US-guided Transversus Abdominis Plane Block Research Articles

The Postoperative Analgesic Effect Of Transversus Abdominis Plane Block Undergoing inguinal Hernia Repair: A Randomized Controlled Study

Aim: The objective of this study was to investigate the effect of preincisional (preemptive) Transversus Abdominis Plane (TAP) block on perioperative opioid consumption, hemodynamic parameters and postoperative rescue anal¬gesic consumption in patients undergoing inguinal hernia repair.
 Methods: 60 adult patients were included in this prospective randomized controlled study. The patients were divided into two groups: those who received conventional systemic analgesia (Group C) and those who received US-guided TAP block (Group TAP). By ultrasonography, normal saline (1 mL) was injected between the internal oblique and transverse abdominal muscles, and after separation was observed, 20 mL of 0.25% bupivacaine was administered. Postoperatively, 1mg/kg Tramadol HCl was given to all patients as a rescue analgesic. Perioperative hemodynamic data, perioperative total amount of remifentanil consumption amount, postoperative Visual Ana¬logue Scale (VAS) scores, starting time and number of rescue analgesics were recorded.
 Results: There was no difference in demographic data. Intraoperative remifentanil dose, VAS values at all times, need for rescue analgesics and the number of applications were significantly lower in Group TAP than in Group C (p=0.012, p

Comparative Study of Post-Operative Analgesic Effect between Wound Site Infiltration and Bilateral U/S Guided Transversus Abdominis Plane Block with 0.25% Bupivacaine after Cesarean Section

Abstract Background The analgesic regimen needs to meet the goals of providing safe, effective analgesia, with minimal side effects for the patient, together with inhibition of trauma –induced nociceptive impulses. Objectives This study assessed the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to local wound infiltration after cesarean section regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). Patients and Methods The study was conducted on 90 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for cesarean section surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 45 patients each: TAP block Group: received general anesthesia and 20 ml of 0.25% bupivacaine on each side by midaxillary approach under ultrasound guidance. Local wound infiltration: received general anesthesia and with 0.25% bupivacaine 30 ml at surgical site. Results The results of the study revealed that the Patients who received TAP block had significantly lower pain scores for 12 h after operation and decreased total need of analgesic in first 12 h post-operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores for 12 hours and lower total 12 hours postoperative pethidine consumption after cesarean section under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Comparison between quadratus lumborum and transversus abdominus plane blocks for analgesia in abdominal surgeries

Background Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Aim The aim was to compare ultrasound (US)-guided quadratus lumborum block and transversus abdominis plane block in abdominal surgeries as regards duration of analgesia, postoperative opioid consumption, and visual analog scale score. Patients and methods A randomized-controlled trial study was carried out at Alexandria University Hospital on 40 American Society of Anesthesiology (ASA)-I and II adult patients scheduled for elective abdominal surgery. The recorded data were analyzed using IBM SPSS software package version 20.0. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, SD, and median. Significance of the obtained results was judged at the 5% level. Results There was no significant difference between the two groups as regards age, sex, heart rate, mean arterial blood pressure, and complications. There was a highly significant difference between the two groups as regards duration of analgesia, visual analog score value, and the opioid analgesic requirements. Conclusion US-guided quadratus lumborum block is superior to US-guided transversus abdominis plane block for control of postoperative pain in abdominal surgeries in terms of pain scores, duration of analgesia, and total analgesic consumption.

Evaluation of the Postoperative Analgesic Effect of 2 Different Blocks after Pediatric Circumcision Surgery

Background: Circumcision is a painful day-case surgery. Regional anesthesia techniques are used effectively for anesthesia and postoperative analgesia after pediatric circumcision surgery. Objective: Our prospective observational study aimed to compare postoperative analgesic efficiency of a dorsal penile nerve (DPN) block with a transversus abdominis plane (TAP) block after male pediatric circumcision surgery and complications related to each block. Study Design: We enrolled 80 male children under the age of 10 years with American Society of Anesthesiologists I–II status scheduled for circumcision in this prospective observational study. A TAP or DPN block was performed after induction of general anesthesia before surgery with ultrasound (US) guidance. Postoperative pain was assessed with Faces Pain Scale-Revised and the Faces, Legs, Activity, Cry and Consolability scale. Results: There was no statistically significant difference between the groups regarding 30-min pain score levels (p > 0.05). But, the 1st hour, 2nd hour, 6th hour, 12th hour, and 24th-hour pain score levels in the TAP block group were statistically significantly higher than those of the DPN block group (p < 0.05). The 1st rescue analgesic requirement in the TAP block group was at the 6th hour postoperative. There was no need for rescue analgesia in the DPN block group during the postoperative 24-h follow-up. Discussion: A US-guided DPN block provided effective and long-lasting postoperative analgesia for circumcision surgery with statistically significantly lower pain score levels than a US-guided TAP block. Conclusion: This study found that a TAP block alone was insufficient to provide adequate postoperative analgesia for circumcision surgery compared to DPN block.

