Transversus abdominis plane block

Dexmedetomidine adjunct to ropivacaine for ultrasound-guided transversus abdominis plane block for open inguinal hernia repair in the older adults: A randomised clinical trial

OBJECTIVE

The aim of this study was to evaluate the effect of adding dexmedetomidine to ropivacaine on pain relief and quality of recovery in older patients undergoing open inguinal hernia repair surgeries.

METHODS

This was a prospective and randomised clinical trial of 102 patients aged over 65 years who received an ultrasound-guided transversus open mesh herniorrhaphy abdominis plane (TAP) block with either 0.375% ropivacaine 20 ml (Group R, n = 47) or 0.375% ropivacaine combined with 1 μg/kg dexmedetomidine 20 ml (Group RD, n = 45) in the pre-anaesthesia care unit before elective open inguinal hernia surgeries. The primary outcome measure was Visual Analogue Scale (VAS) pain scores at rest and on movement at 2, 4, 8, 12 and 24 h and at 1 and 3 months' postoperatively. The secondary outcome measures were the incidence of post-operative delirium (POD), nausea and vomiting and the occurrence of side effects or complications on post-operative day 1.

RESULTS

Group RD had lower VAS scores at rest and on movement at 8 and 12 h postoperatively and a lower incidence of POD on the post-operative day 1 than Group R. Transient bradycardia was more frequent in Group RD than in Group R, and side effects or post-operative complications were reported in either group.

CONCLUSION

The addition of dexmedetomidine to ropivacaine in a TAP block enhances postoperative analgesia during hospitalisation and improves the quality of recovery without affecting chronic pain in older patients undergoing open inguinal hernia repair surgery.

Surgeon administered transversus abdominis plane block: anatomic principles and technique

The Transversus Abdominis Plane (TAP) block is a regional abdominal wall block that has been effectively used as an adjunct to alleviate postoperative pain. The ultrasound-guided TAP (USTAP) administered by anesthesiologists is the gold standard and has been effective for surgeries involving abdominal wall incisions. Recently, the TAP block has been administered by surgeons with the help of direct visualization during minimally invasive surgery. The surgeon-administered or laparoscopic-guided TAP block has been compared to the USTAP with no discernible difference in patient outcomes. Also, directly visualizing the injection in the surgeon-administered block can offset complications such as visceral injury and block failure (injectate in the wrong plane). This review explores the literature's surgeon-administered TAP blocks for minimally invasive surgery in the literature. In addition, the prerequisite anatomy of the anterolateral abdominal wall, various approaches, and other factors that influence the efficacy of the block are described to increase awareness of this analgesic tool among surgeons and achieve better postoperative pain management.

Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial

PURPOSE

To compare the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with patient-controlled intravenous analgesia (PCIA) and PCIA alone on analgesia after laparoscopic cholecystectomy (LC).

METHODS

In this double-blind, randomized controlled trial, 160 patients undergoing LC were randomized into the TAPB group (n = 80) and PCIA group (n = 80). Bilateral ultrasound-guided TAPB was performed with 20 mL 0.5% ropivacaine and the PCIA pump was given after LC in the TAPB group. The PCIA group received the PCIA pump alone as a control group. The primary outcome was postoperative pain, assessed by the visual analog scale (VAS).

RESULTS

VAS pain (including abdominal wall pain or visceral pain) scores at rest and coughing were significantly lower in the TAPB group at 1, 4, 12, 24, 36, and 48 h after LC (P < 0.05). Postoperative additional analgesic needs, analgesic pump compressions, and PCIA analgesic dosages, and total morphine equivalents were significantly reduced in the TAPB group, and postoperative hospital stay, total hospitalization expenses, expenses within 24 h or 48 h (from analgesia and adverse reactions), and patient satisfaction were significantly higher in the TAPB group than the PCIA group (all P < 0.05). No significant between-group differences were observed in operation time, intraoperative blood loss, unplugging the analgesic pump due to adverse reactions, first exhaust time, and postoperative adverse events between the two groups.

