Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques

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

OBJECTIVE

To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management.

METHODS

Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48 h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure.

RESULTS

34 patients were included. During the median length of stay of 4 days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12 h post-op, decreasing to 38% by 48 h post-op. The median consumption decreased in the first 48 h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48 h intervals, respectively. The median time to perform block procedure was 6 min (IQR 4-8 min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption.

CONCLUSION

Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.

Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients

Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.

Postoperative pain control and opioid use with transversus abdominis plane block and scheduled multimodal pain management in patients undergoing cesarean section

OBJECTIVE

The impact of a transversus abdominis plane (TAP) block in patients undergoing cesarean section requires further evaluation. The aim of this study was to compare postoperative pain scores and opioid use in cesarean surgery patients undergoing either a TAP block and scheduled multimodal pain management (SMPM) or SMPM alone.

METHODS

In this retrospective, dual cohort study, cesarean surgery patients underwent neuraxial anesthesia and a TAP block (SMPM/TAP) or SMPM; the TAP block incorporated ropivacaine (20-30 mL) administered bilaterally. The group analyses involved a comparison of postoperative pain scores using the visual analog scale and opioid consumption at 24 and 24-48 h.

RESULTS

There were 94 (52.8%) patients in the SMPM/TAP group and 84 (47.2%) subjects in the SMPM alone group. At 24 h postoperatively, the SMPM/TAP group exhibited significantly lower pain scores (4.07 vs 4.54) than the SMPM group (P < 0.001) and reduced opioid consumption (2.29 vs 3.28 mg; P < 0.001). However, at 24-48 h, the SMPM group demonstrated lower pain scores (5.46 vs 5.98) compared to the SMPM/TAP group (P < 0.001) and reduced opioid consumption (8.75 vs 10.21 mg; P < 0.001); overall opioid consumption was higher (12.50 vs 12.02 mg) in the SMPM/TAP group (P < 0.001).

CONCLUSION

The TAP block improved cesarean surgery patients' pain scores and reduced opioid consumption at 24 h postoperatively but the effect of the TAP block was ephemeral as the SMPM/TAP group exhibited inferior pain scores and greater opioid consumption compared to the SMPM group at 24-48 h postoperatively.

Comparative Study of Levobupivacaine Versus Levobupivacaine With Dexmedetomidine as an Adjuvant in Transversus Abdominis Block for Postoperative Pain Relief in Abdominal Hysterectomy Patients: A Randomized, Double-Blind Study

Background Adjuvants have been discovered to prolong the analgesic impact of local anesthetics (LA), while the transversus abdominis plane (TAP) block offers sufficient postoperative pain relief after various abdominal procedures. Nevertheless, the impact of the given LA will determine the duration of the TAP block. Thus, in this investigation, we aimed to estimate the analgesic impact of combining dexmedetomidine (DEX) with levobupivacaine in the TAP block for patients having an infraumbilical incision for an abdominal hysterectomy while under spinal anesthetic. Aim This study aimed to determine the analgesic effect of DEX (0.5 mcg/kg) to 20 ml of 0.25% levobupivacaine on each side in the TAP block in patients undergoing total abdominal hysterectomy (TAH). Materials and methods Two groups of 30 patients each, with ASA grades 1 and 2, were randomly selected from patients. Group N, comprising 30 patients, had a bilateral TAP block using 2 mL of normal saline and 20 mL of 0.25% levobupivacaine. Group D (n = 30 patients) was given DEX at a dose of 0.5 mcg/kg (2 mL) in addition to 20 mL of 0.25% levobupivacaine given bilaterally. The TAP block was administered just after skin closure. Time of the initial analgesic dose administration; total fentanyl doses utilized as rescue analgesia; pain scores (numerical rating scale (NRS)) at 2, 4, 6, 8, 12, and 24 hours; and pre- and postoperative cortisol levels were also noted. For each group, 1 gram IV paracetamol was administered every eight hours. Drugs used for rescue analgesia (RA) were diclofenac 75 mg IV stat and fentanyl 1 mcg/kg. Results and discussion In addition to Group N having lower NRS scores at rest, Group D had a considerably longer time for initial rescue analgesia than Group N. There was also a significant decrease in the total fentanyl consumption and postoperative serum cortisol levels in Group D in contrast to Group N. Conclusion Potential adjuvant DEX prolongs postoperative analgesia in patients experiencing abdominal hysterectomy when used alongside LA in TAP.

Transversus Abdominis Plane Block versus Epidural Anesthesia for Pain Management Post-Caesarean Delivery: A Pilot Study

Background

Effective post-operative analgesia profoundly influences patient recovery and outcomes after caesarean delivery. The Transversus Abdominis Plane (TAP) block represents a potential alternative, potentially offering greater effectiveness than epidural analgesia while causing fewer adverse effects.

Objective

To assess if the abdominal transverse block provides superior postoperative pain relief in patients undergoing caesarean delivery compared to epidural analgesia.

Methods

Participants were divided into parallel groups: an experimental group receiving TAP block (n=25) and a control group receiving epidural analgesia (n=24). All patients received a 10 mg dose of hyoscine at the end of the surgery. Experimental Group received a total of 20 mL of 0.2% ropivacaine. In Epidural group received 0.2% ropivacaine at 4 mL/h for 24 hours. All participants were administered combined with neuroaxial block anesthesia. The patients selected for epidural analgesia received the mentioned dose, while the other group block had the epidural catheter removed after the cesarean section. The primary outcome was post-caesarean pain, evaluated using the Visual Analog Scale (VAS) at four intervals (0, 6, 12, and 24 hours). Also, surgical bleeding and residual motor were evaluated. VAS pain scores between the groups were compared using the Friedman test and Generalized Linear Model (GLM) for non-normally distributed data. The effect size was estimated with Eta Square ([Formula: see text]), considering values ≥0.38 as indicative of large effects. A two-tailed p-value < 0.05 was deemed statistically significant.

Results

Statistically significant differences in pain scores were noted at 0 and 6 hours post-surgery (p<0.01). The TAP block group reported lower pain scores at 0 hours (mean=0.04) and 6 hours (mean=1.16) compared to the epidural group, reflecting a substantial effect size.

Conclusion

The TAP block proves advantageous in mitigating postoperative pain for women post-caesarean delivery, particularly in the initial 6 postpartum hours. This relief promotes early mother-infant bonding and facilitates breastfeeding.

Comparative evaluation of pre-emptive analgesic efficacy of Posterior Transversus Abdominis Plane block with Fascia Transversalis Plane Block in adult patients undergoing unilateral inguinal hernia repair: A prospective, randomized, single-blind, two-arm parallel study

Introduction

Abdominal wall blocks, in conjunction with multimodal analgesia, have demonstrated efficacy in providing post-operative analgesia, reducing opioid requirements in patients undergoing inguinal hernia repair. The inguinal region is primarily innervated by the ilioinguinal nerve (IIN) and iliohypogastric nerve (IIH). Posterior transverse abdominis plane block (pTAP) and fascia transversalis plane block (TFP) have been observed to reliably block IIN and IIH. We hypothesized that posterior TAP block (pTAP) owing to its potential paravertebral spread will provide better post-operative analgesia than TFP block in patients undergoing unilateral open inguinal hernia repair.

Methods

This prospective, randomized, single-blind, two-arm parallel study was conducted over a duration of one year for which sixty patients undergoing unilateral open inguinal hernia repair under spinal anesthesia were enrolled. They were equally and randomly assigned to receive either preoperative pTAP block or TFP block. The primary aim of the study was to compare median static and dynamic NRS scores during a 24-hour period, with the secondary aim to compare the number of patients who required rescue analgesics in each group.

Results

All enrolled patients completed the study. Results showed no statistically significant difference in median static NRS scores between Group pTAP and Group TFP at the designated time of observation during the 24-hour period [1.2 (0.4-1.60 vs. 1 (0.6-1)]. Group pTAP reported a higher median dynamic NRS scores during the 24-hour period [2.6 (1.2-3) v/s 2 (1.6-2.4); P < 0.035], although this difference was clinically insignificant. The mean time to request for the first rescue analgesia was comparable (11.7 h v/s 12 h; P = 0.99). In all the patients of both groups, loss of pinprick and cold touch sensation was observed at T10, T12, and L1 dermatomal levels. However, sensory assessment at T6 and T8 levels showed variability between the two groups (P > 0.05).

Conclusion

In conjunction with background analgesia and the use of dexamethasone as an adjuvant, both blocks (pTAP and TFP) were observed to be equally effective for post-operative pain relief with similar patient satisfaction scores.