Comparative Study between Ultrasound Guided Oblique Subcostal Transversus Abdominis Plane Block and Local Wound Infiltration as Postoperative Analgesia in Hepatectomy

Abstract Background Poorly controlled acute pain after hepatectomy is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after hepatectomy regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 60 randomly chosen patients aged 18 to 60 years, American Society of Anesthesiologists (ASA) class I ,II and III scheduled for hepatectomy in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 30 patients each: Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores for 12 h after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration. Conclusion oblique subcostal TAP block was effective in reducing postoperative pain scores at rest and movement for 12-24 hours and lower total 24-h postoperative opioid and analgesic consumption after hepatectomy under general anesthesia, compared to local wound infiltration.

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&amp;6 hrs.4 patients require rescue doses of nalbuphine between 6&amp;12 hrs, while 26 patients require rescue doses of nalubuphine between 12&amp;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.

Laparoscopic versus ultrasound-guided visualization of transversus abdominis plane blocks

BackgroundUltrasound-guided (US) transversus abdominis plane (TAP) block is commonly utilized as part of a multi-modal approach for postoperative pain management. This study seeks to determine whether laparoscopic-guided TAP blocks are as effective as US-guided TAP blocks among pediatric patients. MethodIn this prospective, randomized controlled trial, pediatric patients undergoing laparoscopic procedures were randomly assigned to one of two treatment arms: US-guided TAP block (US-arm) or laparoscopic-guided TAP block (LAP-arm). Primary outcome was PACU pain scores. Secondary outcomes included PACU opioid consumption, block completion time and block accuracy. ResultsTwenty-five patients were enrolled in each arm. In the LAP-arm, 59% of blocks were in the transversus abdominis plane compared to 74% of TAP blocks in the US-arm (p = 0.18). Blocks were completed faster in the LAP-arm (2.1 ± 1.9 vs. 7.9 ± 3.4 min, p<0.001). The average highest PACU pain score was 3.4 ± 3.1 for the LAP-arm and 4.3 ± 3.8 for the US-arm (p = 0.37). Overall PACU pain scores and opioid consumption were similar between the groups (1.2 ± 1.3 vs. 1.6 ± 1.6, p = 0.24; 2.2 ± 5.8 vs. 0.9 ± 1.4MME, p = 0.26). ConclusionLaparoscopic TAP blocks have equivalent efficacy in post-operative pain scores, narcotic use, and tissue plane accuracy as compared to US-guided TAP blocks. They are also completed faster and may result in less operating room and general anesthetic time for the pediatric patient.

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

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

Comparative study between Bilateral U/S guided Transversus Abdominis Plane Block versus local wound infiltration for post-operative pain management in lower abdominal surgeries

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared local wound infiltration after lower abdominal surgery regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided TAP block and were trained to use the visual analogue scale (VAS). The study was conducted on 100 randomly chosen patients aged 25 to 55 years, American Society of Anesthesiologists (ASA) class I or II scheduled for lower abdominal surgery in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores for 12 h after operation and decrease total need of analgesic in first 24 h post operative compared with patients who received wound infiltration. Conclusion Bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12hours and lower total 24-h postoperative opioid and analgesic consumption after lower abdominal surgeries under general anesthesia, compared to local wound infiltration..

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

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

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

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

Impact of Ultrasound-Guided Transversus Abdominis Plane Block on Postoperative Pain and Early Outcome After Laparoscopic Bariatric Surgery: a Randomized Double-Blinded Controlled Trial.

Based on the promising results of transversus abdominis plane (TAP) block in various abdominal procedures, this study aimed to investigate its effect on postoperative pain and early outcome after laparoscopic bariatric procedures. Patients with morbid obesity were randomly assigned to one of two equal groups; group I had US-guided TAP block upon completion of the bariatric procedure and before recovery from general anesthesia and group II did not have TAP block. All procedures were performed laparoscopically with a standardized five-trocar technique. Ninety-two patients of a mean age of 34.7years and mean BMI of 49.5kg/m2 were included. The mean pain score in group I was significantly lower than group II at 1 and 6h postoperatively, whereas no significant differences in pains scores at 12 and 24h between the two groups were observed. Eight patients in group I required rescue opioid analgesia within the first 24h postoperatively, compared with 24 patients in group II (P < 0.0001). The postoperative nausea and vomiting (PONV) score at 24h was significantly lower in group I than group II. Group I required a significantly shorter time to full ambulation and to pass flatus compared with group II. Hospital stay was similar in the two groups. Using US-guided TAP block in adjunct with laparoscopic bariatric surgery managed to achieve lower pain scores, lower opioid requirements, lower PONV scores, earlier ambulation, shorter time to pass flatus, and comparable hospital stay and complication rate to the control group.