CONCLUSIONS

Ultrasound-guided TAPB combined with PCIA was an effective and safe perioperative analgesic technique for patients undergoing LC compared to PCIA only.

Analgesia Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Intravenous Analgesia After Cesarean Section: A Double-Blind Controlled Trial

INTRODUCTION

Complete postoperative analgesia is very important for puerperae after cesarean section. The objective of this study was to explore the optimal postoperative analgesia after cesarean section.

METHODS

A total of 180 full-term puerperae who underwent cesarean section in Hanzhong People's Hospital from March 2019 to March 2020 were enrolled and were randomly divided into three groups. Group A was given 0.9% normal saline, group B and C were given 0.4% ropivacaine for transversus abdominis plane block (TAPB). Postoperative patient-controlled intravenous analgesia (PCIA) pumps were 2 μg/kg sufentanil + 2.5 mg droperidol, 1.5 μg/kg and 1.3 μg/kg sufentanil, respectively. All puerperae were given different but effective analgesia programs. The primary outcome indicators were visual analog scores (VAS), the first compression time of postoperative analgesia pump and the total number of compressions in 48 h. The secondary outcome indicators were vital signs, Ramsay sedation scores, comfort scores (BCS), the frequency of analgesic rescue, postoperative side effects and satisfaction.

RESULTS

The dynamic and static VAS scores of the puerperae in group B at T₂ and T₆ were significantly lower than group A and at T₁₂, T₂₄ and T₄₈ were significantly lower than group C. Compared with group A, the dynamic and static VAS scores of puerperae in group C were lower at T₂ and T₆ and higher at T₁₂, T₂₄ and T₄₈. The Ramsay score and BCS score of the puerperae in group C at T₁₂, T₂₄ and T₄₈ were significantly lower than those in groups A and B.

CONCLUSIONS

PCIA with sufentanil alone or combined with TAPB can be safely and effectively used for postoperative analgesia after cesarean section. PCIA combined with TAPB had better analgesic effect and lower incidence of side effects while reducing the dose of opioids. The results of this study provide new ideas and insights for the choice of analgesia after cesarean section.

Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial

BACKGROUND

Laparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain.

METHODS

In this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction.

RESULTS

Overall, 160 patients aged 18-74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group.

CONCLUSIONS

Peroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction.

Ultrasound-guided peripheral trunk block technique: A new approach gradually stepping onto the stage of clinical anesthesia

In recent years, with the continuous development and validation of new visualization, the ultrasound-guided peripheral trunk block becomes more mature and has a more extensive and broader implementation scope in clinical anesthesia. Based on this, we reviewed and summarized the literature on peripheral trunk nerve block include: paraspinal block, retrolaminar block, plane block of erect spinal muscle, transverse convex to pleural midpoint block, block of the trapezius muscle and anterior serratus muscle, anterior serratus muscle block, thoracic nerve block, abdominal transverse fascia block, type-I block of quadratus lumborum, type-II block of quadratus lumborum, type-III block of quadratus lumborum, block of the sheath of rectus abdominis. This paper reviews the ultrasound-guided peripheral trunk block technique, including development history, anatomic basis, implementation methods, advantages and disadvantages of nerve block technique, and describes the bottleneck and difficulties of nerve block technique at present.

Analgesic efficacy of postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block for laparoscopic colorectal cancer surgery: a randomized, prospective, controlled study

Background

We assessed whether a postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane (TAP) block could reduce 24 h rescue tramadol requirement compared with placebo in patients undergoing elective laparoscopic colorectal cancer surgery.

Methods

Patients scheduled to undergo elective laparoscopic surgery following the diagnosis of colorectal cancer were included in this study and randomized into Group and Group Control. The patients received a postoperative bilateral, ultrasound-guided, posterior TAP block in either 20 mL of 0.5% ropivacaine (Group TAP) per side or an equivalent volume of normal saline (Group Control). The primary outcome was the cumulative consumption of rescue tramadol within 24 h after the surgery. Secondary endpoints included (1) resting and movement numerical rating scale (NRS) pain scores at 2, 4, 6, 12, 24, 48, and 72 h; (2) incidences of related side effects; (3) time to the first request for rescue tramadol; (4) patient satisfaction regarding postoperative analgesia; (5) time to restoration of intestinal function; (6) time to mobilization; and (7) the length of hospital stay.

