Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Laparoscopy-guided transverse abdominis plane block versus port site infiltration for post-operative pain relief after laparoscopic cholecystectomy

INTRODUCTION

Post-operative analgesia is an important component of patient satisfaction and early discharge from the hospital. A variety of modalities have been tested and are still evolving. The present study is one such evaluation of a novel technique of laparoscopy-guided transverse abdominis plane (LTAP) block for post-operative analgesia in laparoscopic cholecystectomy.

PATIENTS AND METHODS

A prospective randomised control trial was conducted to verify the effectiveness of LTAP block over port site local anaesthesia infiltration (PSLAI) for post-operative analgesia in patients undergoing laparoscopic cholecystectomy. This study was done over a period of 18 months in a tertiary hospital. A total of 84 patients were recruited and were divided equally into two groups (LTAP and PSLAI).

RESULTS

There was no statistical difference between the two groups with respect to gender distribution, comorbidities, number of gallstones, duration of symptoms and surgery time. The rescue dose of diclofenac requirement was less for the LTAP group in comparison to the PSLAI group. No difference was observed in the pain score at 1st h. However, LTAP proved efficient later in the post-operative course (6 h, 24 h and at discharge). There was significant a difference in the pain scores between the two groups, favouring the LTAP group. Hospital stay in the LTAP group was less in comparison to the PSLAI group.

CONCLUSION

LTAP block is an effective method of post-operative analgesia. It impacts analgesia to the whole anterior abdominal wall for a prolonged period when compared to the PSLAI without adding any extra procedural time.

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.

Chest Wall and Abdominal Blocks for Thoracic and Abdominal Surgeries: A Review

PURPOSE OF REVIEW

The purpose of this review is to provide an up-to-date description and overview of the rapidly growing literature pertaining to techniques and clinical applications of chest wall and abdominal fascial plane blocks in managing perioperative pain.

RECENT FINDINGS

Clinical evidence suggests that regional anesthesia blocks, including fascial plane blocks, such as pectoralis, serratus, erector spinae, transversus abdominis, and quadratus lumborum blocks, are effective in providing analgesia for various surgical procedures and have more desirable side effect profile when compared to traditional neuraxial techniques. They offer advantages such as reduced opioid consumption, improved pain control, and decreased opioid-related side effects. Further research is needed to establish optimal techniques and indications for these blocks. Presently, they are a vital instrument in a gamut of multimodal analgesia options, especially when there are contraindications to neuraxial or para-neuraxial procedures. Ultimately, clinical judgment and provider skill set determine which blocks-alone or in combination-should be offered to any patient.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block vs. local anesthetic infiltration technique in major gynecologic surgery: A randomized controlled trial

Background and Aim

Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial.

Material and Methods

Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia and postoperative analgesia were standardized. Outcome measures were cumulative and rescue tramadol consumption, numerical rating score (NRS) for pain and side effects in post-anesthesia care unit (PACU) at 4, 8, 12 hours postoperatively.

Results

Tramadol consumption, need for rescue analgesia, and NRS for pain between three groups at 4, 8, and 12 hours postoperatively had no statistically significant difference (P < 0.05). In PACU, median tramadol consumption used for rescue analgesia between group T (15 (15-30)) and group C (30 (15-45)) (P = 0.035), and between group T (15 (15-30)) and group I (30 (15-52)) was statistically significant (P = 0.034). In PACU, the percentage of patients having NRS >4 on movement in group C (72%) compared to group T (46.5%) and group I (46.5%) was significant (P = 0.034). No statistically significant difference was observed in the incidence of side effects among study groups (P > 0.05).

Conclusion

Except for the immediate postoperative period, neither TAP block nor LAI had added benefit to the multimodal analgesia regimen in patients undergoing gynecological surgeries.

Transversus Abdominis Plane Block With Liposomal Bupivacaine vs. Regular Anesthetics for Pain Control After Surgery: A Systematic Review and Meta-Analysis

Background: Transverse abdominal plane (TAP) blocks are used to provide pain relief after abdominopelvic surgeries. The role of liposomal bupivacaine (LB) for TAP blocks is unclear. Therefore, this study aimed to synthesize evidence on the efficacy of LB vs. regular anesthetics in improving outcomes of TAP block. Methods: PubMed, Science Direct, Embase, Springer, and CENTRAL databases were searched up to July 24, 2020. Studies comparing LB with any regular anesthetic for TAP block for any surgical procedure and reporting total analgesic consumption (TAC) or pain scores were included. Results: Seven studies including five randomized controlled trials (RCTs) were reviewed. LB was compared with regular bupivacaine (RB) in all studies. A descriptive analysis was conducted for TAC due to heterogeneity in data presentation. There were variations in the outcomes of studies reporting TAC. Meta-analysis of pain scores indicated statistically significant reduction of pain with the use of LB at 12 h (MD: -0.89 95% CI: -1.44, -0.34 I2 = 0% p = 0.01), 24 h (MD: -0.64 95% CI: -1.21, -0.06 I2 = 0% p = 0.03), 48 h (MD: -0.40 95% CI: -0.77, 0.04 I2 = 0% p = 0.03) but not at 72 h (MD: -0.37 95% CI: -1.31, 0.56 I2 = 57% p = 0.43). Pooled analysis indicated no difference in the duration of hospital stay between LB and RB (MD: -0.18 95% CI: -0.49, 0.14 I2 = 61% p = 0.27). LB significantly reduced the number of days to first ambulation postsurgery (MD: -0.28 95% CI: -0.50, -0.06 I2 = 0% p = 0.01). Conclusions: Current evidence on the role of LB for providing prolonged analgesia with TAP blocks is unclear. Conflicting results have been reported for TAC. LB may result in a small reduction in pain scores up to 48 h but not at 72 h. Further, high-quality homogenous RCTs are needed to establish high-quality evidence.