic living donor nephrectomy: A prospective randomized, double-blind study

Comparison of ultrasound-guided transversus abdominis plane block and quadratus lumborum block for postoperative analgesia following laparoscopic living donor nephrectomy: A prospective randomized, double-blind study

Preemptive analgesic effect of ultrasonography-guided transversus abdominis plane block performed by adding dexamethasone to bupivacaine

The objective of this study was to evaluate the preemptive analgesic effect of ultrasound-guided transversus abdominis plane block performed with bupivacaine or adding dexamethasone on bupivacaine in laparoscopic cholecystectomy. This retrospective study was conducted on a total of 84 patients who underwent ultrasound-guided TAP block in laparoscopic cholecystectomy. Patients were divided into two groups: Group Bupivacaine (Group B) and Group Bupivacaine+Dexamethasone (Group B+D). Intraoperative hemodynamic changes, intraoperative remifentanil consumption, postoperative visual analog scale scores, tramadol consumption in 24 hours postoperatively, and postoperative first analgesic time were obtained from the records and compared between the groups. There were no statistically significant differences between both groups in terms of intraoperative heart rate, mean arterial pressure, oxygen saturation, and end-tidal CO2 values. Postoperative visual analog scale scores, doses of remifentanil and total tramadol, and time of receiving the first analgesic were similar. Dexamethasone can be added to the bupivacaine for the TAP block without major side effects. Adding dexamethasone to bupivacaine in transverse abdominis plane block performed in laparoscopic cholecystectomy procedures did not create a significant difference in VAS score. We think that the use of dexamethasone does not have an additional analgesic effect. However, our results should be supported by further studies.

Is Ultrasound-Guided Transversus Abdominis Plane Block Superior to a Caudal Epidural or Wound Infiltration for Intraoperative and Postoperative Analgesia in Children Undergoing Unilateral Infraumbilical Surgery? A Double-blind Randomized Trial.

ABSTRACTBackground and Aim:Caudal block (CB) is the standard of care in pediatric surgeries. Ultrasound (USG) transversus abdominis plane (TAP) block has also been used as an effective regional anesthesia technique. We compared the duration of postoperative and intraoperative analgesia between TAP block, CB, and local wound infiltration (LI) in children undergoing unilateral infraumbilical abdominal surgery.Materials and Methods:One hundred and twenty children, 3–10 years old and American Society of Anesthesiologists Grade I and II, undergoing elective unilateral infraumbilical abdominal surgery were allocated to three groups. Group TAP: USG-guided TAP block with 0.5 ml/kg of 0.25% bupivacaine; Group CB: CB with 0.75 ml/kg of 0.25% bupivacaine; and Group LI: Local wound infiltration along the incision with 0.5 ml/kg of 0.25% bupivacaine. The primary outcome was the efficacy of postoperative analgesia using modified objective pain score (MOPS), and the secondary outcome was to determine intraoperative analgesia with fentanyl requirement and minimum alveolar concentration (MAC) hour of isoflurane among the three groups.Results:The MOPS was statistically better in Group TAP compared to group CB and group LI at 8 and 24 h postoperatively. The mean ± standard deviation duration of postoperative analgesia in groups CB, LI, and TAP was 6.84 ± 0.47, 2.3 ± 1.26, and 9.78 ± 1.02 h, respectively. The intraoperative requirement of fentanyl and MAC hour was least in Group CB.Conclusion:We found that USG-guided TAP block is a good alternative, with longer and effective postoperative analgesia compared to CB. However, the quality of intraoperative analgesia was best in group CB. Local infiltration was a poor alternative.

Learning Curve of Ultrasound-Guided Surgeon-Administered Transversus Abdominis Plane (Ugsa-Tap) Block on a Porcine Model

Learning Curve of Ultrasound-Guided Surgeon-Administered Transversus Abdominis Plane (Ugsa-Tap) Block on a Porcine Model

Addition of dexamethasone to levobupivacaine in the ultrasound-guided bilateral subcostal transversus abdominis plane block improves the quality of postoperative analgesia after laparoscopic cholecystectomy: A prospective randomized clinical study