Results

In total, 92 patients were randomized, and 82 patients completed the analysis. The total rescue tramadol requirement (median [interquartile range]) within the first 24 h was lower in Group TAP (0 [0, 87.5] mg) than in Group Control (100 [100, 200] mg), P < 0.001. The posterior TAP block reduced resting and movement NRS pain scores at 2, 4, 6, 12, and 24 h after surgery (all P < 0.001) but showed similar scores at 48 h or 72 h. A higher level of satisfaction with postoperative analgesia was observed in Group TAP on day 1 (P = 0.002), which was similar on days 2 (P = 0.702) and 3 (P = 0.551), compared with the Group Control. A few incidences of opioid-related side effects (P < 0.001) and a lower percentage of patients requiring rescue tramadol analgesia within 24 h (P < 0.001) were observed in Group TAP. The time to the first request for rescue analgesia was prolonged, and the time to mobilization and flatus was reduced with a shorter hospital stay in Group TAP as compared with Group Control.

Conclusions

A postoperative bilateral, ultrasound-guided, posterior TAP block resulted in better pain management and a faster recovery in patients undergoing laparoscopic colorectal cancer surgery, without adverse effects.

Trial registration

The study was registered at http://www.chictr.org.cn (ChiCTR-IPR-17012650; Sep 12, 2017).

Ultrasound-guided modified subcostal transversus abdominis plane block and influence of recumbency position on dye spread in equine cadavers

OBJECTIVE

To describe and evaluate an ultrasound-guided modified subcostal approach for the transversus abdominis plane (TAP) block in horse cadavers in lateral or dorsal recumbency.

STUDY DESIGN

Prospective, experimental cadaveric study.

ANIMALS

Study of one preserved foal and eight fresh adult horse cadavers.

METHODS

The lateral and ventral abdominal wall of a preserved cadaver was dissected to identify the muscles and nerves. A unilateral standard TAP block technique was performed (60 mL of methylene blue dye-bupivacaine) on a fresh cadaver in right lateral recumbency. A modified subcostal technique was performed on the opposite side using a linear ultrasound transducer and in-plane approach. Injection points (two 30 mL dye) were at the level of the TAP (between the rectus abdominis and transversus abdominis muscles and ventral to the cutaneous trunci muscle) perpendicular to: 1) the mid-point between the xiphoid cartilage and umbilical scar; and 2) at a point between the caudal and middle thirds of the abdomen measured from the first injection point to the umbilical scar. The modified subcostal approach was performed in seven additional cadavers in both hemiabdomens, with three cadavers in lateral and four cadavers in dorsal recumbency. Ultrasound guidance was used with all injections.

RESULTS

The standard approach stained the sixteenth to eighteenth thoracic nerves (T16-T18). The modified subcostal approach performed in lateral recumbency provided greater spread (T9-T17) than dorsal recumbency (T12-T18) (p = 0.016).

CONCLUSIONS AND CLINICAL RELEVANCE

The modified subcostal TAP approach resulted in extensive staining exceeding the standard approach. The nerves stained are consistent with production of ventral abdominal wall anesthesia in horses. Clinical studies are needed to verify these findings.

The efficacy of transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy cases: a retrospective evaluation of 515 patients

Objective

To compare patients that received intravenous (i.v.) analgesics with those that received transversus abdominis plane (TAP) block for pain relief after laparoscopic cholecystectomy.

Methods

This retrospective study enrolled patients that had undergone laparoscopic cholecystectomy and divided them into two groups: the i.v. analgesic group (controls; group A) and the TAP block group (group T). Data retrieved from the medical records included postoperative visual analogue scale (VAS) pain scores, duration of intensive care unit (ICU) stay, total hospital stay, additional analgesic requirements and the occurrence of nausea and vomiting.

