A Rare Complication of a TAP Block Performed after Caesarean Delivery

Navigating Pain Relief: A Comprehensive Review of Transversus Abdominis Plane Block

This comprehensive review explores the multifaceted role of the transversus abdominis plane (TAP) block in contemporary pain management. Beginning with a definition and historical evolution, the article elucidates the mechanism of action, emphasizing local anesthesia, interference with pain signal transmission, and its impact on visceral and somatic pain. The review systematically investigates the diverse indications for TAP block, ranging from its applications in various surgical procedures to postoperative pain management and chronic pain conditions. Noteworthy abdominal wall block variations, including rectus sheath block and quadratus lumborum block, underscore the adaptability of TAP block in diverse clinical scenarios. The implications for clinical practice highlight its pivotal role in enhancing recovery after surgery, reducing opioid reliance, and providing patient-centered care. Furthermore, the article outlines recommendations for further research, addressing ongoing trials, technological innovations, and potential expansions into non-surgical settings. In conclusion, TAP block emerges as a dynamic and indispensable tool in pain management, potentially redefining paradigms and optimizing patient outcomes across a spectrum of medical contexts.

Comparison of Dexamethasone Versus Methylprednisolone With Bupivacaine in Transversus Abdominis Plane Block for Attenuation of Chronic Postoperative Abdominal Pain

Background  Opioids, which have well-known adverse effects such as drowsiness paralytic ileus and respiratory depression, were mostly utilised to treat postoperative pain in the past. The increased incidence of side effects has led to a rise in interest in pain management techniques that spare opioids. Persistent abdominal pain following surgery has a major detrimental effect on patients' quality of life. While epidural analgesia is widely regarded as the gold standard to combat the pain that is present post abdominal surgeries, it is not devoid of drawbacks. The transversus abdominis plane (TAP) block has developed as a potentially effective treatment for severe abdominal pain. The TAP block acts on the neuro-fascial plane between the internal oblique and transversus abdominis muscles, which is innervated by spinal nerves from T6 to L1. Studies reveal that the addition of corticosteroids to bupivacaine in TAP blocks provides pain relief and improves the quality of life of the patient. Aims and objectives  In this study, the effects of bupivacaine and corticosteroids, particularly dexamethasone and methylprednisolone, on chronic abdominal pain following surgery are examined. Assessing the quality of pain relief is the primary objective. Methodology  Thirty patients who had undergone abdominal surgery and had been having persistent abdominal pain for six to eight months thereafter and had attempted unsuccessfully to treat the pain with alternative pain relief methods participated in the study. They were divided into two groups at random. Dexamethasone and bupivacaine were given to patients in Group D while methylprednisolone and bupivacaine were given to patients in Group M for ultrasonography (USG)-guided bilateral TAP blocks. At various intervals up to 12 weeks after injection, the patient's pain levels were measured using the visual analogue score (VAS), and their quality of life was assessed using the quality-of-life score. Results  Patients in Group M experienced significantly less pain than those in Group D at the fourth, sixth, and 12th weeks of treatment. Furthermore, in the fourth, sixth, and 12th weeks, patients in Group M reported a superior quality of life in comparison to those in Group D. Conclusion  Patients with persistent postoperative abdominal pain receiving bupivacaine and methylprednisolone in an ultrasonography-guided TAP block experience more effective and long-lasting pain relief than those who receive bupivacaine and dexamethasone. The quality of life for patients may be enhanced by using corticosteroids to optimise postoperative pain management strategies and lessen the need for opioids, as this study highlights.

The evaluation of the efficacy of 0.25% Bupivacaine and 0.5% Ropivacaine in ultrasound guided bilateral transversus abdominis plane block for post operative analgesia in lower abdominal surgeries

The increasing use of nerve blocks for post operative analgesia has led to the development of several newer interfascial injection techniques for analgesia of the chest and abdominal wall. The unique feature of ultrasound guided truncal blocks is that in all of these techniques, in contrast to peripheral nerve blocks, no nerve or plexus needs to be identified. Local anaesthesia is injected in a particular muscle plane, in which the injectate spreads and reaches the intended nerves. Transversus abdominis plane (TAP) block has become a common analgesic method after surgery involving the abdominal wall. Aim: 1. To assess the efficacy of 0.25% Bupivacaine and 0.5% Ropivacaine in pain relief after lower abdominal surgeries using ultrasound guided transversus abdominis plane block (TAP). 2. Requirement of first rescue dose. 3.To assess complications related to the technique and drug related adverse effects. Methods: A comparative, randomised, double blinded study was carried out on 60 ASA physical status grade I and II patients of either sex between 18-40 years of age, scheduled for elective lower abdominal surgeries. 60 patients were divided equally by using computer generated random numbers into two groups. Group B received 15 ml of 0.25% Bupivacaine. Group R received 15 ml of 0.5% Ropivacaine. The TAP block was performed at the end of the surgery using the ultrasound. Results: Mean duration of analgesia was 373.75 minutes with SD of 66.1512 in Bupivacaine group and 687 minutes with SD of 119.433 in Ropivacaine group. The difference was highly significant in Group R compared to Group B (p < 0.0001). Conclusion: Thus, we conclude that 0.5% Ropivacaine provided longer duration of analgesia than 0.25% Bupivacaine when used in TAP block for providing post operative analgesia after lower abdominal surgeries.