Peripheral nerve blocks for analgesia following cesarean delivery A narrative review

Spinal and epidural blocks are commonly employed for pain relief during and following cesarean section. Intrathecal morphine (ITM) has been the gold standard for the same for many years. In recent times, many peripheral nerve blocks (PNBs) have been tried for postoperative analgesia following cesarean delivery (PACD). This article has reviewed the common PNBs used for PACD. The role of PNBs along with ITM has been studied and the current best strategy for PACD has also been explored. Currently, Ilio-inguinal nerve and anterior transversus abdominis plane block in conjunction with intrathecal morphine have been found to be the most effective strategy, providing lower rest pain at 6 hours as compared to ITM alone. In patients not receiving intrathecal morphine, recommended PNBs are lateral transversus abdominis plane block, single shot local anesthetic wound infiltration, or continuous wound infiltration with catheter below rectus fascia. PNBs are recommended for PACD. They have an opioid-sparing effect and are devoid of adverse effects associated with central neuraxial blocks such as hypotension, bradycardia, and urine retention. However, caution must be observed with PNBs for possible local anesthetic toxicity due to the large volumes of drug required.

Subcostal TAP block: one or two sequential injections? A cadaveric study

BACKGROUND AND OBJECTIVES

The subcostal transversus abdominis plane block (scTAPB) provides analgesia to the anterior abdominal wall but analgesic spread following a single injection remains modest and variable. The oblique scTAPB, which is performed with a continuous injection during needle progression into the TAP along the oblique subcostal line, may extend the block to the whole anterior abdominal wall but needle progression by hydrodissection may be difficult, explaining why this block is not widely used. This study investigated if two sequential scTAPB injections (2scTAPI) may reach more nerves than a single scTAPB (1scTAPI).

METHODS

After institutional approval and under ultrasound guidance, a single injection of 20 mL of blue dye was performed in 16 cadaveric subjects into the TAP along the costal margin and lateral to the semilunaris line (1scTAPI). On the opposite side, a 20 mL of green solution was split into two injections (2scTAPI), using one injection medial and one lateral to the semilunaris line. Dye spread was assessed via gross anatomical dissection using an indirect method to quantify the involvement of the anterior cutaneous branches of the intercostal nerves with each technique. A nerve was considered stained if the dye was observed in the TAP, reaching the costal margin aligned with the bony extremity of its corresponding rib.

RESULTS

According to the spread to the costal margin, the estimated median number of consecutive nerves reached by dye after 2scTAPI was 5 (IQR 5-6) vs 3 (IQR 3-4) for 1scTAPI (p=0.00001). Spread after 2scTAPI suggested coverage of nerves originating from T8 to T12 in 85% of the subjects, and from T7 to T12 in 5 out of 17 cases. Spread following the 1scTAPI suggested coverage of nerves from T9 to T11 in most cases.

CONCLUSIONS

In a cadaveric model, a larger spread at the costal margin was obtained after 2scTAPI, suggesting a greater coverage of anterior branches of abdominal wall nerves compared with 1scTAPI. Clinical studies are needed to confirm these results.

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

Background

Surgeons commonly perform ultrasound-guided Transversus Abdominis Plane blocks to manage acute pain following abdominal surgeries. There is no consensus on whether surgeons should undergo basic hands-on training to perform TAP blocks or if video-based learning is sufficient. We theorized that simulation-based learning is superior to video-based learning. In the present study, we present the analysis of technical skills of UGSA-TAP block performance on a live porcine model by general surgery trainees after undergoing video or simulation-based learning.

Methods

We performed a prospective, double-blinded, randomized study. Ten surgery residents and two surgery critical-care fellows (n = 12) without prior experience in performing the TAP block were recruited. The participants were randomized either into a video-based or simulation-based training group. After that, all participants performed a TAP block on a live anesthetized pig, which was recorded and scored by three blinded anesthesiologists. All participants completed a post-performance survey to assess their confidence in gaining competency in the UGSA-TAP block. Statistical analyses were performed to assess the differences between the two groups. P < 0.05 was considered statistically significant.

Results

All simulation-based learning participants successfully performed a survey scan, identified the three muscular layers of the abdominal wall, and identified the transversus abdominis plane compared to 50 %, 50 %, and 33 % video-based learning group participants for the respective parameters (p < 0.05). While some performance metrics showed no statistically significant differences between the groups, substantial effect sizes (Cohen's ℎ up to 1.07) highlighted notable differences in participants' performance. Both groups exhibited confidence in core competencies, with varied rates of satisfactory skill execution. Performance assessed using a global rating scale revealed a higher passing rate for the simulation group (83 % vs. 33 %). Participant feedback via the Likert scale reflected confidence post-training. Inter-rater reliability (0.83-1) confirmed the robustness of study evaluations.

Conclusion

The UGSA-TAP block curriculum should be introduced into the surgical residency programs with an emphasis on simulation-based learning to enhance the procedural skills of the trainees before transitioning to surgical patients.

Transversus abdominis plane block improves postoperative recovery following cesarean delivery under general anesthesia: A propensity score matched retrospective cohort study

OBJECTIVE

To evaluate the effects of transversus abdominis plane (TAP) block on postoperative recovery 24 h after cesarean delivery under general anesthesia.

METHODS

A propensity-score-matched, retrospective cohort study was used. A total of 173 pregnancies resulting in elective cesarean delivery under general anesthesia between March 2021 and March 2022 were analyzed retrospectively. Patients receiving TAP block were compared with those receiving only intravenous analgesia. The Quality of Recovery 15 (QoR-15) score, assessed 24 h postoperatively using a 15-item questionnaire, was the primary outcome. Secondary outcomes included time to first ambulation, time to first flatus postoperatively, ability to tolerate ambulation, visual analog scale (VAS) score, hospitalization cost, and postoperative nausea and/or vomiting.

RESULTS

The total QoR-15 score 24 h postoperatively in the TAP group was significantly higher than in the Control group (P < 0.001). Patients in the TAP group had higher Bruggemann comfort scale scores (P < 0.001), could better tolerate early postoperative ambulation (P < 0.001), and had shorter time to first ambulation (P < 0.001) and flatus (P < 0.001). Correlation analysis demonstrated an inverse relationship between the cumulative VAS pain scores, time to first postoperative ambulation, time to first flatus, and total QoR-15 score 24 h postoperatively.

CONCLUSIONS

Following cesarean delivery under general anesthesia, TAP block combined with intravenous analgesia can improve postoperative recovery and shorten the time to postoperative ambulation and recovery of intestinal function.

Open Approach to the Transversus Abdominis Plane in Horses: A Cadaver Feasibility Study

The study's objective was to evaluate the feasibility and dispersion of an open approach to the transversus abdominis plane (TAP) block in eight adult equine cadavers. A ventral midline incision was made, starting 2 cm cranial to the umbilicus and extending 25 cm cranially. In total, 0.5 mL/kg of new methylene blue (NMB) was injected per horse, divided into six injections. Using an 18 g, 8 cm Tuohy needle, three injections were made per side. The needle was guided blindly into the TAP using palpation. A 60 mL syringe was attached directly to the needle, depositing ~0.08 mL/kg at each site. The time to complete the injections was recorded for each cadaver. Following injection, the ventral body wall was dissected to determine if the dye was present within the TAP space as well as to measure the extent of the dispersion of the dye, the cranial to caudal extent, and the width of the dye's spread. Complete deposition of NMB into the TAP (six of six sites) was achieved in 5/8 horses. The median time needed to perform all the injections was 263 s. Increased adiposity (retroperitoneal fat) was associated with unsuccessful injections. This approach to the TAP was easily and quickly performed, though less successful in horses with increased retroperitoneal fat and increased BCS.