Comparative study between different ultrasound-guided techniques for postoperative analgesia in children undergoing lower abdominal surgeries

Background and aim Ultrasound (US)-guided transversus abdominis plane (TAP) block, caudal block, and US-guided ilioinguinal/iliohypogastric (II/IH) nerve block are safe and effective methods in children. The aim of the study was to compare the effectiveness and occurrence of complications. Patients and methods A total of 100 patients undergoing lower abdominal operations (infraumbilical incision) between 5 and 10 years were included in the study. The patients scheduled for elective operation were randomized into four groups: group A (n=25) received US-guided TAP block; group B (n=25) received US-guided caudal block; group C (n=25) received US-guided II/IH nerve; and group D (n=25) received Ketorolac 0.5 mg/kg intravenously to be considered as the control group. The Objective pain score, postoperative complication, satisfaction of the parents, and postoperative analgesic requirements were recorded. Results Postoperative analgesia requirements were significantly higher in group D compared with group A, B, and C; meanwhile, it was significantly highest in group D compared with both groups A and group B. There was significant difference between group A and group D in pain score assessment, but no significant difference between group A and group B. Patient and parent satisfaction was markedly observed in groups A and B more than in group D (the control group) and more satisfaction in group A than group B. Conclusion TAP block, caudal block, and US-guided II/IH nerve blockade under US guidance proved to be safe with no recorded postoperative complications. Patient and parent satisfaction was markedly observed in case of TAP block.

Efficacy of US-guided transversus abdominis plane block and rectus sheath block with ropivacaine and dexmedetomidine in elderly high-risk patients.

This study was designed to evaluate the effectiveness and safety of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks with ropivacaine and dexmedetomidine in elderly, high-risk patients undergoing emergency abdominal surgery. Sixty elderly patients undergoing emergency abdominal surgery receiving both bilateral ultrasound-guided TAP and RS blocks were randomly divided into two groups: R+D (10 mL of 0.25% ropivacaine+0.5μg/kg dexmedetomidine) and R (10 mL of 0.25% ropivacaine). Pain scores (at rest and with movement) and overall analgesia satisfaction were assessed. The total amount of sufentanil administered postoperatively during the first 24 h, duration of sensory blockade, first time and total number of patient-controlled intravenous analgesia (PCIA) pump activations on the first postoperative day were recorded. The duration of sensory blockade and the first time to PCIA pump activation in the R+D group were longer than that of the R group (P<0.05). The total number of PCIA pump activations on the first postoperative day as well as the total amount of sufentanil administered during the first 24 h in R+D group were less than in the R group (P<0.05). VAS scores at rest and during activity in the R+D group were lower than those in the R group at 2, 6, and 12 h after surgery (P<0.05). Ultrasound-guided TAP and RS blocks with ropivacaine and dexmedetomidine are more effective in promoting block effect, prolonging the duration of analgesia, reducing postoperative pain in elderly high-risk patients undergoing emergency abdominal surgery.

A Comparative Study of Postoperative Analgesia Provided by Ultrasound-Guided Transversus Abdominis Plane Block Using Two Concentrations of Bupivacaine in Patients Undergoing Inguinal Hernia Repair.

Background:Pain after open inguinal hernia surgery can be moderate to severe and is known to prolong hospital stay and delay return to normal daily activities.Settings:A randomized controlled trial conducted in the Department of Anesthesiology in a tertiary care hospital.Aims and Objectives:To compare the efficacy of postoperative analgesia provided by equal volumes of 0.125% and 0.25% bupivacaine administered in an ultrasound (US)-guided transversus abdominis plane (TAP) block in patients undergoing unilateral inguinal hernia repair.Materials and Methods:After obtaining Institutional Ethics Committee approval and informed consent, sixty patients posted for inguinal hernia repair were recruited. Randomization was done using a sealed envelope technique. Patients were divided into two groups; Group 0.125 received 20 ml of 0.125% bupivacaine and Group 0.25 received 20 ml of 0.25% bupivacaine through US-guided TAP block at the end of surgery. Visual analog scale (VAS) scores and duration of analgesia were recorded.Results:There was no significant difference in the VAS scores among both groups. The duration of analgesia provided by 0.25% bupivacaine was significantly longer than that provided by 0.125% (Group 0.125 - 355.67 ± 118.88 min and Group 0.25 - 635.73 ± 195.58 min; P < 0.05). No complications were noted in both groups.Conclusion:The duration of analgesia provided by 0.25% bupivacaine was significantly longer than that provided by 0.125% bupivacaine through US-guided TAP block in inguinal hernia repair.