Background and Aims: Addition of dexamethasone to levobupivacaine in the peripheral nerve block provides improved pain scores, prolonged pain relief, and reduced postoperative opioid requirement. However, the evidence regarding its efficacy in the transversus abdominis plane (TAP) block is limited. Therefore, we conducted this study to evaluate the potential benefits of combining dexamethasone with levobupivacaine in the subcostal TAP block during the first 24 h after laparoscopic cholecystectomy. Materials and Methods: Seventy-six patients were enrolled in the study and divided into two groups to receive 20 ml of 0.25% levobupivacaine with 1 ml NS bilaterally (Group LS) or 20 ml of 0.25% levobupivacaine with 4 mg dexamethasone bilaterally (Group LD). Each patient received a standard multimodal analgesic regimen. Pain scores were recorded at rest and during coughing at 0, 2, 4, 6, 12, and 24 h postoperatively. Total opioid consumption and associated complications were recorded during the first 24 h. Results: Pain scores were lower in the LD group as compared to the LS group at all time points. Reduction in Numeric Rating Scale values was statistically significant at 4, 6, and 12 h both at rest and during coughing. Estimated P values on coughing at these time points were 0.000, 0.001, and 0.017, respectively. Postoperative opioid requirement was also significantly reduced between 2 and 24 h (P = 0.007). We did not record any complications in our study population. Conclusion: The combination of dexamethasone and levobupivacaine in the subcostal TAP block significantly improves the efficacy of multimodal analgesic regimen during the first 24 h after laparoscopic cholecystectomy.

Comparing the intraoperative and postoperative analgesic effect of transabdominal block versus caudal block in children undergoing laparoscopic appendectomy

Background: Laparoscopic appendectomy is commonly performed in children. Regional anesthesia in children is complementary to general anesthesia, which allows conscious postoperative analgesia and reducing hospital stay. Caudal anesthesia and transverses abdominis plane (TAP) block is commonly used in children because it is easy to practice and provides effective analgesia during surgery. However, its efficacy in laparoscopic appendectomy is not tested much.Aim: The aim of this study is to evaluate the analgesic efficacy of caudal block and TAP block, when used as pre-emptive analgesia using ropivacaine in terms of opioid consumption, postoperative visual analog score (VAS), duration of analgesia, time for rescue analgesia, postoperative nausea, and vomiting and other side effects following elective laparoscopic appendectomy.Methodology: The study design was a prospective, double-blinded, comparative randomized trial on children undergoing laparoscopic appendectomy. Sixty patients between 12 and 18 years were included in the study. They were allocated into any one of two groups of 30 patients each, employing computer-generated randomization. Group I: receive ultrasound-guided caudal block using 0.2% ropivacaine 1 mL/kg. Group II: receive ultrasound-guided TAP block using 0.2% ropivacaine 1 mL/kg.Results: Total intraoperative consumption of opioid fentanyl in Group I is 14.83 ± 18.78 compared to 25.50 ± 17.88 in Group II, which is statistically significant P = 0.028*. VAS score was significantly lower in Group II compared to Group I, P < 0.001**.Conclusion: Caudal block is effective for intraoperative management, whereas TAP block is effective for postoperative management in children undergoing laparoscopic appendectomy.

Postoperative Analgesic Efficacy of Transverse Abdominis Plane Block versus Port Site Local Infiltration in Laproscopic Gynaecological SurgeriesA Randomised Clinical Trial