Regional anesthesia for transplantation surgery - A White Paper Part 2: Abdominal transplantation surgery

Transplantation surgery continues to evolve and improve through advancements in transplant technique and technology. With the increased availability of ultrasound machines as well as the continued development of Enhanced Recovery after Surgery (ERAS) protocols, regional anesthesia has become an essential component of providing analgesia and minimizing opioid use perioperatively. Many centers currently utilize peripheral and neuraxial blocks during transplantation surgery, but these techniques are far from standardized practices. The utilization of these procedures is often dependent on transplantation centers' historical methods and perioperative cultures. To date, no formal guidelines or recommendations exist which address the use of regional anesthesia in transplantation surgery. In response, the Society for the Advancement of Transplant Anesthesia (SATA) identified experts in both transplantation surgery and regional anesthesia to review available literature concerning these topics. The goal of this task force was to provide an overview of these publications to help guide transplantation anesthesiologists in utilizing regional anesthesia. The literature search encompassed most transplantation surgeries currently performed and the multitude of associated regional anesthetic techniques. Outcomes analyzed included analgesic effectiveness of the blocks, reduction in other analgesic modalities-particularly opioid use, improvement in patient hemodynamics, as well as associated complications. The findings summarized in this systemic review support the use of regional anesthesia for postoperative pain control after transplantation surgeries. Part 1 of the manuscript focused on regional anesthesia performed in thoracic transplantation surgeries, and part 2 in abdominal transplantations. Specifically, regional anesthesia in liver, kidney, pancreas, intestinal, and uterus transplants or applicable surgeries are discussed.

Double-Edge, Single-Edge, and Intermediate-Edge Ultrasound Sign and Correlation With Fascial Plane Block Efficacy: An Experimental Study

Introduction Ultrasound-guided fascial plane blocks are nowadays the gold standard technique for regional anesthesia and postoperative analgesia. Despite their high success rate, cases of partial or total failure of this method have been reported. This experimental study aims to address the corresponding ultrasound signs and their association with fascial plane block efficacy. Methods After capturing the appropriate sonographic image that included muscle layers and their fasciae, an 18-gauge epidural needle penetrated the cadaveric porcine tissue and was forwarded until the tip of the needle reached the target fascial plane. The infusion of methylthioninium chloride or methylene blue dye was performed, causing tissue hydro dissection. The documentation of the generated ultrasound images was followed by surgical exposure of the tip of the needle. Results The distribution of the dye into the plane of interest (double-edge sign) was equivalent to block success, whereas the single-edge sign (accumulation of the dye between fascia and epimysium) indicated total block failure. The intermediate-edge sign, a combination of the previous ultrasound signs, is related to partial failure of block performance. Conclusion The identification of the three novel sonographic signs is an accurate predictive factor of peripheral nerve block efficacy. The respective data are expected to aid the rapid improvement of interfascial plane block accuracy and techniques, leading to their more effective execution and simultaneously eliminating the failure rates. Thereby, the amelioration of intra and postoperative analgesia will be accomplished, expediting the patient's hospital discharge and reducing or even avoiding opioid consumption.

Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials

BACKGROUND

Transversus abdominis plane (TAP) block has been utilized to alleviate pain following laparoscopic cholecystectomy (LC). However, the optimal timing of administration remains uncertain. This study aimed to compare the efficacy of pre-operative and postoperative TAP blocks as analgesic options after LC.

METHODS

A frequentist network meta-analysis of randomized controlled trials (RCTs) was conducted. We systematically searched PubMed (via the National Library of Medicine), EMBASE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science up to March 2023. The study included RCTs that enrolled adult patients (≥ 18 years) who underwent LC and received either pre-operative or postoperative TAP blocks. The primary outcome assessed was 24-hour postoperative morphine consumption (mg). Additionally, pain rest scores within 3 hours, 12 hours, and 24 hours, as well as postoperative nausea and vomiting (PONV), were considered as pre-specified secondary outcomes.

RESULTS

A total of 34 trials with 2317 patients were included in the analysis. Postoperative TAP block demonstrated superiority over the pre-operative TAP block in reducing opioid consumption (MD 2.02, 95% CI 0.87 to 3.18, I2 98.6%, p < 0.001). However, with regards to postoperative pain, neither pre-operative nor postoperative TAP blocks exhibited superiority over each other at any of the assessed time points. The postoperative TAP block consistently ranked as the best intervention using SUCRA analysis. Moreover, the postoperative TAP block led to the most significant reduction in PONV.

CONCLUSIONS

The findings suggest that the postoperative TAP block may be slightly more effective in reducing 24-hour postoperative opioid consumption and PONV when compared to the pre-operative TAP block.

TRIAL REGISTRATION

PROSPERO, CRD42023396880 .

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

Background

In the postoperative period, open total abdominal hysterectomy (TAH) surgeries induce considerable pain. Multimodal strategies are being used to alleviate pain.

Objectives

This study aimed to examine the efficacy and safety of dexamethasone and dexmedetomidine as an adjuvant to levobupivacaine in ultrasound-guided transversus abdominis plane (TAP) blocks for postoperative pain in TAH patients.

Methods

A total of 72 patients with ASA grade I and grade II were randomly and equally assigned to two groups. After the completion of surgery with a subarachnoid block (SAB), patients in group 1 received a mixture of 20 mL of 0.25% levobupivacaine and 4 mg of dexamethasone on each side of the TAP block. Patients in group 2 received a mixture of 20 mL of 0.25% levobupivacaine and dexmedetomidine, with a total dose of 1 µg/kg body weight evenly distributed bilaterally in the TAP block. Patients were evaluated for pain using the Visual Analog Scale (VAS), total tramadol consumption as rescue analgesia, time to first rescue analgesia, any adverse effects, and patient satisfaction.

Results

When comparing VAS scores for pain assessment, we observed that the mean VAS score was initially comparable between the two groups for the first hour. However, at 6, 9, and 12 h, VAS scores were significantly lower in group 2. The mean total tramadol consumption was higher in group 1 than in group 2 (213.33 ± 44.08 vs 161.11 ± 37.93 mg, P-value 0.027). The time to the first rescue analgesia after the TAP block in the postoperative period was significantly longer in group 2 (47.5 ± 62.76 vs 77.22 ± 56.14 min, P-value 0.002). No significant side effects were noted, and a greater proportion of patients in group 2 expressed satisfaction with their overall pain treatment.

Conclusions

The addition of dexmedetomidine to levobupivacaine is superior to the addition of dexamethasone, as it prolongs the duration of the block in the dexmedetomidine group. However, the use of dexamethasone as an adjuvant is a good alternative option, particularly due to its lower cost and reduced incidence of adverse effects such as postoperative nausea and vomiting.

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.

The Impact of Missing Postoperative Longitudinal Pain Data on Study Results Investigating Analgesia from Transversus Abdominis Plane Block on Postoperative Day One Following Abdominal Surgery: A Single-Center Retrospective Chart Review

Background

The aims of this study are to analyze the association between the number of recorded pain scores and baseline pain following surgery, analgesia technique, and patient demographics, as well as the substitution of missing data with the results from mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.

Methods

This retrospective chart review was approved by the Institutional Review Board (IRB). The following data were collected: patient demographics (age, gender, body mass index (BMI), race, and ethnicity); surgery type and date; analgesia with or without transversus abdominis plane (TAP) block; as well as the time, date, and value for all postoperative pain scores on the first postoperative day (POD). The following null hypotheses were tested: (1) the number of pain recordings will be independent of TAP block analgesia, baseline pain on POD 1, and patient demographics; and (2) there will be no significant differences in pain scores with and without TAP block analgesia following complete case analysis, mean substitution, last observation carried forward, regression imputation, multiple imputation, and mixed models.

Results

This study analyzed 486 patients including 2562 recorded pain scores. An increase in age by one year is, on average, associated with a 0.04 (95% confidence interval (CI) -0.060 to -0.025) decrease in the number of pain scores recorded (p < 0.001). Black race is associated with 0.763 less pain scores, on average (95% CI -1.49 to -0.039) and this value is statistically significant (p = 0.039). All datasets with substituted values for missing data yield lower pain scores for patients who did not receive TAP block. Significant differences in recorded pain scores are only noted for scores recorded between 0400 and 0759 and 1600-1959 in mixed models.

Conclusion

Discrepancies in pain score recordings among patients are associated with age and black race. When these discrepancies are addressed with statistical methods, clinically significant differences are appreciated.

Regional Analgesia for Cesarean Delivery: A Narrative Review Toward Enhancing Outcomes in Parturients

Introduction

With the current surge on peripheral nerve blocks in post-cesarean pain management and the historical lack of unequivocal evidence supporting its universal use, this review intended to re-examine the extended scope of literature on regional anesthesia and postoperative analgesia in low-transverse cesarean section.

Methods

A literature search was conducted up to April 2023 using PubMed to identify articles relevant to our search words "cesarean section", "neuraxial morphine", "post-cesarean analgesia", as well as the name of each individual nerve block. The literature search was ultimately narrowed to systematic reviews and randomized controlled trials published between 2012 and 2023. We define, describe, and discuss the evidence surrounding each individual regional anesthetic technique in the presence and absence of intrathecal morphine, which is used as the gold standard when appropriate.