The transversus abdominis plane block: Case for optimal tap.

The transversus abdominis plane block: Case for optimal tap.

Ultrasound-guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing unilateral open inguinal herniotomy: A comparative study

Background Ultrasound (US)-guided transversus abdominis plane (TAP) block is an effective technique in providing analgesia for abdominal surgery. This study was designed to evaluate the efficacy of a US-guided TAP block and to compare it with a caudal block in unilateral day-case open inguinal hernia repair in children. Patients and Methods Forty ASA I-II, 1-5-year-old children scheduled for elective unilateral open inguinal herniotomy were studied. All patients received general anesthesia; sevoflurane was used for induction and maintenance of anesthesia and laryngeal mask airway (LMA) was used to secure the airway. After securing an intravenous cannula, patients were randomized to a US-guided TAP block ( n = 20) (group T) using 0.5 ml/kg 0.25% bupivacaine, injected on the same side of surgery, and group C received a caudal block using 1 ml/kg 0.2% bupivacaine ( n = 20). Surgery was allowed 15 min after administration the block. Block failure was considered in case of gross movement or more than 20% change in heart rate and/or ABP persisting more than 1 min after skin incision. Any adverse events were recorded. After surgery, patients remained for 4 h in the recovery room. Postoperative analgesia was evaluated using Children and Infants Postoperative Pain Scale (CHIPPS). An anesthesiologist, who was not part of the study team, evaluated the need for rescue analgesia in the intraoperative and postoperative period and a recovery nurse collected the data. If the CHIPPS score was greater than 4, a rescue analgesia of 20 mg/kg acetaminophen was administered. Results No difference was found in hemodynamics in both groups. Also, intraoperative fentanyl consumption was not different and no rescue analgesia was required in the postanesthesia care unit. Conclusion A US-guided TAP block is as effective as a caudal block in providing immediate postoperative analgesia in inguinal hernia repair.

Ultrasound-guided transversus abdominis plane block for post-operative analgesia in patients undergoing caesarean section.

Background and Aims:Transversus abdominis plane (TAP) block is a fascial plane block providing post-operative analgesia in patients undergoing surgery with infra-umbilical incisions. We evaluated analgesic efficacy of TAP block with ropivacaine for 24 h after caesarean section through a Pfannenstiel incision.Methods:Sixty patients undergoing caesarean section under spinal anaesthesia were randomised to undergo TAP block with ropivacaine (n = 30) versus control group (n = 30) with normal saline, in addition to standard analgesia with intravenous paracetamol and tramadol. At the end of the surgery, ultrasound-guided TAP plane block was given bilaterally using ropivacaine or normal saline (15 ml on either side). Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS) and requirement of analgesia. SPSS version 18.0 software was used. Demographic data were analysed using Student's t-test and the other parameters using paired t-test.Results:TAP block with ropivacaine compared with normal saline reduced post-operative VAS at 24 h (P = 0.004918). Time for rescue analgesia in the study group was prolonged from 4.1 to 9.53 h (P = 0.01631). Mean requirement of tramadol in the first 24 h was reduced in the study group.Conclusion:US guided TAP block after caesarean section reduces the analgesic requirement in the first 24 h.

The use of four-point transversus abdominis plane block for liver resection.

