Ultrasound-guided Transversus Abdominis Plane Research Articles

How Effective is Transversus Abdominis Plane Block in Reducing Pain and Opioid Needs Following Bariatric Surgery?

How Effective is Transversus Abdominis Plane Block in Reducing Pain and Opioid Needs Following Bariatric Surgery?

Optimal approach for ultrasound-guided transversus abdominis plane (TAP) blocks for abdominal surgeries: a protocol for systematic review and meta-analysis

IntroductionTransversus abdominis plane (TAP) blocks are commonly used for postoperative analgesia after various abdominal surgeries. There are several different approaches for performing TAP blocks, mainly including posterior, lateral and subcostal...

Laparoscopic assisted versus ultrasound guided transversus abdominis plane block in laparoscopic bariatric surgery: a randomized controlled trial

BackgroundTransversus abdominis plane block (TAPB) guided by laparoscopy and ultrasound showed promise in enhancing the multimodal analgesic approach following several abdominal procedures. This study aimed to compare the efficacy and safety between Laparoscopic (LAP) TAP block (LTAP) and ultrasound-guided TAP block (UTAP) block in patients undergoing LAP bariatric surgery.Patients and methodsThis non-inferiority randomized controlled single-blind study was conducted on 120 patients with obesity scheduled for LAP bariatric surgeries. Patients were allocated into two equal groups: LTAP and UTAP, administered with 20 mL of 0.25% bupivacaine on each side.ResultsThere was no statistically significant difference in the total morphine consumption, Visual Analogue Scale (VAS) score at all times of measurements, and time to the first rescue analgesia (p > .05) between both groups. The duration of anesthesia and duration of block performance were significantly shorter in the LTAP group than in the UTAP group (p < .001). Both groups had comparable post-operative heart rate, mean arterial pressure, adverse effects, and patient satisfaction.ConclusionsIn LAP bariatric surgery, the analgesic effect of LTAP is non-inferior to UTAP, as evidenced by comparable time to first rescue analgesia and total morphine consumption with similar safety blocking through the low incidence of post-operative complications and patient satisfaction.Trial registrationThe study was registered in Pan African Clinical Trials Registry (PACTR) (ID: PACTR202206871825386) on June 29, 2022.

Comparison of USG guided with Anatomical Landmark guided TAP Block following Total Abdominal Hysterectomy

A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.

Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study.

To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management. Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure. 34 patients were included. During the median length of stay of 4days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12h post-op, decreasing to 38% by 48h post-op. The median consumption decreased in the first 48h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48h intervals, respectively. The median time to perform block procedure was 6min (IQR 4-8min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption. Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.

Effect of ultrasound-guided transversus abdominis plane block in reducing atelectasis after laparoscopic surgery in children: A randomized clinical trial

BackgroundAtelectasis is a commonly observed postoperative complication of general anesthesia in children. Pulmonary protective ventilation strategies have been reported to have a beneficial effect on postoperative atelectasis in children. Therefore, the present study aimed to evaluate the efficacy of the ultrasound-guided transversus abdominis plane (TAP) block technique in preventing the incidence of postoperative atelectasis in children. Materials and methodsThis study enrolled 100 consecutive children undergoing elective laparoscopic bilateral hernia repair and randomly divided them into the control and TAP groups. Conventional lung-protective ventilation was initiated in both groups after the induction of general anesthesia. The children in the TAP group received an ultrasound-guided TAP block with 0.3 mL/kg of 0.5% ropivacaine after the induction of anesthesia. ResultsAnesthesia-induced atelectasis was observed in 24% and 84% of patients in the TAP (n = 50) and control (n = 50) groups, respectively, before discharge from the post-anesthetic care unit (T3; PACU) (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.019–0.179; P < 0.001). No significant difference was observed between the control and TAP groups in terms of the lung ultrasonography (LUS) scores 5 min after endotracheal intubation (T1). However, the LUS scores were lower in the TAP group than those in the control group at the end of surgery (T2, P < 0.01) and before discharge from the PACU (T3, P < 0.001). Moreover, the ace, legs, activity, cry and consolability (FLACC) pain scores in the TAP group were lower than those in the control group at each postoperative time point. ConclusionUltrasound-guided TAP block effectively reduced the incidence of postoperative atelectasis and alleviated pain in children undergoing laparoscopic surgery.