Results

A total of 515 patients were included (group A, n = 247; group T, n = 268). Postoperative VAS pain scores at 0, 2, 4 and 6 h and the need for additional analgesics were significantly lower in group T than in group A. Postoperative VAS pain scores at 12 and 24 h were significantly higher in group T than in group A. Postoperative nausea and vomiting were significantly lower in group T than in group A. The rate of ICU admission in group T was significantly lower than in group A.

Conclusions

Effective postoperative analgesia can be achieved with TAP block and undesirable effects can be reduced.

Anesthetic techniques: focus on transversus abdominis plane (TAP) blocks

Transverse abdominis plane (TAP) blocks, over the past decade, have emerged as a reliable tool in multimodal analgesia. Although they block only the somatic component of pain, studies have still revealed a consistent benefit in the first 24-48 hours after surgery in terms of pain scores and overall opioid consumption. The safety and dependability has increased with ultrasound usage. The aim of this review is to help the reader appreciate the applied anatomy required for a TAP block and its congeners, to standardize its nomenclature, and to help choose between variants of a TAP block and its complications and safety profile.

Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block: A Randomized Controlled Trial

BACKGROUND AND AIMS

Multimodal analgesia comprising opioid, paracetamol, and non-steroidal anti-inflammatory drugs is used for managing postoperative surgical pain after ileostomy closure (IC). We investigated the efficacy of unilateral dual transversus abdominis plane (TAP) block to reduce morphine consumption in the first 24 hours along with a reduction in visual analogue score for pain and in postoperative nausea/vomiting.

METHODS

This was a single-center, investigator-initiated, prospective, parallel-group, placebo-controlled randomized study involving patients undergoing IC under general anesthesia. We recruited 55 patients in two groups: 28 in a TAP group and 27 in a placebo group. The TAP group patients received 30 mL of 0.375% bupivacaine: 15 mL by a posterior TAP approach and 15 mL by a subcostal approach using ultrasonography. Patients in the placebo group received 30 mL normal saline (placebo) using the same approaches. Blocks were administered at the end of surgery before extubation. To monitor for the primary outcome-24-hour morphine consumption for both groups-patients were transferred to a high-dependency unit. The secondary outcome was to compare postoperative nausea/vomiting in both groups.

RESULTS

The demographic data, gender distribution, ASA physical status, duration of surgery, and time of first morphine dose was comparable in both groups. The 24-hour morphine consumption was 3.29±2.78 mg and 9.23±2.94 mg for the TAP and placebo groups, respectively, which was statistically significant (P=0.001).

CONCLUSION

Dual TAP block reduces opioid consumption in the first 24 hours after an IC and can facilitate early recovery with less adverse effects seen than with opioids and NSAIDs.

Ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy: comparison of efficacy of bupivacaine and levobupivacaine on postoperative pain control

Background and objective

The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy.

Methods

Fifty patients (ASA I/II), undergoing laparoscopic cholecystectomy were randomly allocated into two groups. Following anesthesia induction, ultrasound-guided bilateral transversus abdominis plane block was performed with 30 mL of bupivacaine 0.25% in Group B (n = 25) and 30 mL of levobupivacaine 0.25% in Group L (n = 25) for each side. The level of pain was evaluated using 10 cm visual analog scale (VAS) at rest and during coughing 1, 5, 15, 30 min and 1, 2, 4, 6, 12 and 24 h after the operation. When visual analogue scale > 3, the patients received IV tenoxicam 20 mg. If visual analogue scale remained >3, they received IV. tramadol 1 mg.kg⁻¹. In case of inadequate analgesia, a rescue analgesic was given. The analgesic requirement, time to first analgesic requirement was recorded.

Results

Visual analogue scale levels showed no difference except first and fifth minutes postoperatively where VAS was higher in Group L (p < 0.05). Analgesic requirement was similar in both groups. Time to first analgesic requirement was shorter in Group L (4.35 ± 6.92 min vs. 34.91 ± 86.26 min, p = 0.013).

Conclusions

Bupivacaine and levobupivacaine showed similar efficacy at TAP block in patients undergoing laparoscopic cholecystectomy.

[Ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy: comparison of efficacy of bupivacaine and levobupivacaine on postoperative pain control]

BACKGROUND AND OBJECTIVE

The use of transversus abdominis plane block with different local anesthetics is considered as a part of multimodal analgesia regimen in laparoscopic cholecystectomy patients. However no studies have been published comparing bupivacaine and levobupivacaine for transversus abdominis plane block. We aimed to compare bupivacaine and levobupivacaine in ultrasound-guided transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy.

METHODS

Fifty patients (ASA I/II), undergoing laparoscopic cholecystectomy were randomly allocated into two groups. Following anesthesia induction, ultrasound-guided bilateral transversus abdominis plane block was performed with 30mL of bupivacaine 0.25% in Group B (n=25) and 30mL of levobupivacaine 0.25% in Group L (n=25) for each side. The level of pain was evaluated using 10cm visual analog scale (VAS) at rest and during coughing 1, 5, 15, 30min and 1, 2, 4, 6, 12 and 24h after the operation. When visual analogue scale>3, the patients received IV tenoxicam 20mg. If visual analogue scale remained >3, they received IV. tramadol 1mg.kg^-1. In case of inadequate analgesia, a rescue analgesic was given. The analgesic requirement, time to first analgesic requirement was recorded.

RESULTS

Visual analogue scale levels showed no difference except first and fifth minutes postoperatively where VAS was higher in Group L (p<0.05). Analgesic requirement was similar in both groups. Time to first analgesic requirement was shorter in Group L (4.35±6.92min vs. 34.91±86.26min, p=0.013).

CONCLUSIONS

Bupivacaine and levobupivacaine showed similar efficacy at TAP block in patients undergoing laparoscopic cholecystectomy.

Comparison of ultrasound-guided posterior transversus abdominis plane block and lateral transversus abdominis plane block for postoperative pain management in patients undergoing cesarean section: a randomized double-blind clinical trial study

Background

Due to the importance of pain control after abdominal surgery, several methods such as transversus abdominis plane (TAP) block are used to reduce the pain after surgery. TAP blocks can be performed using various ultrasound-guided approaches. Two important approaches to do this are ultrasound-guided lateral and posterior approaches. This study aimed to compare the two approaches of ultrasound-guided lateral and posterior TAP blocks to control pain after cesarean section.

Materials and methods

In this double-blind clinical trial study, 76 patients scheduled for elective cesarean section were selected and randomly divided into two groups of 38 and underwent spinal anesthesia. For pain management after the surgery, one group underwent lateral TAP block and the other group underwent posterior TAP block using 20cc of ropivacaine 0.2% on both sides. Pain intensity was evaluated based on Numerical Analog Scale (NAS) at rest and when coughing, 2, 4, 6, 12, 24 and 36 hours after surgery.

Results

The pain at rest in the posterior group at all hours post surgery was lower than the lateral group, especially at 6, 12 and 24 hours after the surgery and the difference was statistically significant (p=0.03, p<0.004, p=0.001).

Conclusion

The results of this study show that ultrasound-guided posterior TAP block compared with the lateral TAP block was more effective in pain control after cesarean section.

Transversus Abdominis Plane Block and Free Flap Abdominal Tissue Breast Reconstruction: Is There a True Reduction in Postoperative Narcotic Use?

INTRODUCTION

The use of the transversus abdominis plane (TAP) block is increasing in abdominally based autologous tissue breast reconstruction as a method to provide postoperative donor site analgesia. The purpose of this study was to evaluate the efficacy of the TAP block in the immediate postoperative period.

METHODS

A retrospective analysis of all patients who underwent autologous microsurgical breast reconstruction over a 2-year period (2013-2015) was conducted. Only patients with an abdominal donor site were included. Patients were grouped based on the presence or absence of TAP blocks. Primary endpoints included patient-reported pain score, daily and total narcotic use during the hospitalization, antiemetic use, as well as complications.