Results

In the absence of neuraxial morphine, all regional anesthetic techniques have some level of analgesic benefit in the post-cesarean analgesia. Transversus Abdominis Plane blocks continue to have the most studies in their use. Newer fascia plane blocks including the anterior Quadratus Lumborum, and Erector Spinae Plane blocks provide significant analgesia. In addition, direct comparison among peripheral nerve blocks consistently favors the more proximal, centralized techniques. Conversely, in the presence of neuraxial morphine, no peripheral anesthetic technique has reliably and reproducibly demonstrated an added analgesic benefit regardless of the peripheral nerve block technique or location of local anesthetic injection in the post-cesarean population.

Conclusion

Neuraxial morphine continues to be the gold standard for post-cesarean section analgesia, the benefit of additional single injection regional anesthetic is currently not evidence supported. In cases where neuraxial opioids have not or cannot be given, there is overwhelming evidence that regional anesthetic techniques improve post-cesarean section analgesia and decrease post-operative opioid consumption. Even though there is no consensus on the optimal peripheral nerve block, emerging evidence suggests more centralized abdominal fascia plane block trends towards better analgesia.

The Shining Star of the Last Decade in Regional Anesthesia Part-II: Interfascial Plane Blocks for Cardiac, Abdominal, and Spine Surgery

The sine qua non of enhanced recovery after surgery protocols designed to improve the perioperative experiences and outcomes of patients is to determine the most appropriate analgesia management. Although many regional techniques have been tried over the years in this purpose, interfacial plane blocks have become more popular with the introduction of ultrasound technology into daily practice and they have great potential to support effective postoperative pain management in many surgeries. The current article focuses on the benefits, techniques, indications, and complications of interfascial plane blocks applied in cardiac, abdominal, and spine surgeries.

Transversus abdominis plane block vs quadratus lumborum block for postoperative analgesia in inguinal hernia repair: A systematic review and meta-analysis

PURPOSE

The present review was designed to differentiate between the analgesic value of transversus abdominis plane block (TAP) vs the quadratus lumborum block (QLB) for patients undergoing inguinal hernia surgery.

METHODS

PubMed, CENTRAL, Scopus, Embase, Google Scholar, Open gray, and a clinical trial registry were searched up to 18th February 2023 for randomized controlled trials (RCTs) comparing TAP and QLB for inguinal hernia repair.

RESULTS

Six RCTs from India, Turkey, and Norway published between the years 2019 to 2023 were included. Anesthetic agents and dosages were similar for TAP and QLB groups in each study. On meta-analysis, pain scores were not statistically significant different between TAP and QLB at 3-6 h (MD: 0.46 95% CI: -0.11, 1.03 I2 = 86%), 12 h (MD: 1.34 95% CI: -0.12, 2.80 I2 = 97%), and 24 h (MD: 0.38 95% CI: -0.77, 1.53 I2 = 97%). Meta-analysis of total analgesic consumption showed a tendency of reduced analgesic consumption with QLB as compared to TAP but the difference was not significant (SMD: 0.69 95% CI: 0.00, 1.37 I2 = 83%). Data on complications was scarcely available. GRADE assessment of the evidence was low to moderate.

CONCLUSION

Low to moderate-quality preliminary evidence suggests no difference in the analgesic efficacy of TAP and QLB for adult patients undergoing inguinal hernia repair. While there was a tendency for lower postoperative analgesic consumption with QLB, it needs to be verified by future studies.

Add dexmedetomidine to levobupivacaine for transversus abdominis plane block in elderly patients undergoing inguinal hernia repair: Could it make a difference? A randomised trial

BACKGROUND

Transversus abdominis plane block is becoming more common as part of multimodal analgesia for post-abdominal operation pain relief. This study compared the analgesic effects of adding dexmedetomidine to levobupivacaine (transversus abdominis plane) block in elderly patients undergoing inguinal hernia surgery to adding fentanyl.

METHODS

Overall, 90 elderly patients with a simple inguinal hernia repair were randomly assigned to one of three groups. After spinal anaesthesia, an ultrasound-guided transversus abdominis plane block was performed. Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 0.9% normal saline in Group L (n = 30) (20mL). Transversus abdominis plane block was accomplished with 0.25% levobupivacaine + 1 µg/kg dexmedetomidine in Group D (n = 30) (20mL). Transversus abdominis plane block was obtained with 0.25% levobupivacaine + 1 µg/kg fentanyl in Group F (n = 30) (20mL). The primary outcome was the first analgesic request, and the secondary outcomes were the visual analog scale, postoperative analgesic requirements, sedation, hemodynamic stability, and related complications 24 hours postoperatively. 1gm paracetamol intravenously was provided as rescue analgesia.

RESULTS

The time to first analgesic request in the dexmedetomidine group was substantially more prolonged than in the fentanyl and control groups (516.5±27.8, 451.2±11.1, and 403.9±10.5min, respectively; p < 0.05). Postoperative analgesic requirements were significantly decreased in dexmedetomidine 1(1-2) than control 2(1-3) and fentanyl 1.5(1-2) respectively (P<0.01). VAS was significantly lower in Group D and Group F than in Group L postoperatively. No significant difference in side effects was noted between the groups.

CONCLUSION

The transversus abdominis plane block is the best multimodal analgesia choice for inguinal hernia repair in older patients. Combining dexmedetomidine with levobupivacaine in the transversus abdominis plane block can improve the quality of postoperative analgesia while avoiding significant side effects.

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.

Magnesium Sulfate in Pediatric Abdominal Cancer Surgery: Safety and Efficacy in Ultrasound-Guided Transversus Abdominis Plane (US-TAP) Block in Conjugation with Levobupivacaine

Purpose

Magnesium sulfate (MgSO4) may enhance the effects of local anesthetics when used as an adjuvant in peripheral nerve blocks. Our objective was to evaluate efficiency and safety of utilizing MgSO4 alongside levobupivacaine in bilateral ultrasound-guided transversus abdominis plane (US-TAP) block for postoperative pain in pediatric cancer patients who underwent abdominal surgery.

Methodology

A randomized double-blinded controlled trial at South Egypt Cancer Institute, Assiut University, Assiut, Egypt, included that 40 pediatric patients with Wilms' tumor or neuroblastoma were randomly allocated to get bilateral (US-TAP) block and divided into two groups; M group: received US-TAP with 0.6 mL/kg levobupivacaine 0.25% + 2 mg/kg MgSO4 and C group: received with 0.6 mL/kg levobupivacaine 0.25% only. FLACC scores (Face, Leg, Activity, Cry, Consolability) were used to evaluate post-operative pain, first analgesic request, total analgesic consumption, adverse effects, as well as hemodynamics were monitored for 24 h and recorded at time points (2, 4, 6, 8, 12, 18, and 24h). Parent's satisfaction at discharge, also, was evaluated.

Results

FLACC score in M group was significantly lower than in C group from 4 h to 24 h with the first analgesic request being longer (15.95 ± 1.99 vs 7.70 ± 0.80 (h); p < 0.001) and lower total analgesic consumption (231.75 ± 36.57 vs 576.00 ± 170.71 (mg); p < 0.001) when comparing M group to C group, respectively. Both groups had insignificant differences regarding hemodynamics, parent satisfaction, postoperative agitation, and side effects except vomiting occurred in two patients in the C group and one patient in the M group.

Conclusion

We conclude that adding magnesium sulphate as an adjuvant to local anaesthetic in US-TAP block for pain management in pediatric abdominal cancer surgeries resulted in better and longer analgesia, with less consumption of rescue analgesics with no serious side effects.

Efficacy of modified thoracoabdominal nerve block through perichondrial approach following laparoscopic inguinal hernia repair surgery: a randomized controlled trial

BACKGROUND

Modified thoracoabdominal nerve block through perichondrial approach is a novel fascial plane block and provides abdominal analgesia by blocking thoracoabdominal nerves. Our primary aim was to evaluate the efficacy of M-TAPA on quality of recovery and pain scores in patients who underwent laparoscopic inguinal hernia repair surgery (Trans Abdominal Pre-Peritoneal approach ‒ TAPP).

METHODS

Patients with American Society of Anesthesiologists (ASA) physical status I-II aged between 18 and 65 years scheduled for elective TAPP under general anesthesia were enrolled in the study. After intubation, the patients were randomized into two groups: M: M-TAPA group (n = 30) and the control group (n = 30). M-TAPA was performed with total 40 ml 0.25% bupivacaine in the M group. Surgical infiltration was performed in the control group. The primary outcome of the study was the global quality of recovery score, the secondary outcomes were pain scores, rescue analgesic demands, and adverse effects during the 24-h postoperative period.