Genel Anestezi Altında Göbek Altı Ameliyatları Geçiren Çocuklarda Postoperatif Analjezi için Quadratus Lumborum Bloğu ile Transversus Abdominis Plan Bloğunun Karşılaştırılması: Prospektif Randomize Çalışma

Objective: Quadratus lumborum block (QL block) is a new addition to the truncal blocks used for postoperative analgesia of both upper and lower abdominal surgeries. We conducted this study to evaluate and compare the effect of the two truncal blocks QL-II block and transverses abdominis plane block on the of duration of effective analgesia in children undergoing infra umblical surgeries under general anesthesia. Methods: A prospective randomised study in patients between 1-7 years of age undergoing infraumbilical surgeries. 33 patients in each group. Group A received ipsilateral ultrasound guided Quadratus lumborum (QL) block group (0.5 ml kg-1 0.2% bupivacaine) and Group B received ipsilateral ultrasound guided Transversus abdominis plane block (TAP) (0.5 ml kg-1 0.2% bupivacaine). The primary outcome was the duration of effective in the postoperative period and secondary outcomes were the distribution of FLACC scores and Parent Satisfaction score. Results: The duration of effective analgesia was longer in group A (mean of 18.0 hours) when compared to group B (mean of 9.5 hours) in Quadratus lumborum (Type II) block group tends to have lesser pain scores (FLACC scale) and better parent satisfaction levels when compared with TAP block. Conclusion: Quadratus lumborum-II block provides longer duration of effective analgesia in the post–operative period in children aged 1-7 years undergoing infra umbilical surgeries under general anaesthesia. It also tends to achieve lesser pain scores and better parent satisfaction levels when compared with TAP block. Keywords: Bupivacaine, quadratus lumborum, satisfaction, analgesia, children

Learning curve of ultrasound-guided surgeon-administered transversus abdominis plane (UGSA-TAP) block on a porcine model

BackgroundSurgeons commonly perform ultrasound-guided Transversus Abdominis Plane blocks to manage acute pain following abdominal surgeries. There is no consensus on whether surgeons should undergo basic hands-on training to perform TAP blocks or if video-based learning is sufficient. We theorized that simulation-based learning is superior to video-based learning. In the present study, we present the analysis of technical skills of UGSA-TAP block performance on a live porcine model by general surgery trainees after undergoing video or simulation-based learning. MethodsWe performed a prospective, double-blinded, randomized study. Ten surgery residents and two surgery critical-care fellows (n = 12) without prior experience in performing the TAP block were recruited. The participants were randomized either into a video-based or simulation-based training group. After that, all participants performed a TAP block on a live anesthetized pig, which was recorded and scored by three blinded anesthesiologists. All participants completed a post-performance survey to assess their confidence in gaining competency in the UGSA-TAP block. Statistical analyses were performed to assess the differences between the two groups. P < 0.05 was considered statistically significant. ResultsAll simulation-based learning participants successfully performed a survey scan, identified the three muscular layers of the abdominal wall, and identified the transversus abdominis plane compared to 50 %, 50 %, and 33 % video-based learning group participants for the respective parameters (p < 0.05). While some performance metrics showed no statistically significant differences between the groups, substantial effect sizes (Cohen's ℎ up to 1.07) highlighted notable differences in participants' performance. Both groups exhibited confidence in core competencies, with varied rates of satisfactory skill execution. Performance assessed using a global rating scale revealed a higher passing rate for the simulation group (83 % vs. 33 %). Participant feedback via the Likert scale reflected confidence post-training. Inter-rater reliability (0.83–1) confirmed the robustness of study evaluations. ConclusionThe UGSA-TAP block curriculum should be introduced into the surgical residency programs with an emphasis on simulation-based learning to enhance the procedural skills of the trainees before transitioning to surgical patients.

Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials.

The transversus abdominis plane block (TAPB) is effective for postoperative pain management in patients undergoing colorectal surgery. However, evidence regarding the optimal delivery method, either laparoscopic (L-TAPB) or ultrasound-guided (U-TAPB) is lacking. Our study aimed to compare the effectiveness of these delivery methods. We carried out a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar databases to include randomized studies comparing patients receiving either L-TAPB or U-TAPB during minimally invasive colorectal surgery. The primary endpoint was opioid consumption in the first 24h after surgery. Risk of bias was assessed with the RoB-2 tool. Effect size was estimated for each study with 95% confidence interval and overall effect measure was estimated with a random effect model. The literature search revealed 294 articles, of which four randomized trials were eligible. A total of 359 patients were included, 176 received a L-TAPB and 183 received a U-TAPB. We established the non-inferiority of L-TAPB, as the absolute difference of - 2.6 morphine-mg (95%CI - 8.3 to 3.0) was below the pooled non-inferiority threshold of 8.1 morphine-mg (low certainty level). No difference in opioid consumption was noted at 2, 6, 12, and 48h (low to very low certainty level). Postoperative pain, nausea and vomiting were similar between groups at different timepoints (low to very low certainty level). No TAPB-related complications were recorded. Finally, the length of hospital stay was similar between groups. For postoperative multimodal analgesia both L-TAPB and U-TAPB may result in little to no difference in outcome in patients undergoing colorectal surgery. Registration Prospero CRD42023421141.