RESULTS

We identified 40 patients that had undergone abdominal-based free flap breast reconstruction and TAP block catheter placement for postoperative analgesia that met inclusion criteria. This group was then compared with a matched cohort of 40 patients without TAP blocks. There were no complications associated with using the TAP catheters. There was no statistically significant difference in postoperative pain scores, daily or total narcotic use during the hospitalization, or antiemetic use between the 2 groups. Although not statistically significant, linear regression analysis identified trends of improved donor site analgesia in select groups, such as unilateral immediate reconstructions, body mass index greater than 30 kg/m, and those without abdominal mesh placed at the time of donor site closure in the TAP block group.

CONCLUSIONS

Constant delivery of local anesthetic through the TAP block appears to be safe; however, it did not reduce narcotic requirements or postoperative pain scores in patients undergoing abdominal-based free flap breast reconstruction.

Dermatomal spread following posterior transversus abdominis plane block in pediatric patients: our initial experience

INTRODUCTION

Several techniques for the transversus abdominis plane (TAP) block have been described. The extent of sensory changes using an ultrasound-guided posterior TAP block (pTAP) remains unclear in pediatric patients. The primary aim of this study was to report the extent of sensory changes achieved with pTAP; specifically the highest thoracic dermatome anesthetized. Secondary outcomes were pain scores (PS), opioid consumption, and complications.

METHODS

We retrospectively reviewed the medical records of patients less than 21 years of age undergoing abdominal surgery with a unilateral or bilateral pTAP(s) for postoperative analgesia. The local anesthetic was placed posterior to the termination of the transversus abdominis muscle where the thoracolumbar fascia overrides the quadratus lumborum muscle. The extent of sensory changes, pain scores, and opioid consumption were analyzed.

RESULTS

A total of 10 patients (15 pTAP blocks) met the inclusion criteria. The mean (sd; range) age and weight were 15 years (5 years; range 7-20 years) and 57 kg (21 kg; 27-97 kg), respectively. The cephalad dermatome levels achieved were: T7 in 6/15 (40%); T8 in 10/15 (67%); and T9 in 14/15 (93%). An inferior dermatome level of T12/L1 and sensory extension from midaxillary line to the midline was documented in 15/15 blocks. The mean intraoperative and postanesthesia care unit (PACU) opioid consumption in morphine equivalents were 0.34 mg·kg^-1 (sd = 0.12 mg·kg^-1 ) and 0.04 mg·kg^-1 (sd = 0.05 mg·kg^-1 ), respectively. PACU pain scores were mild (<4) in 60%, moderate (4-7) in 30%, and severe (>7) in 10% of patients. No complications were reported.

DISCUSSION

The current uncertainty regarding sensory blockade limits the clinical application of TAP blocks. While the midaxillary approach results in unpredictable sensory changes of the abdomen, we reliably achieved sensory changes up to a T9 level in 93% of the blocks.

CONCLUSION

In this small series of patients, we demonstrate a high technical success rate of achieving cutaneous analgesia to the abdominal wall. These results should encourage clinical studies of the efficacy of this block for abdominal surgery in pediatric patients.

Transversus abdominis plane block as the primary anesthetic for peritoneal dialysis catheter surgery

STUDY OBJECTIVE

The primary goal of this study was to determine whether transversus abdominis plane (TAP) blocks were effective as the primary anesthetic technique for insertion and/or removal of peritoneal dialysis catheters.

DESIGN

This study is a descriptive case series investigation.

SETTING

Operating rooms at a tertiary care academic medical center.

PATIENTS

Twenty-four patients, American Society of Anesthesiologists (ASA) physical status 3 and 4, were included in this study.

INTERVENTIONS

Patients who had received a TAP block preoperatively for open surgical insertion or removal of a peritoneal dialysis catheter over a 26-month period with the intent of the block to serve as the primary anesthetic were included in this study.

MEASUREMENTS

Preoperative and intraoperative sedative medications and local anesthetic medications were analyzed. The primary outcome of the study was the ability of the TAP block to provide surgical anesthesia as determined by a lack of need to convert to general anesthesia (defined by placement of an airway device, use of volatile anesthetics, intraoperative propofol infusion dose equal to or greater than 100 μg kg(-1) min(-1)). Secondary outcomes included analysis of any complications from the higher concentrations of local anesthetics required for surgical block.

