Ultrasound Transversus Abdominis Plane Block Research Articles

Efficacy of ultrasound-guided transversus abdominis plane block versus erector spinae plane block for postoperative analgesia in patients undergoing emergency laparotomies: A randomized, double-blinded, controlled study

ABSTRACT Ninety-three adult ASA I–III E patients undergoing emergency laparotomies were investigated in this research. Subjects were randomly divided into three groups. Following general anesthesia, bilateral peripheral nerve blocks guided by ultrasound Transversus abdominis plane block (TAPB) or erector spinae plane block (ESPB) were administered. Pain scores at rest and movement, time to first analgesic request, and total fentanyl consumption were recorded postoperatively and compared. Pain scores at rest were significantly reduced in the research groups for 12 and 18 h in TAPB and ESPB, respectively, also there was a significant decrease at 2, 4, 6, and 8 h in the ESPB group compared to the TAPB group. While pain scores at movement were significantly reduced in the ESPB group for the first 8 h than in the TAPB group both study groups demonstrated significantly reduced pain scores than the control group for the first 8 h for the ESPB group and the first 4 h for TAPB group. The time to first analgesic demand was longer in the ESPB group than in the TAPB group and both study groups were longer than the control group. Fentanyl consumed in the ESPB group was reduced than in the TAPB group and both study groups were reduced than the control group in the first 24 h. For patients having emergency laparotomies, bilateral ultrasound-guided ESPB with 40 ml of 0.25% bupivacaine reduces pain scores both at rest and motion, fentanyl use, and extends the duration of analgesia postoperatively compared to bilateral ultrasound-guided TAPB.

Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study

BackgroundTransversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery. MethodsA prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0–100mm) at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge) and 24h after surgery (T3). Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS>30mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24h after surgery. Statistical analysis: Student's t-test and Chi-square test, and linear regression models. A p-value<0.05 was considered significant. Data are presented as mean (SD). ResultsForty patients were enrolled in the study. The primary outcome variable, VAS pain scores did not show a statistical significant difference between groups (p>0.05). VAS at rest (TAP vs. TSI groups) was: T1=33±29 vs. 39±32, T2=10±9 vs. 17±18 and T3=7±12 vs. 10±18. VAS with cough (TAP vs. TSI groups) was: T1=51±34 vs. 45±32, T2=24±24 vs. 33±23 and T3=20±23 vs. 23±23. VAS with incentive spirometer (TAP vs. TSI groups) was: T3=21±27 vs. 21±25. Intraoperative remifentanil consumption was similar between TAP (0.16±0.07mcg.kg−1.min−1) and TSI (0.18±0.9mcg.kg−1.min−1) groups. There were no differences in opioid consumption between TAP (4.4±3.49mg) and TSI (6.87±4.83mg) groups during recovery. Functional recovery parameters were not statistically different between groups. ConclusionsMultimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic nephrectomies.

Efficacy of Transversus Abdominis Plane Block for Acute Postoperative Pain Relief in Kidney Recipients: A Double-Blinded Clinical Trial

After renal transplantation, postoperative pain is usually mild to moderate. Postoperative pain is a concern and administration of systemic analgesic may be difficult because of underlying co-morbidities and variable responses of the graft. The transversus abdominis plane (TAP) block is one of the different approaches for postoperative pain relief following abdominal surgeries. We evaluated analgesic efficacy of TAP block on early postoperative pain by numeric rating scale (NRS) and morphine consumption during the first 24 hours after kidney transplantation. Forty-four patients, scheduled as kidney recipients were randomized into two equal groups and were anesthetized with the same technique. After the induction of anesthesia, 15 mL of 0.25% Bupivacaine plus 5 μ/ml epinephrine or saline was deposited into the transversus abdominis neuro-fascial plane on the side of surgery by ultrasound guide. Each patient was assessed by a blinded investigator using NRS at 1st, 4th, 8th, 12th, and 24th hour postoperatively. Demographic data were not significantly different between the study groups. There was significant difference in median of NRS score measured at all time points in the study groups (P < 0.001). The 24-hour morphine consumption (mean ± SD) was 10.8 ± 9.5 mg in bupivacaine group compared with 41.2 ± 3.8 mg in the saline group (P = 0.001). There was statistically significant reduction in intraoperative fentanyl consumption in the TAP group 120 ± 20 μg compared to the control group 358 ± 24 μg (P = 0.001). In study group 4 patients and in control group 90 patients received morphine titration for pain relief (P = 0.03). There was no complication in the study groups related to nerve block. Only two patients in saline group had nausea (P = 0.07). None of our patients received any other oral or IV rescue medication. Ultrasound TAP block can reduce postrenal transplantation pain and the amount of opioids consumption intraoperatively and during the first 24 hours after surgery in kidney recipients.

Bilateral Ultrasound Transversus Abdominis Plane Block in A Patient Affected from Menkes Disease

This case report demonstrates the utility and safety of ultrasound transversus abdominis plane (TAP) block in a paediatric patient suffering from Menkes disease. Anaesthetists, and particularly paediatric and neonatal anaesthetists, have to make a careful assessment of these patients, who are subjected to frequent surgeries, despite their tender years. These operations are often necessary in order to improve the patient's quality of life as much as possible. The choice of anaesthetic technique must take the particular nature of the disease and the patient's medical history into consideration, while careful preparation and preoperative evaluations make it possible to administer the general or local anaesthetic safely. Official literature on the subject does not provide sufficient information about the use of local anaesthetic techniques. Moreover, the use of ultrasound TAP block in patients affected by Menkes disease has never been published in literature. In our experience, ultrasound TAP block has provided positive results, although the rarity of this childhood disease makes a detailed study difficult.

Bilateral ultrasound transversus abdominis plane block in a patient affected from Menkes disease

Bilateral ultrasound transversus abdominis plane block in a patient affected from Menkes disease