Analgesic Strategies for Urologic Videolaparoscopic or Robotic Surgery in the Context of an Enhanced Recovery after Surgery Protocol: A Prospective Study Comparing Erector Spinae Plane Block versus Transversus Abdominis Plane Block.

Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound-guided bilateral transversus abdominis plane block (TAPB) on postoperative analgesia after laparoscopic or robotic urologic surgery. This was a prospective observational study; 97 patients (ESPB-group) received bilateral ultrasound-guided ESPB with 20 mL of ropivacaine 0.375% plus 0.5 mcg/kg of dexmedetomidine in each side at the level of T7-T9 and 93 patients (TAPB-group) received bilateral ultrasound-guided TAPB with 20 mL ropivacaine 0.375% or 0.25%. The primary outcome was the postoperative numeric rating scale (NRS) pain score, which was significantly lower in the ESPB group on postoperative days 0, 1, 2, and 3 (p < 0.001) and, consequently, the number of patients requiring postoperative supplemental analgesic rescue therapies was significantly lower (p < 0.001). Concerning the secondary outcomes, consumption of ropivacaine was significantly lower in the group (p < 0.001) and the total amount of analgesic rescue doses was significantly lower in the ESPB-group than the TAPB-group in postoperative days from 2 to 4 (1 vs. 3, p > 0.001). Incidence of postoperative nausea and vomiting was higher in the TAPB group and no block-related complications were observed. Our data indicate that ESPB provides postoperative pain control at least as good as TAPB plus morphine, with less local anesthetic needed.

Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Pain Control in Patients intraoperative Cesarean Section

Ultrasound-Guided Transversus Abdominis Plane (TAP) Block for Pain Control in Patients intraoperative Cesarean Section

Bilateral ultrasound-guided quadratus lumborum block versus bilateral transversus abdominis plane block for postoperative analgesia after cesarean section

Background For mothers caring for newborns, adequate pain control after cesarean section is critical, as is early ambulation to prevent thromboembolism and chronic abdominal and pelvic pain. Aim The primary goal of the research is to compare the effectiveness of ultrasound-guided quadratus lumborum block (QLB) versus transversus abdominis plane (TAP) block for postoperative analgesia and opioid consumption after a cesarean section. The secondary goal of the research is to assess the time required for each technique and postoperative complications and patient satisfaction in each group. Patients and methods Current research occurred in Elshatby University Hospital on 40 American Society of Anesthesiologists I or II studied cases with a gestation of at least 37 weeks (according to sample size calculation) scheduled for elective cesarean section. Results Comparing the time of analgesia between the two groups was longer in the QLB1 group than the control group (P≤0.001). The total amount of rescue analgesia (nalbuphine) consumption ranged between 0 and 6 mg with a mean value of 0.60±1.85 mg/24 h in the QLB1 group, and between 0 and 12 mg with a mean value of 8.40±5.30 mg/24 h in TAP block group. The total amount of postoperative nalbuphine consumption was greater in the TAP block group compared with the QLB1 group (P&lt;0.001). Patient satisfaction with pain control has been assessed on four-point scale like: excellent, good, fair and poor. Comparison between the two groups showed significantly better patient satisfaction in QLB1 group compared with the TAP block group where the P value was 0.016. Conclusion From the present research, the following can be concluded: ultrasound-guided QLB is a more influential method than TAP block for postoperative analgesia in studied cases undergoing cesarean section as it is more effective in reducing both somatic and visceral pain. Ultrasound-guided QLB is associated with a decrease in total opioid consumption, longer time of analgesia and greater studied case satisfaction.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value &lt;0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO2 (p=0.404) were comparable between the two groups (p&gt;0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

Efficacy of Ultrasound-guided Transverse Abdominis Plane Block versus Epidural Block in Nephrectomy Patients: A Randomised Controlled Study