RESULTS

The global quality of recovery scores at 24 h were significantly higher in the M group (p < 0.001). There was a reduction in the median static and dynamic NRS for the first postoperative 8 h in the M group compared to the control group (p < 0.001). The need for rescue analgesia was significantly lower in the M group compared to the control group (13 patients vs. 24 respectively, p < 0.001). The incidence of side effects was significantly higher in the control group (p < 0.001).

CONCLUSION

In our study, M-TAPA increased patient recovery scores, and provided pain relief in patients who underwent TAPP.

REGISTER NUMBER

NCT05199922.

Transversus abdominis plane block versus caudal block with bupivacaine and dexmedetomidine for unilateral inguinal hernia repair in pediatric patients: a randomized clinical trial

BACKGROUND

This study compared the transversus abdominis plane (TAP) block with bupivacaine and dexmedetomidine to the same mixture in the caudal block in delivering postoperative analgesia in children after unilateral inguinal hernia surgery.

METHODS

The current study included 80 children aged two to eight years who were scheduled for unilateral inguinal hernia surgery under general anesthesia. A caudal block (1 mL/kg 0.25% bupivacaine and one µg /kg dexmedetomidine) or a TAP block (1 mL/kg 0.25% bupivacaine and one µg /kg dexmedetomidine) was given to each participant at random. The time it took to request analgesia for the first time, the postoperative pain score, total analgesic use, sedation, family satisfaction, and side effects were all measured. The primary outcome was time to first analgesic request.

RESULTS

The caudal block group had a considerably shorter time to first analgesic request than the TAP block group. The caudal block group received more rescue analgesia doses within 24 hours than the TAP block group. The mean total dose of intravenous paracetamol within the first 24 hours postoperatively was greater in the caudal block group. The caudal block group had much higher family satisfaction.

CONCLUSIONS

The TAP block and caudal block provide good postoperative analgesia in children undergoing unilateral inguinal hernia repair. Adding dexmedetomidine to the TAP block was superior to the caudal block in terms of extending the length of the initial analgesic request, lowering analgesic requirement, and lowering pain scores without causing substantial adverse effects.

On-demand (SOS) analgesia through Transversus Abdominis Plane (TAP) catheter route for post-operative pain relief in Emergency Laparotomies-a non-randomised interventional study (STAPLE trial)

INTRODUCTION

This study aimed to compare the efficacy and safety of on-demand bupivacaine infusion via transversus abdominis plane (TAP) catheter in emergency laparotomy patients.

METHODS

A non-randomised interventional study was conducted on patients undergoing emergency midline laparotomy. The intervention group received an on-demand infusion of 10 ml 0.5% bupivacaine through TAP catheters, whilst the control group received standard analgesic care. The primary outcome was the amount of rescue analgesic consumption. Secondary outcomes included the post-operative, measured by visual analogue scores (VAS), side effects, time to first flatus, post-operative nausea and vomiting, and pulmonary complications.

RESULTS

One-hundred-twenty patients (58 in the TAP-SOS group, 62 in the control group) were included in the final analysis. The TAP-SOS group showed significantly reduced rescue analgesic requirement by 91% (p < 0.001) and lower VAS scores at 3, 6, 12, and 24 h (adjusted p < 0.00). Time to out-of-bed mobilisation was significantly shorter in the TAP-SOS group by 12.47 h (p < 0.001), and post-operative pulmonary complications were lower by 75% (p < 0.05). There were no significant differences in bowel recovery, catheter-related complications, or post-operative morbidity. No incidences of catheter-site infection were reported on follow-up; however, the catheter tip-culture was positive in 3 (5.17%) patients.

CONCLUSION

On-demand bupivacaine infusion through a TAP catheter effectively reduced post-operative pain and opioid requirements in emergency laparotomy patients without complications. If an epidural is not an option, the TAP-SOS approach can be a helpful adjunct in implementing the ERAS protocol in an emergency since it allows for early ambulation and better pain management.

Perioperative truncal peripheral nerve blocks for bariatric surgery: an opioid reduction strategy

BACKGROUND

Bariatric surgical patients are vulnerable to cardiopulmonary depressant effects of opioids. The enhanced recovery after surgery (ERAS) protocol to improve postoperative morbidity recommends regional anesthesia for postoperative pain management. However, there is limited evidence that peripheral nerve blocks (PNB) have added benefit.

OBJECTIVE

Study the effect of PNB on postoperative pain and opioid use following bariatric surgery.

SETTING

Academic medical center, United States.

METHODS

We conducted a cohort study of patients who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. A total of 44 patients received the control ERAS protocol with preoperative oral extended-release morphine sulfate (MS), while 45 patients underwent a PNB with either intrathecal morphine (IM) or oral MS per local ERAS protocol. The PNB group either underwent preoperative bilateral T7 paravertebral (PVT) PNBs (27 patients) with IM or postoperative transversus abdominis plane (TAP) PNBs (18 patients) with oral MS. The primary outcome compared total opioid consumption between the ERAS control group and the PNB group up to 48 hours postoperatively. Secondary outcomes included comparison by block type and postoperative pain scores.

RESULTS

PVT or TAP PNB patients had a reduction in mean postoperative oral morphine equivalent (OME) requirements compared with the ERAS protocol cohort at 24 hours (93.9 versus 42.8 mg), P < .0001; at 48 hours (72.6 versus 40.5 mg); and in pain scores at 24 hours (5.64/10 versus 4.46/10), P = .02. OME and pain scores were higher in the SG cohort.

CONCLUSION

Addition of truncal PNB to standard ERAS protocol for bariatric surgical patients reduces postoperative total opioid consumption.

Effects of Novel Multimodal Transversus Abdominis Plane Block on Postoperative Opioid Usage and Hospital Length of Stay Following Elective Ventral Hernia Repair

Background and objective Traditional transversus abdominis plane (TAP) blocks consisting of a local anesthetic, typically bupivacaine, have previously been shown to reduce postoperative pain following gastrointestinal surgery, including hernia repair. However, elective abdominal wall reconstructions for the repair of large ventral hernias continue to cause patients significant postoperative pain, resulting in prolonged hospital stays and need for opioid pain medication. This study aimed to analyze the postoperative opioid pain medication usage and hospital length of stay (LOS) in patients who received a nontraditional multimodal TAP block of ropivacaine (local anesthetic), ketorolac (non-steroidal anti-inflammatory), and epinephrine following elective ventral hernia repair. Methods A retrospective review of medical records for patients who underwent elective robotic ventral hernia repair by a single surgeon was conducted. Postoperative hospital LOS and opioid usage for patients with the multimodal TAP block were compared to those without. Results A total of 334 patients met the inclusion criteria for LOS analysis: 235 received the TAP block and 109 did not. Patients who received the TAP block had a statistically significant shorter LOS compared to patients who had no TAP block (1.09 ± 1.22 days vs. 2.53 ± 1.57 days; P<0.001). Medical records for 281 patients, 214 with the TAP block and 67 without the TAP block, contained information and were analyzed for postoperative opioid usage. A statistically significantly fewer number of patients who had the TAP block required hydromorphone patient-controlled analgesia pump (3.3% vs. 36%; P<0.001) and oral opioids (29% vs. 78%; P<0.001) postoperatively. Those with TAP block required intravenous opioids more frequently (50% vs 10%; P<0.001) although at much less dosages than those without TAP block (4.86 ± 2.62 mg vs. 10.29 ±3.90 mg; P<0.001). Conclusion In conclusion, this multimodal TAP block of ropivacaine, ketorolac, and epinephrine may represents an effective method to improve hospital LOS and postoperative opioid usage in patients undergoing robotic abdominal wall reconstruction for ventral hernia repair.

Efficacy of Transversus Abdominis Plane Block for Postoperative Analgesia in Different Lower Abdominal Surgeries in a Tertiary Care Hospital-Chengalpattu District

Background

Transversus abdominis plane (TAP) block is one of the novel approaches and an effective method for providing postoperative analgesia in patients undergoing lower abdominal surgeries.

Objectives

To evaluate the efficacy and routine usage of TAP block for postoperative analgesia in different lower abdominal surgeries.