Introduction: Pain relief postoperatively has advantages related to better patient satisfaction in terms of early ambulation and discharge and also better cardiovascular stability, decreased infections, neurological complications, prevention of thromboembolic phenomenon, and chronic pain syndrome. Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and opioids are the most commonly used drugs in pain management. Transverse Abdominis Plane (TAP) block is a regional analgesic technique, which provides analgesia of the anterolateral abdominal wall and hence can be used to provide analgesia for cesarean section, hernia repairs, hysterectomies, cholecystectomy. Aim: To compare the effectiveness of bilateral TAP block versus port sites local anaesthetic infiltration to relieve postoperative pain in laparoscopic gynaecological surgeries. Materials and Methods: This single-blinded randomised controlled study conducted at PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India, from January 2020 to June 2021. The clinical trial was conducted on 80 patients belonging to American Society of Anesthesiologists (ASA) I and II posted for elective laparoscopic gynaecological surgeries. Patients were randomly allocated into two groups with 40 patients in each group. Group T (TAP block) received 0.6 mL/ kg of 0.25% bupivacaine for bilateral ultrasound guided TAP block and group O (port sites local infiltration) received 0.6 mL/ kg of 0.25% bupivacaine for port sites infiltration. At the end of surgery, patients received either TAP block or port site infiltration as per the group allocated and then extubated. Postoperative pain intensity using Visual Analogue Scale (VAS) score were recorded at the time of shifting as 0 hr and then every 2 hrs, 4 hrs, 6 hrs, 8 hrs, 12 hrs, 24 hrs. The mean time for first rescue analgesia and total number of rescue analgesic given in first 24 hrs were noted. Haemodynamic parameters and side-effects with study drug were noted. For inferential statistics, numerical data was analysed by Chi-square test and for categorical data student’s t-test was used. A p-value &lt;0.05 was considered as statistically significant. Results: Demographic parameters in both groups were comparable. There was no significant difference in VAS score up to 4 hours in between two groups. But mean VAS score was significantly low in group T when compared to group O at 6 hours (2.2±0.4 vs 2.7±0.5), 8 hours (2.7±0.4 vs 3.2±0.7) and 12 hours (3.3±0.5 vs 3.6±0.5). The time to receive rescue analgesic was longer in TAP block group (13.7±1.5 vs 10.6±1.64 hrs) when compared to port sites local infiltration group. And total number of rescue analgesia received was low in TAP block group (70% recieved single dose) when compared to port sites local infiltration group (80%received two doses). Conclusion: The TAP block and port sites infiltration in patients undergoing laparoscopic gynaecological surgeries are used for effective postoperative analgesia as part of multimodal analgesia, which reduces the use of other analgesics like NSAIDS and opioids. However, TAP block provides superior and prolonged pain relief when compared to port sites local infiltration.

Ultrasound Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Total Abdominal Hysterectomy.

Quadratus lumborum (QL) block has emerged as a good option to be included in multimodal analgesia for abdominal surgeries. The aim of the present study was to compare the effectiveness of the QL block with the more established transversus abdominis plane (TAP) block along with a control group in terms of duration of analgesia as the primary outcome in total abdominal hysterectomy (TAH). This randomised, double-blind, controlled trial was performed after ethics committee approval and written informed consent. Ultrasound-guided QL (group Q) and TAP (group T) blocks were administered on either side using 20mL of 0.25% bupivacaine after surgery under general anaesthesia, and group C did not receive any intervention. There was a significant difference in the duration of analgesia among the groups (P ¼ .00). It was significantly longer in group Q (mean ¼ 8.05 hours; 95% CI, 7.28, 8.81) compared to group T (mean ¼ 5.59 hours; 95% CI, 4.63, 6.45) and group C (mean ¼ 1.19 hours; 95% CI, 1.04, 1.34). The verbal rating score (P ¼ .001) and the cumulative analgesic consumption (P ¼ .00) were the least in group Q. There was no complication in any of the groups. However, the level of satisfaction in patients receiving QL blocks did not differ significantly than in those receiving TAP block. It is highly recommended to include QL block as a part of multimodal analgesia in TAH as it is superior to TAP block in analgesic effect.

Ultrasound-guided quadratus lumborum block verses transversus abdominis plane block for post-operative analgesia in patients undergoing total abdominal hysterectomy: A prospective observational study

Background: Total abdominal hysterectomy (TAH) is a major surgical procedure associated with significant post-operative pain and discomfort. Ultrasound-guided (USG) quadratus lumborum (QL) and transversus abdominis plane (TAP) block are regional analgesic techniques that have role in post-operative pain management after TAH. Aims and Objectives: This study aims to compare quality of post-operative analgesia and analgesic consumption in USG-guided QL block and TAP block in patients undergoing TAH under spinal anesthesia. Materials and Methods: Hundred patients scheduled for TAH were observed over a period of 2 years. The patients who had received either TAP block or QL block were assigned in two groups. Patients who received TAP block after spinal anesthesia were labeled as Group A and patients who received QL block after spinal anesthesia were labeled as Group B. Postoperatively, VAS score, rescue analgesia, analgesic consumption, and hemodynamic parameters were observed at 0, 1, 3 6, 9, 12, 18, 24, and 48 h. Statistical Analysis: Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. P&lt;0.05 was considered statistically significant. Results: Time for rescue analgesic requirement was higher in the Group B than the Group A (mean±SD: 16.5±3.096 h vs. 8.5±1.998 h) (P&lt;0.001). Group B had significantly less analgesic demand (P&lt;0.001) at 12, 24, and 48 h postoperatively. The VAS at rest and movement was significantly reduced in Group B at all times. Hemodynamic parameters and post-operative side effects between two groups remained insignificant. Conclusion: USG-guided quadratus lumber block provided prolonged analgesia as compared to TAP block in patients undergoing TAH after spinal anesthesia. USG-guided quadratus lumber block provides better multimodal post-operative analgesia relief in patients.