Introduction: Partially controlled acute pain after abdominal surgery is associated with a variety of unwanted postoperative consequences, like respiratory complications, delirium, myocardial ischaemia, prolonged hospital stays, and chronic pain later on. A good postoperative recovery depends greatly on a proper analgesic regimen. While epidural analgesia has been used to provide postsurgical abdominal pain relief, peripheral nerve blockade is a good alternative. Aim: To compare the analgesic efficacy of Transverse Abdominis Plane (TAP) block and Epidural block in patients undergoing nephrectomy. Materials and Methods: In this single-blinded parallel-group randomised controlled study was conducted in the Department of Urology at the Institute f Postgraduate Medical Education and Research in Kolkata, West Bengal, India from November 2021 to October 2022. A total of 78 patients (18-65 years) with American Society of Anaesthesiologists (ASA) Grade-I and II were randomly assigned to Group-EA (Epidural) and Group-TA (TAP Block). Group-EA received 11 mL of 0.125% bupivacaine, and Group-TA received 11 ml of 0.125% bupivacaine, both given at an 8-hour interval for 24 hours. The primary outcome was to compare postoperative pain using the Visual Analogue Scale (VAS) score at 1, 8, 12, and 24 hours after surgery. Secondary outcome measures included assessing motor function using the Bromage Score, monitoring haemodynamic parameters (pulse rate, mean arterial pressure), and evaluating Postoperative Nausea and Vomiting (PONV). A p-value &lt;0.05 was considered statistically significant when comparing the data. Results: The authors found that the distribution of male and female patients (p=0.650), ASA Grades (I:II) (p=0.515), mean age (p=0.899), and mean SpO2 (p=0.404) were comparable between the two groups (p&gt;0.05). The pain scores between the EA and TA groups at 1, 8, 12, and 24 hours (0.10 vs. 0.08, 0.74 vs. 0.82, 1.00 vs. 1.31, 1.80 vs. 1.92) showed no significant difference at the specified times. However, the comparison of the mean Bromage scores in the EA and TA groups at the same time intervals (1 vs. 1.15, 1.08 vs. 2.51, 1.97 vs. 3.21, 1.97 vs. 4.74) revealed a significantly higher value in the TAP block group compared to the Epidural block group. The Epidural group had significantly lower blood pressure and pulse rate but experienced more PONV (15.4 vs. 2.6) compared to the TAP block group. Conclusion: Epidural block resulted in hypotension, bradycardia, shivering, and PONV as side-effects, which were negligible in the TAP block group. However, postoperative analgesia was quite comparable between the two groups. Postoperative pain, as assessed by VAS score, changed significantly in the TAP block group (intragroup p-value=0.0063), whereas it remained constant in the epidural group (intragroup p-value 0.094), and the difference between the two groups was statistically insignificant. The occurrence of hypotension, bradycardia, and PONV was significant in the epidural group, whereas postoperative mobility was better in the TAP group.

Comparison of the Mean Post-Operative Pain Score with Ultrasound Guided Transversus Abdominis Plane (TAP) Block and Wound Infiltration with Local an Aesthetic Agent in Abdominal Surgeries

Objectives: To compare the mean post-operative pain score with ultrasound-guided transversus abdominis plane block and wound infiltration with local anaesthetic agents in abdominal surgeries. Study design: Comparative prospective study Place and Duration of Study: Department of Anaesthesia, Intensive Care and Pain Management, Combined Military Hospital, Bahawalpur Pakistan, from Oct 2018 to Apr 2019. Methodology: Sixty patients undergoing abdominal surgery aged 18-60 years were included. The patients in Group-A received transverses abdominis plane block with 20 ml of 0.25% Bupivacaine bilaterally, while those in Group-B received 20 ml of 0.25% Bupivacaine as local wound infiltration. Each patient was followed till 6 hours post-operatively. Results: Out of 60 patients, 35(58.33%) were male, and 25(41.67%) were females. In our study, the Visual analogue score was 1.63±0.85 in Group-A (ultrasound-guided TAP block) compared with 4.47±1.07 in patients with Group-B (wound infiltration with a local anaesthetic agent) with a p-value of 0.001, which was statistically significant. Conclusion: The study concluded that the mean pain score in patients with ultrasound-guided Transversus abdominis plane block is less compared to wound infiltration with local anaesthetic agents in abdominal surgeries.

Dexmedetomidine vs Dexamethasone as an Adjuvant to Levobupivacaine in Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomies.

In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain. This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients. A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction. When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment. The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.