Sir, Transversus abdominis plane (TAP) block is a safe and relatively easy block to perform for post-operative analgesia.[1] We describe the use of four TAP blocks and subsequent placement of two TAP catheters in a lady who underwent a combined anterior resection and liver resection for metastatic sigmoid cancer. Although epidurals have historically been a standard of practice for adjunct intra- and post-operative analgesia, TAP blocks have been introduced since 2001 by Rafi as a landmark technique and then in 2007 with ultrasound (US) guidance by Hebberd et al.[2] Our patient was a 34-year-old lady who underwent a laparotomy with sigmoid resection as well as a hepatectomy for a recently diagnosed metastatic sigmoid cancer. She had no other co-morbidities and was to receive general anaesthesia for the surgery. She declined an epidural placement, which is the standard of care for analgesia in our institution for such cases, due to a history of lower back pain. Her intra-operative course was remarkable only for persistent tachycardia with extensive resection; however, blood loss was minimal and haemodynamic instability was well controlled. Postoperatively, while still under general anaesthesia, four TAP blocks were carried out using the US for guidance. We used a Hitachi Aloka® machine with a probe frequency of 13 MHz and a 50 mm Stimuplex® needle. Two were subcostal injections and two injections, just superior to the iliac crest along the anterior abdominal wall. The probe was placed in the midline of the abdomen 2 cm below the xiphisternum and moved right, laterally along the subcostal margin to the anterior axillary line. The transversus abdominis muscle was identified lying beneath and extending lateral to the rectus abdominis muscle. The block needle was then guided, in plane, to a point just inferior to the right costal margin at the anterior axillary line such that the tip lay between the transversus abdominis and internal oblique muscle within the neurovascular fascial plane. About 10 ml of 0.5% ropivacaine were deposited in each site. Following this, two TAP catheters were placed in the inferior sites using a similar technique but with a 18-gauge Tuohy needle through which an epidural catheter was inserted. The catheters were anchored at 9 and 10 cm at the skin, respectively and secured with a Tegaderm™ dressing. An infusion was subsequently started via a filter, with 0.1% ropivacaine via the 2 catheters at 5 ml/h. This technique used for lower abdominal surgery before is scarcely described in literature for hepatic resection. The TAP block has been shown to reduce peri-operative opioid use in elective abdominal surgery.[3] Postoperatively, the lady was comfortable and relatively pain-free. She was mobilised on post-operative day one and discharged from the Intensive Care Unit the next day. The safety profile of four TAP blocks is good with a dose limit of 200 mg in total. The risk of inadvertent liver injury is also minimum using the US for guidance. The absolute contraindications to TAP blocks only include patient refusal and site infection. Her pain scores were satisfactory avoiding the risk profile related to epidural analgesia (EA). The recent prospect guidelines have suggested that there is a higher risk using EA for major laparotomies.[4] A recent article in IJA mentioned, that ‘the available evidence so far are in favour of US-guided TAP block as a simple and effective analgesic technique, especially for lower abdominal surgeries’.[5] Further trials are needed in a procedure specific manner to compare TAP blocks with EA and other analgesic regimes. In summary, the present study provides further evidence that TAP block can produce effective analgesia for upper abdominal and hepatic surgery. Given the added complications of EA, TAP blocks used more abundantly for liver resection may be the way forward for providing reasonable and satisfactory analgesic techniques.[6,7,8] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Ultrasound-guided transversus abdominis plane block versus dexmedetomidine infusion in open ovarian cystectomy: Analgesic efficacy and effect on stress response

Background Ultrasound (US)-guided transversus abdominis plane (TAP) block has been proven to be an effective method of providing postoperative analgesia in laparotomy. Dexmedetomidine has sedative, analgesic, sympatholytic, and amnestic properties. In the present study, we evaluated the analgesic efficacy and the attenuation of stress surgical response of US-guided TAP block in comparison with dexmedetomidine infusion in patients undergoing open ovarian cystectomy in a randomized, double-blinded clinical study. Patients and methods A total of 60 patients were randomly assigned into two groups (30 in each) to be administered, before skin incision, either a combination of general anesthesia with a US-guided TAP block (TAP group), or an intraoperative intravenous infusion of dexmedetomidine (DEX group). In the DEX group, loading dose of 1 μg/kg of dexmedetomidine was infused over 10 min, followed by infusion of 0.2-0.6 μg/kg/h. Measurements included hemodynamics, stress hormones, pain score, time of first analgesia, and amount of pethidine during the first 24 h postoperative. Results In the DEX group, there was a significant decrease in heart rate (HR) at 45, 60, and 90 min after surgical incision in comparison with preoperative HR. In the TAP group, there was a significant decrease in HR at 60 and 90 min after surgical incision in comparison with preoperative HR. In the DEX group, there was a significant decrease in mean arterial pressure at 30, 45, 60, and 90 min after surgical incision in comparison with preoperative mean arterial pressure. The DEX group had shown a statistically significant increase with regard to change in the blood level of stress hormones 12 and 24 h postoperative in comparison with the preoperative values. There was a highly significant increase in postoperative pethidine supplementation in the DEX group than in the TAP group. There was a significant difference with regard to time of the first postoperative request of analgesia in the DEX group than in the TAP group. Conclusion In open ovarian cystectomy, US-guided TAP block was comparable to dexmedetomidine infusion with regard to intraoperative hemodynamic stability and opioid requirement without change in stress response hormones. However, TAP block provided superior analgesia when compared with dexmedetomidine infusion up to 24 h postoperatively.