The Effect of an Abdominal Binder on Postoperative Pain after Laparoscopic Incisional Hernia Repair-A Multicenter, Randomized Pilot Trial (ABIHR-I) of the Intraperitoneal Onlay-Mesh Technique

BACKGROUND

Incisional hernias with apertures measuring less than 7 cm can generally be treated adequately with the laparoscopic intraperitoneal onlay-mesh (IPOM) technique. The wearing of an abdominal binder after surgery is often recommended in order to promote wound healing and prevent recurrent herniation. We carried out a multicenter, randomized pilot trial to evaluate the utility of abdominal binders.

METHODS

The trial was conducted from May 2019 to December 2020. Persons treated for an incisional hernia with a laparoscopic IPOM procedure were included in the trial and randomized preoperatively into two equal-sized groups: the patients in one group wore an abdominal binder during the daytime for 14 days after surgery, while those in the other group wore no binder. The primary endpoint was pain at rest on postoperative days 1, 2, and 14, as measured on a visual analog scale. The secondary endpoints were overall subjective wellbeing, the rates of wound infection and recurrence, the complication rate, mobility, and the rate and size of postoperative wound seroma formation (on postoperative days 1, 2, and 14).

RESULTS

40 patients were included in the pilot trial. Three had to be excluded because of intraoperative conversion to an open surgical technique. The binder and no-binder groups (18 and 19 patients, respectively) did not differ in their biometric and perioperative data to any statistically significant extent. The patients in the binder group had significantly less postoperative pain (F [dfn, dfd] 4.44, 95% confidence interval [1; 35], p = 0.042).The patients in the binder group also had better overall subjective well-being and a higher rate of postoperative wound seroma formation than those in the no-binder group, but these differences did not reach statistical significance. The patients in the binder group had less limitation of mobility than those in the other group; this difference did not reach statistical significance, either.

CONCLUSION

A postoperatively worn abdominal binder may reduce pain after incisional hernia repair with the IPOM technique. The postoperative use of analgesic medication was not measured.

Practical Review of Abdominal and Breast Regional Analgesia for Plastic Surgeons: Evidence and Techniques

Regional analgesia has been increasing in popularity due to its opioid- sparing analgesic effects and utility in multimodal analgesia strategies. Several regional techniques have been used in plastic surgery; however, there is a lack of consensus on the indications and the comparative efficacy of these blocks. The goal of this review is to provide evidence-based recommendations on the most relevant types of interfascial plane blocks for abdominal and breast surgery. A systematic search of the PUBMED, EMBASE, and Cochrane databases was performed to identify the evidence associated with the different interfascial plane blocks used in plastic surgery. The search included all studies from inception to March 2020. A total of 126 studies were included and used in the synthesis of the information presented in this review. There is strong evidence for using the transversus abdominis plane blocks in both abdominoplasties as well as abdominally-based microvascular breast reconstruction as evidenced by a significant reduction in post-operative pain and opioid consumption. Pectoralis (I and II), serratus anterior, and erector spinae plane blocks all provide good pain control in breast surgeries. Finally, the serratus anterior plane block can be used as primary block or an adjunct to the pectoralis blocks for a wider analgesia coverage of the breast. All the reviewed blocks are safe and easy to administer. Interfascial plane blocks are effective and safe modalities used to reduce pain and opioid consumption after abdominal and breast plastic surgery.

Ultrasound-versus visual-guided transversus abdominis plane block prior to transabdominal preperitoneal ingunial hernia repair. A retrospective cohort study

BACKGROUND

The transversus abdominis plane block is a regional anesthesia technique. Recently, its impact on early chronic pain and the cumulative need of analgesic medication following inguinal hernia repair is being monitored. In terms of effectiveness and patient safety, it remains unclear whether the approach should be conducted preoperatively through ultrasound guidance, or through intraoperative visual guidance.The study at hand aims to provide more evidence on this topic.