Perioperative analgesic effects of an ultrasound-guided transversus abdominis plane block using bupivacaine in goats undergoing celiotomy

Perioperative analgesic effects of an ultrasound-guided transversus abdominis plane block using bupivacaine in goats undergoing celiotomy

Laparoscopic versus Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia Management after Radical Prostatectomy: Results from a Single Center Study.

(1) Background: Regional anesthesia, achieved through nerve blocks, has gained widespread acceptance as an effective pain management approach. This research aimed to evaluate the efficacy of laparoscopic (LAP) transversus abdominis plane (TAP) block in patients undergoing laparoscopic radical prostatectomy. (2) Methods: From January 2023 to July 2023, 60 consecutive patients undergoing minimally invasive radical prostatectomy were selected. Patients were split into two groups receiving ultrasound-guided (US) or laparoscopic-guided TAP block. The primary outcome was a pain score expressed by a 0-10 visual analog scale (VAS) during the first 72 h after surgery. (3) Results: Both LAP-TAP and US-TAP block groups were associated with lower pain scores postoperatively. No statistically significant differences were observed between the two groups in surgery time, blood loss, time to ambulation, length of stay, and pain after surgery (all p > 0.2). In the LAP-TAP block group, the overall operating room time was significantly shorter than in the US-TAP block group (140 vs. 152 min, p = 0.04). (4) Conclusions: The laparoscopic approach, compared to the US-TAP block, was equally safe and not inferior in reducing analgesic drug use postoperatively. Moreover, the intraoperative LAP-TAP block seems to be a time-sparing procedure that could be recommended when patient-controlled analgesia cannot be delivered.

Pre-peritoneal Plus Portal Infiltration Versus Bilateral Transversus Abdominis Plane Block in Laparoscopic Hernia Repair.

Background and objective The role of the pre-peritoneal infiltration of local anesthetic (PILA) in laparoscopic hernia repair has been equivocal. Ultrasound-guided transversus abdominis plane (TAP) block has been extensively studied. However, studies comparing these two methods are very scarce. Hence, this study was undertaken to compare the efficacy of pre-peritoneal plus portal infiltration with TAP block in this population. Materials and methods This double-blinded randomized comparative study was conducted on a total of 32 patients by allotting 16 patients in each group. Group A patients were given pre-peritoneal plus portal infiltration of 15 mL of 0.5% ropivacaine for each technique by the operating surgeon, while Group B patients were administered bilateral TAP block with 0.5% ropivacaine, 15 mL on each side under ultrasound guidance by the anesthesiologist. Results The demographic variables and duration of surgery were comparable between the two groups. Also, the postoperative requirement of fentanyl between the two groups was insignificant. However, the duration of anesthesia was significantly longer in Group B attributing to the extra time taken for the administration of the TAP blocks. Conclusion Both ultrasound-guided TAP block and the PILA plus portal infiltration are effective techniques for pain relief after laparoscopic hernia repair. Either of these two techniques can be chosen depending on the availability of resources, expertise, etc.

Ultrasound-Guided Transversus Abdominis Plane Blocks Versus Local Infiltration Anesthesia on Postanesthesia Care Unit Pain Control in Patients Undergoing Abdominoplasty.

The goal of this study was to compare ultrasound-guided transversus abdominis plane (TAP) blocks to local infiltration anesthesia with or without blind rectus sheath blocks in patients who underwent abdominoplasty at an outpatient surgery center. A retrospective review was conducted of patients who underwent outpatient abdominoplasty performed by the senior surgeon (J.T.L.). Group 1 received local infiltration anesthesia with or without blind rectus sheath blocks between April 2009 and December 2013. Group 2 received surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks between January 2014 and December 2021. Outcomes measured were opioid utilization (morphine milligram equivalents), pain level at discharge, and time spent in postanesthesia care unit (PACU). Sixty patients in each of the 2 study groups met the study criteria for a total of 120 patients. The study groups were similar except for a lower average age in group 1. Patients who received TAP blocks (group 2) had significantly lower morphine milligram equivalent requirements in the PACU (3.07 vs 8.93, P = 0.0001) and required a shorter stay in PACU (95.4 vs 117.18 minutes, P = 0.0001). There were no significant differences in pain level at discharge. Surgeon-led, intraoperative, ultrasound-guided, 4-quadrant TAP blocks statistically significantly reduced opioid utilization in PACU by 65.6% and average patient time in the PACU by 18.5% (21.8 minutes).