Methods

It is a randomized, double-blind trial. Sixty patients undergoing lower abdominal surgeries in sub-arachnoid block with bupivicaine 0.5% were randomized to undergo TAP block (n = 30) using ropivacaine 0.375% as the study group. In the control group (n = 30), only the standard analgesic regimen (paracetamol 1 gm IV and tramadol 50 mg IV) was given. Postoperative pain was assessed using Visual Analogue Scale (VAS) at 30 min and 4, 8, 12, 16, 20, and 24 hrs. First analgesic request after TAP block was compared with a subsequent number of analgesics given postoperatively. Rescue analgesia given postoperatively at request after TAP block was paracetamol 1 gm IV and tramadol 50 mg IV.

Results

Patients who received TAP block had a significant reduction in postoperative pain scores at 30 min - 0 (0 - 1), 4 hrs - 0 (0 - 4), 8 hrs - 4 (3 - 5), 12 hrs - 1 (0 - 4), 16 hrs - 1 (1 - 2), 20 hrs -1 (0 - 2), 24 hrs -1 (0 - 1) with P-value < 0.05 in the first 24 hrs. TAP block also delayed the first rescue analgesic request (265 ± 24 min Vs. 66 ± 15 min with P-value < 0.005) and reduction in subsequent analgesic requirements in the first 24 hrs (1.04 ± 0.26 Vs. 2.3 ± 0.48 with P-value < 0.05).

Conclusions

TAP block holds a considerable part in postoperative analgesia. Highly effective for the first 24 hrs in patients undergoing different lower abdominal surgeries, it delays the first rescue analgesic request, decreases the subsequent analgesic requirement, and augments early mobilization, discharge, and cost-effectiveness.

Analgesic efficacy of modified thoracoabdominal nerves block through the perichondrial approach in laparoscopic cholecystectomy: A retrospective study with propensity analysis

Modified thoracoabdominal nerves block through the perichondral approach (M-TAPA) was recently reported to provide broad analgesia with only a single injection of local anesthetics (LA) on each side. However, the effectiveness of M-TAPA in laparoscopic cholecystectomy (LC) is not often reported. We retrospectively evaluated the analgesic efficacy of M-TAPA in patients who underwent LC and compared it with conventional LA infiltration (LAI) by calculating the propensity score. The primary outcome was the frequency of analgesic use after surgery. Although there was no difference in the frequency of analgesic use within 48 hours (P = .063), there was significantly less analgesic use 24-48 hours after surgery in the TAPA group (P = .02). Intraoperative remifentanil administration also significantly decreased in the TAPA group (P < .001). We found that pre-incisional M-TAPA may have an advantage over LAI with respect to analgesia on postoperative day 1.

Ultrasound-guided transversus abdominis plane block as an effective anesthetic technique for transverse colostomy in a high-risk elderly patient: A case report

Ultrasound-guided transversus abdominis plane (TAP) block is considered to be one of most prevalent and effective adjuvant analgesic methods for various abdominal surgeries. However, whether TAP blocks can be used alone as an effective anesthetic technique in minor abdominal operations has rarely been reported. Here we presented a 66-year-old male who had sustained right somatic dysfunction and mild brain dysfunction caused by cerebral infarctions and poorly treated hypertension. The patient received a confine operation of transverse colostomy to alleviate an intestinal obstruction caused by rectal cancer. A 22G needle was advanced in the plane under ultrasound guidance until it reached the TAP. A total of 10 mL 0.375% ropivacaine with 5 mg dexamethasone and 10 μg dexmedetomidine was injected into the TAP. The operation went stably and smoothly without any complaints. After the operation, the patient returned to the care of the surgical recovery staff with patient-controlled intravenous analgesia (PCIA) containing 0.7 mg/kg oxycodone and 2.5 μg/kg dexmedetomidine. During the perioperative period, the elderly patient did not experience apparent or unbearable pain. All these evidences indicated the ultrasound-guided subcostal and lateral TAP block was a simple and effective procedure for transverse colostomy in a high-risk elderly patient.

Preoperative transversus abdominis plane block decreases intraoperative opiate consumption during minimally invasive cholecystectomy

BACKGROUND

The ongoing epidemic of prescription opiate abuse is one of the most pressing health issues in the United States today. Consequently, analgesic adjuncts, such as multimodal drug regimens and regional anesthetic blocks (like transversus abdominis plane (TAP) block), have been introduced to the perioperative period in hopes of decreasing postoperative opiate use. However, the effect of these interventions on intraoperative opiate use has not been examined. We hypothesized that preoperative TAP block would be associated with decreased intraoperative opiate use during minimally invasive cholecystectomy.

METHODS

This was a retrospective review of patients undergoing minimally invasive cholecystectomy between June 2018 and January 2021. Perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements.

RESULTS

261 patients were included in this study, of which 62 (23.8%) received preoperative TAP block and 199 (76.2%) did not. Preoperative TAP block was associated with decreased intraoperative opiate use (0.199 vs 0.312, p < 0.001), while there were no statistically significant differences associated with other analgesic adjuncts including preoperative acetaminophen (p = 0.485), celecoxib (p = 0.112), gabapentin (p = 0.165), or intraoperative ketorolac (p = 0.200). On multivariate analysis, preoperative TAP block was independently associated with decreased intraoperative opiate use (< 0.001), while chronic cholecystitis on final pathology was associated with increased intraoperative opiate use (p = 0.002).

CONCLUSION

The use of preoperative TAP block was associated with decreased intraoperative opiate use during minimally invasive cholecystectomy and should be considered for routine use. Future research should investigate whether preoperative TAP blocks and a subsequent decrease of intraoperative opiates, also result in a decrease in postoperative opiate use and improvements in postoperative outcomes.

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.

Motor-Sparing Effect of Adductor Canal Block for Knee Analgesia: An Updated Review and a Subgroup Analysis of Randomized Controlled Trials Based on a Corrected Classification System

OBJECTIVE

Discrepancies in the definition of adductor canal block (ACB) lead to inconsistent results. To investigate the actual analgesic and motor-sparing effects of ACB by anatomically defining femoral triangle block (FTB), proximal ACB (p-ACB), and distal ACB (d-ACB), we re-classified the previously claimed ACB approaches according to the ultrasound findings or descriptions in the corresponding published articles. A meta-analysis with subsequent subgroup analyses based on these corrected results was performed to examine the true impact of ACB on its analgesic effect and motor function (quadriceps muscle strength or mobilization ability). An optimal ACB technique was also suggested based on an updated review of evidence and ultrasound anatomy.

MATERIALS AND METHODS

We systematically searched studies describing the use of ACB for knee surgery. Cochrane Library, PubMed, Web of Science, and Embase were searched with the exclusion of non-English articles from inception to 28 February 2022. The motor-sparing and analgesic aspects in true ACB were evaluated using meta-analyses with subsequent subgroup analyses according to the corrected classification system.

RESULTS

The meta-analysis includes 19 randomized controlled trials. Compared with the femoral nerve block group, the quadriceps muscle strength (standardized mean difference (SMD) = 0.33, 95%-CI [0.01; 0.65]) and mobilization ability (SMD = -22.44, 95%-CI [-35.37; -9.51]) are more preserved in the mixed ACB group at 24 h after knee surgery. Compared with the true ACB group, the FTB group (SMD = 5.59, 95%-CI [3.44; 8.46]) has a significantly decreased mobilization ability at 24 h after knee surgery.

CONCLUSION

By using the corrected classification system, we proved the motor-sparing effect of true ACB compared to FTB. According to the updated ultrasound anatomy, we suggested proximal ACB to be the analgesic technique of choice for knee surgery. Although a single-shot ACB is limited in duration, it remains the candidate of the analgesic standard for knee surgery on postoperative day 1 or 2 because it induces analgesia with less motor involvement in the era of multimodal analgesia. Furthermore, data from the corrected classification system may provide the basis for future research.

Ultrasound-Guided Quadratus Lumborum Block at the Lateral Supra-Arcuate Ligament versus Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia Following Open Hepatectomy: A Randomized Controlled Trial

Purpose

Many studies confirmed that several approaches of quadratus lumborum block (QLB) were superior to transversus abdominis plane block (TAPB) in reducing opioid consumption during postoperative period. As a new QLB approach at the lateral supra-arcuate ligament (QLB-LSAL), the analgesic efficacy and safety in patients undergoing open hepatectomy are still unknown. This study aims to compare postoperative analgesia between the blocks in open hepatectomy.