METHODS

A monocentric retrospective matched pair analysis was performed. The intraoperative visual guided and ultrasound guided -transversus abdominis plane block prior to inguinal hernia repair in transabdominal preperitoneal technique were consecutively compared in regard to analgesic effectiveness and complication rate. The data of individuals who were operated on from June 2007 to February 2019 were analyzed. The matching criteria were ASA-Score, Gender, Age ( ±6 years), and hernia size (<1,5 cm, 1,5-3 cm, >1,5 cm).

RESULTS

A total of 116 patients were enrolled. Both groups were homogenous in terms of age, gender contribution, body mass index, ASA-Score, hernia type, and size. The pain score at the postoperative anesthesia care unit was lower in the ultrasound-guided-transversus abdominis plane group without being statistically significant (VAS-Score: 0.67 vs.0.84). Patients of the ultrasound-guided-transversus abdominis plane group received significantly less metamizole on the day of operation (1.29 g (0.96) vs. 1.68 g (0.70), p = 0.015).

CONCLUSION

Due to our findings, we assume that the ultrasound-guided-transversus abdominis plane -Block may reduce postoperative pain and analgesic consumption more effectively than the visual-guided-transversus abdominis plane lock. Further prospective clinical trials are mandatory.

The transversus abdominis plane block may reduce early postoperative pain after laparoscopic ventral hernia repair a matched pair analysis

PURPOSE

Patients suffering from a ventral hernia can be treated by laparoscopic ventral hernia repair (VHR) with the intraperitoneal onlay mesh (IPOM) technique. To reduce early postoperative pain and the analgesic cumulative need for medication (CNM), the transversus abdominis plane (TAP) block has recently been investigated and implemented in hernia surgery. We aimed to investigate its impact when conducting a VHR in IPOM technique.

METHODS

A single center retrospective observational matched pair analysis has been conducted from March to April 2020. The data of patients who underwent VHR in IPOM technique with prior TAP block administration were enrolled. The matching was performed using the variables age ( ±5 years), gender, type of surgery, BMI and ASA stage.

RESULTS

52 patients were enrolled. Among the individuals of the TAP block group, (18 males, 8 females) the average age was 52.4 (15.9). The average BMI was 29.0 (3.95) kg/m2. 14 patients suffered from an umbilical, 9 from an incisional, and three from an epigastric hernia. Except for COX-2-inhibitors, (TAP group: 41.9 mg (31.0), Control group 9.23 (22.1), p < 0.001) the analgesic CNM of both groups did not statistically differ from each other. The literature review yielded four relevant publications (n = 100). The authors stated a positive impact of the TAP block on early postoperative pain and analgesic medication consumption.

CONCLUSION

The TAP block prior to laparoscopic ventral hernia repair may reduce early postoperative pain and analgesic medication consumption in selected patients. More randomized clinical trials are needed to confirm these findings.

The transversus abdominis plane block reduces the cumulative need of analgesic medication following inguinal hernia repair in TAPP technique: a retrospective single center analysis among 838 patients

PURPOSE

Laparoscopic inguinal hernia repair (IHR) may lead to early postoperative pain. Therefore, opioid and non-opioid analgesic agents are often administered in the post-anesthesia care unit (PACU). To reduce the postoperative cumulative need of analgesic medication, as well as to accelerate the physical recovery time, the transversus abdominis plane (TAP) block has recently been studied. The TAP block is a regional anesthesia technique. Even though there is evidence about the efficacy of the block used in procedure such as an open inguinal hernia repair, the evidence regarding its use for the TAPP (transabdominal preperitoneal) technique remains low. We aim to provide more sufficient evidence regarding this topic.

METHODS

A monocentric retrospective observational study investigating the effect of the TAP block prior to primary IHR in TAPP technique was conducted. The data of 838 patients who were operated on using this technique from June 2007 to February 2019 were observed. 72 patients were excluded because of insufficient information regarding their analgesic medication protocol. The patients' data were taken from their files.

RESULTS

The patients in the TAP block group (n = 364) did not differ statistically significantly compared to the control group (n = 402) in terms of gender, BMI and age. Individuals of the TAP block group experienced less postoperative pain in the PACU (p < 0.001) and received less analgesic medication (morphine, oxycodone, piritramide, acetaminophen; p < 0.001).

CONCLUSION

We assume that the TAP block is a sufficient approach to reduce postoperative pain and analgesic medication administration for IHR in TAPP technique.