Transversus Abdominis Plane (TAP) Block: A Comparative Study between Levobupivacaine versus Levobupivacaine plus Ketamine in Abdominoplasty.

Purpose We conducted this study to explore the hypothesis that the addition of ketamine to levobupivacaine in ultrasound-guided Transversus Abdominis Plane (TAP) block would result in a better and prolonged duration of postoperative analgesia for patients undergoing abdominoplasty. Material and Methods. This randomized prospective study was conducted on 50 patients who were scheduled for abdominoplasty. TAP block was performed bilaterally for all patients either with levobupivacaine 0.5% 15 ml plus ketamine 0.5 mg/kg in a total volume of 20 ml in the LK group (n = 25) or with levobupivacaine 0.5% 15 ml plus 5 ml normal saline in a total volume of 20 ml in the L group on each side. Results Visual analogue scale (VAS) was significantly lower in the LK group in resting condition at 6, 12, and 16 h postoperatively compared to the L group. On movement, the VAS was significantly lower at 4, 6, 8, 12, 16, and 24 h postoperatively in the LK group compared to the L group. The time for first rescue analgesia was longer in the LK group (18.7 ± 4.8 h) than that in the L group (6.5 ± 2.4 h) with the reduced total amount of rescue morphine in the LK group (1.14 ± 2.2 mg) versus the L group (5.86 ± 3.6 mg). Only six patients in the LK group requested rescue morphine, whereas nineteen patients requested rescue morphine in the L group. Conclusions In TAP block, adding ketamine 0.5 mg/kg enhanced the analgesic efficacy of levobupivacaine 0.5% in patients undergoing abdominoplasty and reduced the required analgesics postoperatively.

Laparoscopic-guided distal loco-regional anesthetic infiltration technique in TAPP inguinal hernia repair: a double-blind randomized clinical trial.

Ultrasound-guided transversus abdominis plane block (US-TAP) is an important component of multimodal analgesia in laparoscopic inguinal hernia repair, although it has certain limitations. To overcome them, surgeons have developed several techniques to perform local anesthetic infiltration under laparoscopic guidance, but no trials evaluating these in transabdominal preperitoneal (TAPP) hernia repair were conducted till the date. The aim of this study was to compare the efficacy of a novel laparoscopic-guided local anesthetic infiltration technique (LDAI) with US-TAP in postoperative pain control and analgesic consumption for patients undergoing elective TAPP hernia repair. This was a double-blind randomized controlled trial conducted at a single tertiary academic center between 2019 and 2020 on adult patients undergoing elective laparoscopic TAPP inguinal hernia repair. Postoperative pain and analgesic consumption were compared for LDAI vs. US-TAP up to 30 postoperative days. 62 patients were included (31 LDAI, 31 US-TAP). Female gender was significantly higher in the LDAI group (8, 25.81%; US-TAP 0; p = 0.005). Mean anesthetic time (US-TAP group: 142.2min, SD = 17.7; LDAI group: 127.1min, SD = 15.5; p < 0.001) and mean operative time (US-TAP group: 117.2min, SD = 15.9; LDAI group: 103.8min, SD = 15.2; p < 0.001) were significantly shorter in the LDAI group. Pain scores assessed at the first-hour postoperative, at the moment of discharge, and at 8, 24, and 48 postoperative hours showed no significant differences between both groups. No significant difference was found regarding postoperative analgesic rescue administration in the recovery room and analgesic consumption after discharge between groups. LDAI is a safe and effective local anesthetic technique in elective TAPP hernia repair. Pain control is similar to US-TAP block, with shorter anesthesthetic and surgical time and better health resources allocation.