Patients and Methods

Sixty-two patients undergoing open hepatectomy were enrolled and randomly allocated into the QLB-LSAL group (group Q) and the subcostal TAPB group (group T). Preoperatively, patients received ultrasound-guided bilateral QLB-LSAL or subcostal TAPB with injection of 0.5% ropivacaine (a total volume of 40 mL). The primary outcome was cumulative total morphine equivalent consumption in the first postoperative 24 h. Other outcomes included numerical rating scale (NRS) scores at rest and coughing, cumulative total morphine equivalent consumption at 2, 6, 12, 48 h, Quality of Recovery-15 (QoR-15) scores, time to first patient-controlled intravenous analgesia (PCIA) request, time to first ambulation and adverse effects.

Results

The cumulative total morphine equivalent consumption in group Q was decreased significantly at all postoperative time points (P < 0.01). The postoperative NRS scores at rest and coughing in group Q were lower than those in group T at all postoperative time points except 48 h (P < 0.05). A significant increase was also observed in the QoR-15 scores among patients in group Q. Time to first PCIA request was significantly prolonged in group Q than in group T, and time to first ambulation was shortened. Adverse effects showed no statistical significance between the two groups.

Conclusion

Compared with subcostal TAPB, preoperative bilateral QLB-LSAL provided superior analgesic properties and promoted early postoperative recovery quality in patients undergoing open hepatectomy.

Trial Registration

China Clinical Trials Registration Center (http://www.chictr.org.cn) ChiCTR2200063291, 3/9/2022.

ASSESSMENT OF THE EFFICIENCY OF ANALGETIC ACTION OF LAPAROSCOPICALLY ASSISTED TAP BLOCK AS A COMPONENT OF PERIOPERATIVE MULTIMODAL ANALGESIA PLAN IN OBESE PATIENTS UNDERGOING METABOLIC SURGERY

OBJECTIVE

The aim: To assess the effectiveness and feasibility of laparoscopically assisted TAP block utilization in the system of multimodal analgesia by comparing the severity of pain and associated postoperative recovery indicators in obese patients after laparoscopic sleeve gastrectomy.

PATIENTS AND METHODS

Materials and methods: The retrospective study included 39 patients, who underwent metabolic surgery from 2013-2022. All patients were divided into 2 groups depending on the chosen perioperative analgesia protocol. Group 1 included 19 patients who prior to skin incision a local infiltration of the trocar puncture areas of the abdominal wall. Group 2 included 20 patients, whom in addition to the above-described anaesthesia procedure after completion of the main stage of surgery, a laparoscopically assisted bilateral subcostal TAP block was additionally performed.

RESULTS

Results: The need to use opioid analgesics in the rescue analgesia mode arose in 17.6% (3/17) of patients of the first group, and 5% (1/20) of patients in the second group Average duration of postoperative hospitalization in group 1 was 7.2±1.1 days, and in group 2 it was 6.2±1.4 days (P <0.05).

CONCLUSION

Conclusions: Subcostal TAP block in obese patients is a safe and effective method of regional anaesthesia. Further study of this option of regional anaesthesia is required in order to be able to form clearer recommendations for its routine use in clinical practice.

Ultrasound-Guided Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Laparoscopic Inguinal Hernia Repair and Appendicectomy Using Ropivacaine With Dexmedetomidine

Background The present study aims to investigate the efficacy of ultrasound-guided quadratus lumborum (QL) block versus transversus abdominis plane (TAP) block for laparoscopic inguinal hernia repair and appendicectomy using ropivacaine with dexmedetomidine for quality and duration of postoperative analgesia. Settings and design This was a prospective, randomized, single-blind study conducted for one year (September 2020-August 2021) in the Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, after obtaining ethical clearance from the institutional ethics committee. Methods A total of 64 patients of American Society of Anesthesiologists (ASA) grades I-II and ages between 20 and 50 years undergoing laparoscopic inguinal hernia repair and appendicectomy were randomly allocated into two groups of 32 each; group A received ultrasonography (USG)-guided quadratus lumborum block using 0.5% ropivacaine 20 ml with dexmedetomidine 0.5 mcg/kg of body weight, and group B was given USG-guided transversus abdominis plane block using 0.5% ropivacaine 20 ml with dexmedetomidine 0.5 mcg/kg of body weight after the induction of general anesthesia and before surgical incision. Data were analyzed using Student's t-test, Mann-Whitney U test, and chi-square test as applicable. Results The duration of analgesia was statistically higher (P<0.001) in group A (21.00±3.73 hours) as compared to group B (14.44±2.99 hours). Group A had significantly less analgesic (P<0.001) at 12, 18, and 24 hours postoperatively. The visual analog scale (VAS) was significantly decreased in group A at rest and movement. The range of percentage changes in heart rate (HR) was significantly higher in group B as compared to group A at 12, 18, and 24 hours (group A: 7.23%-14.70%; group B: 6.41%-28.01%). The mean blood pressure (MBP) was significantly increased in group B at 12, 18, and 24 hours as compared to group A. The range of changes in baseline MBP in group A was less than in group B (group A: 0.73%-8.34%; group B: 0.73%-18.20%). Conclusion Quadratus lumborum block is effective and better than transversus abdominis plane block for providing postoperative analgesia during laparoscopic inguinal hernia repair and appendicectomy.

Transversus abdominis plane block with different bupivacaine concentrations in children undergoing unilateral inguinal hernia repair: a single-blind randomized clinical trial

BACKGROUND

Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair.

METHODS

After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg^- 1 bupivacaine as either 0,25% (0,4 ml.kg^- 1) (Group 1) or 0,125% (0,8 ml.kg^- 1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with a lateral approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the efficacy which is assessed by postoperative FLACC behavioral pain assessment score at 15', 30', 45', 1 h, 2 h, 6 h, and 24 h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients' parents and the surgeons.

RESULTS

Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6^thhour. No local or systemic complication or side effect related to anesthesia or surgery was reported.

CONCLUSION

TAPB using 1 mg.kg^- 1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects.

TRIAL REGISTRATION

This trial was retrospectively registered at Clinicaltrals.gov , NCT04202367 .

Use of Transversus Abdominis Plane and Intercostal Blocks in Bitches Undergoing Laparoscopic Ovariectomy: A Randomized Controlled Trial

In humans and dogs, loco-regional anesthesia is associated with lower peri-operative opioid consumption and less related side effects. The combination of transversus abdominis plane (TAP) and intercostal blocks can be used to desensitize the entire abdominal wall in dogs. The aim of this study was to evaluate the effectiveness of TAP and intercostal blocks in bitches undergoing laparoscopic ovariectomy. Twenty client-owned bitches were enrolled in this double-blinded randomized controlled trial. After premedication with dexmedetomidine, methadone and ketamine, the animals were randomized into two groups. Dogs in the TAP group received intercostal blocks from T8 to T10 and a TAP block with ropivacaine. Dogs in the FEN group received a fentanyl bolus and a constant rate infusion for the entire duration of the procedure. Intra-operative cardiovascular stability, post-operative pain scores, rescue opioid requirement, dysphoria during recovery, time to attain sternal recumbency and interest in food at 6 h post-extubation were compared. Bitches in the TAP group received a statistically significant lower amount of rescue fentanyl intra-operatively and methadone post-operatively. Pain scores were lower in the TAP group until 6 h post-extubation. No difference was found for dysphoric recoveries, time to attain sternal recumbency and appetite at 6 h post-extubation. No adverse event was recorded for any of the dogs. The combination of TAP and intercostal blocks can be part of an effective multi-modal analgesic strategy in bitches undergoing laparoscopic ovariectomy.

Ultrasound-guided lumbar plexus block versus transversus abdominis plane block for analgesia in children with hip dislocation: A double-blind, randomized trial

Lumbar plexus block is often used as analgesia for adult hip surgery, but it is rarely used in pediatric patients. This study aimed to compare the efficacy and feasibility of ultrasound-guided lumbar plexus block versus transversus abdominis plane block for postoperative analgesia in children with hip dislocation. Eighty children undergoing unilateral hip dislocation surgeries at our hospital from October 2019 to February 2021 were randomized to the lumbar plexus block group (group L) and transversus abdominis plane block group (group T). Compared with group L, the regional block time in group T was lower (8.0 ± 2.5 vs 11.5 ± 2.3 min, P < 0.05), and the ultrasound image definition was better (P < 0.05). There were no significant differences in mean blood pressure and heart rate within 24 h (all P > 0.05). Children’s Hospital of Eastern Ontario Pain Scale scores were lower in group L than in group T at 18–24 h only (all P < 0.05). The satisfying analgesia rate in group L was higher than in group T (87.5 vs 65%, P < 0.05). No regional block-related complications were found in both groups. Ultrasound-guided lumbar plexus block showed a longer postoperative analgesic effect in children with hip dislocation compared with transversus abdominis plane block.