MANI RESULTS

Of 24 patients, 21 underwent the procedure without conversion to general anesthesia as defined above. No complications related to local anesthetics were found.

CONCLUSION

Transversus abdominis plane blockade can be successful at serving as the primary anesthetic modality for the insertion and/or removal of a peritoneal dialysis catheter by open-surgical approach. There were no systemic toxic effects or other complications recorded.

Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia

Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery. 318 patients were propensity matched on 18 potential factors among three groups (106 per group): 1) TAP infiltration with bupivacaine liposome; 2) continuous Epidural analgesia with plain bupivacaine; and; 3) intravenous patient-controlled analgesia (IV PCA). We claimed TAP noninferior (not worse) over Epidural if TAP was noninferior (not worse) on total morphine-equivalent opioid and time-weighted average pain score (10-point scale) within first 72 hours after surgery with noninferiority deltas of 1 (10-point scale) for pain and an increase less of 20% in the mean morphine equivalent opioid consumption. We claimed TAP or Epidural groups superior (better) over IV PCA if TAP or Epidural was superior on opioid consumption and at least noninferior on pain outcome. Multivariable linear regressions within the propensity-matched cohorts were used to model total morphine-equivalent opioid dose and time-weighted average pain score within first 72 hours after surgery; joint hypothesis framework was used for formal testing. TAP infiltration were noninferior to Epidural on both primary outcomes (p<0.001). TAP infiltration were noninferior to IV PCA on pain scores (p = 0.001) but we did not find superiority on opioid consumption (p = 0.37). We did not find noninferiority of Epidural over IV PCA on pain scores (P = 0.13) and nor did we find superiority on opioid consumption (P = 0.98). TAP infiltration with liposomal bupivacaine and continuous epidural analgesia were similar in terms of pain and opioid consumption, and not worse in pain compared with IV PCA. TAP infiltrations might be a reasonable alternative to epidural analgesia in abdominal surgical patients. A large randomized trial comparing these techniques is justified.

Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage

Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall.

Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients

Transversus abdominis plane (TAP) block technique seems to offer one of the most efficient methods for a local pain control. Our aim is to demonstrate the effectiveness and safety of TAP block for post-operative pain control under laparoscopic vision in elderly patients during laparoscopic cholecystectomy. The patients aged more than 65 years old, who had cholecystectomy due to symptomatic cholelithiasis, were retrospectively evaluated. The patients that were operated under general anesthesia + laparoscopic TAP block and those who were operated only under only general anesthesia were compared according to their' age and gender, comorbidities, American Society of Anesthesiologists scores, visual analog scale (VAS) for pain and length of stay in the hospital. Median (±interquartile range) values of post-operative 24th-hour-VAS for pain was found consecutively 2 (±1-3) in TAP block + group and 3 (±2-5) in TAP block - group. The median post-operative 24th-hour-VAS value in overall patients was three. Patients' VAS values were higher in the TAP block - group with a statistically significant difference (p = 0.001). Furthermore, no statistically significant difference was found for other parameters in two groups. The laparoscopic-guided TAP block can easily be performed and has potential for lower visceral injury risk and shorter operational time. Efficacy, safety and other advantages (analgesic requirements, etc.) make it an ideal abdominal field block in elderly patients.

Evolution of transversus abdominis plane infiltration techniques for postsurgical analgesia following abdominal surgeries

Transversus abdominis plane (TAP) infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by administration of a local anesthetic in close proximity, TAP infiltration involves administration and spread of local anesthetic within an anatomical plane of the surgical site.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial

Background and Aims:

The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial.

Materials and Methods:

Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant.

Results:

There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A.

Conclusion:

Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery.

Continuous bilateral TAP block in patient with prior abdominal surgery

We present as an option for epidural analgesia and intravenous opioid infusion a clinical case of transversus abdominis plane (TAP) block, with bilateral placement of catheter for postoperative analgesia after exploratory laparotomy performed in a patient with previous abdominal surgery and heart, kidney and liver failure.