Erector spinae plane block versus transversus abdominis plane block in laparoscopic hysterectomy

Background: The objective was to determine whether an erector spinae plane (ESP) block could provide additional postoperative analgesic benefits compared with a transversus abdominis plane block. Methods: 78 patients were separated into two groups (n = 39 per group). Both groups received bilateral injections of 266 mg Exparel^® (20 ml) and 60 ml of 0.125% bupivacaine. Patients undergoing a transversus abdominis plane block received these injections intraoperatively, while patients undergoing an ESP block received these preoperatively. Outcomes were measured based on scores in opioid usage; pain (visual analog scale) at rest and with movement; nausea; sedation and patient satisfaction. Results: There were no significant intergroup differences in any category (all scores had p > 0.05). Conclusion: No additional analgesic benefits were found using the ESP block procedure.

Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: A systematic review and meta-analysis of randomized trials

Objectives

Erector spinae plane block (ESPB) has been used for many thoracic and abdominal surgeries. However, evidence of its analgesic efficacy following abdominal surgery, compared with that of thoracic analgesia, is insufficient. Our study explored the analgesic effect of ESPB after abdominal surgery.

Methods

We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Primary outcomes were pain scores at 6, 12 and 24 h and 24-h opioid consumption. Secondary outcomes included time to first rescue analgesia, length of hospital stay, and incidence of postoperative nausea and vomiting (PONV). We calculated standardized mean differences (SMDs) with 95% confidence intervals (CIs) for primary outcomes and mean differences (MDs) and risk ratios (RRs) with 95% CIs for secondary outcomes.

Results

We systematically included 1,502 cases in 24 trials. Compared with placebo, ESPB significantly reduced pain scores at 6 h (SMD -1.25; 95% CI -1.79 to -0.71), 12 h (SMD -0.85; 95% CI -1.33 to -0.37) and 24 h (SMD -0.84; 95% CI -1.30 to -0.37) and 24-h opioid consumption (SMD -0.62; 95% CI -1.19 to -0.06) post-surgery. ESPB prolonged the time to first rescue analgesia and decreased the incidence of PONV. Compared with transversus abdominal plane block (TAPB), ESPB significantly reduced pain scores at 6, 12, and 24 h and 24-h opioid consumption and prolonged the time to first rescue analgesia postsurgically. Furthermore, subgroup analysis showed that ESPB significantly reduced pain scores at various time points and opioid consumption within 24 h after laparoscopic cholecystectomy, percutaneous nephrolithotomy and bariatric surgery.

Conclusion

Compared with placebo, ESPB improves the postoperative analgesic efficacy after abdominal surgery. Furthermore, our meta-analysis confirmed that ESPB provides more beneficial analgesic efficacy than TAPB.

Systematic review registration

[https://www.crd.york.ac.uk/PROSPEROFILES/301491_STRATEGY_20220104.pdf], identifier [CRD42022301491].

Novel external oblique muscle plane block for blockade of the lateral abdominal wall: a pilot study on volunteers

PURPOSE

No reports have described techniques to efficiently anesthetize the lateral cutaneous branches of the entire abdomen. The aim of this study was to investigate an effective procedure for blocking the lateral cutaneous branches in the abdominal region. We sought to describe the sensory distribution of the previously described thoracoabdominal nerve block through perichondrial approach (TAPA) and the novel costal and lateral external oblique muscle plane (EXOP) blocks in healthy volunteers.

METHODS

This was a proof-of-concept pilot study that comprised ten volunteers with an American Society of Anesthesiologists Physical Status I. The participants underwent modified TAPA (M-TAPA), injection 2 of TAPA (injection into the anterior aspect of the 10th costal cartilage: I2-TAPA), costal EXOP, and lateral EXOP blocks with injection of 20 mL of ropivacaine 0.2% for each block. A pinprick test was performed one hour after injection and repeated at 30-min intervals until the effect of the nerve block disappeared.

RESULTS

The M-TAPA injection anesthetized the anterior branches from T6/7 to T11/12, whereas the I2-TAPA injection had no effect. Costal and lateral EXOP injections anesthetized the lateral cutaneous branches of T7-10 and T11-12, respectively.

CONCLUSION

The results of this pilot study in ten healthy volunteers indicate that novel EXOP blocks involving local anesthetic injection superficial to the external oblique muscle efficiently anesthetize the lateral cutaneous branches of the thoracoabdominal nerves. Our study shows that it may be anatomically plausible for the combined use of these blocks to anesthetize the entire abdominal wall.

A Retrospective Comparison of Three Patient-Controlled Analgesic Strategies: Intravenous Opioid Analgesia Plus Abdominal Wall Nerve Blocks versus Epidural Analgesia versus Intravenous Opioid Analgesia Alone in Open Liver Surgery

Background: Adequate pain control is of crucial importance to patient recovery and satisfaction following abdominal surgeries. The optimal analgesia regimen remains controversial in liver resections. Methods: Three groups of patients undergoing open hepatectomies were retrospectively analyzed, reviewing intravenous patient-controlled analgesia (IV-PCA) versus IV-PCA in addition to bilateral rectus sheath and subcostal transversus abdominis plane nerve blocks (IV-PCA + NBs) versus patient-controlled thoracic epidural analgesia (TEA). Patient-reported pain scores and clinical data were extracted and correlated with the method of analgesia. Outcomes included total morphine consumption and numerical rating scale (NRS) at rest and on movement over the first three postoperative days, time to remove the nasogastric tube and urinary catheter, time to commence on fluid and soft diet, and length of hospital stay. Results: The TEA group required less morphine over the first three postoperative days than IV-PCA and IV-PCA + NBs groups (9.21 ± 4.91 mg, 83.53 ± 49.51 mg, and 64.17 ± 31.96 mg, respectively, p < 0.001). Even though no statistical difference was demonstrated in NRS scores on the first three postoperative days at rest and on movement, the IV-PCA group showed delayed removal of urinary catheter (removal on postoperative day 4.93 ± 5.08, 3.87 ± 1.31, and 3.70 ± 1.30, respectively) and prolonged length of hospital stay (discharged on postoperative day 12.71 ± 7.26, 11.79 ± 5.71, and 10.02 ± 4.52, respectively) as compared to IV-PCA + NBs and TEA groups. Conclusions: For postoperative pain management, it is expected that the TEA group required the least amount of opioid; however, IV-PCA + NBs and TEA demonstrated comparable postoperative outcomes, namely, the time to remove nasogastric tube/urinary catheter, to start the diet, and the length of hospital stay. IV-PCA with NBs could thus be a reliable analgesic modality for patients undergoing open liver resections.

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.

Transversus abdominis plane block for laparoscopic colorectal surgery: A meta-analysis of randomised controlled trials

BACKGROUND

The effectiveness of transversus abdominis plane block (TAP) on pain management after laparoscopic colorectal surgery (CRS) remains unclear since the only relevant meta-analysis on this topic did not separate laparoscopic CRS from open CRS. The aim of the study was to compare the analgesic efficacy and safety of TAP with non-TAP in patients undergoing laparoscopic CRS.

METHODS

Four databases were searched for randomized controlled trials (RCTs) on this topic using relevant keywords. Two authors independently completed evidence selection, data extraction, and critical appraisal. Available data were pooled in the random-effects model, and point estimates with 95% confidence interval (CI) were reported for postoperative pain at rest and on coughing, opioid consumption, length of hospital stay, and adverse events.

RESULTS

A total of 14 RCTs (n = 1216) contributed to the present synthesis. Pooled result showed that patients in the TAP group had lower pain at rest than those in the non-TAP group at postoperative 2-h (mean difference [MD] = -1.42; P < 0.05), 4-h (MD = -0.97; P < 0.05), 12-h (MD = -0.75; P < 0.05), and 24-h (MD = -0.61; P < 0.05). Patients in the TAP group also had lower postoperative pain on coughing than those in the non-TAP group on the first day (MD = -1.02; P < 0.05). Moreover, TAP had lesser postoperative opioid consumption than non-TAP (standardized mean difference, -0.26; P < 0.05; I-square = 20%), and there were non-significant differences in hospital stay and adverse event between the two groups.

CONCLUSION

Intraoperative TAP is a safe and feasible pain management for laparoscopic CRS, particularly it is recommended when patient-controlled analgesia is not delivered. Therefore, laparoscopic TAP block might be a favorable administered strategy.