Comparison of local anesthetic infusion pump bupivacaine versus transversus abdominis plane (TAP) block liposomal bupivacaine for pain management after bilateral deep inferior epigastric perforator free flap reconstruction

2017 ◽  
Vol 70 (12) ◽  
pp. 1779-1781 ◽  
Author(s):  
Rebecca Knackstedt ◽  
James Gatherwright ◽  
Amir Ghaznavi ◽  
Steven Bernard ◽  
Graham Schwarz ◽  
...  
Keyword(s):  
Pain Management ◽  
Free Flap ◽  
Local Anesthetic ◽  
Infusion Pump ◽  
Transversus Abdominis ◽  
Flap Reconstruction ◽  
Tap Block ◽  
Free Flap Reconstruction ◽  
Transversus Abdominis Plane ◽  
Deep Inferior Epigastric Perforator

scholarly journals Development of A Surgical Treatment Algorithm for Breast Reconstruction in Poland Syndrome Patients Considering Severity, Sex, and BMI

2021 ◽  
Vol 10 (19) ◽  
pp. 4515
Author(s):  
Maximilian Mahrhofer ◽  
Thomas Schoeller ◽  
Maria Casari ◽  
Kathrin Bachleitner ◽  
Laurenz Weitgasser
Keyword(s):  
Chest Wall ◽  
Free Flap ◽  
Treatment Algorithm ◽  
Poland Syndrome ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Perforator Flaps ◽  
Fat Transfer ◽  
Institutional Experience ◽  
Deep Inferior Epigastric Perforator

Introduction: Poland syndrome is a rare, challenging combination of chest wall and breast deformities for reconstructive surgeons and selecting the treatment can prove difficult. This study aims to help surgeons in choosing the best viable option for treatment by sharing our institutional experience and proposing a guiding algorithm. Methods: A retrospective analysis of all patients with Poland syndrome undergoing treatment for breast and chest wall deformities at a single institution between December 2011 and May 2020 was performed. Medical charts were reviewed to allow for a description of patient demographics, treatment modalities and complications. A treatment algorithm to aid in selecting the adequate reconstructive option based on our institutional experience was formulated. Results: A total of 22 patients (six male, 16 female) were identified who received treatment for Poland Syndrome related deformities. Nine received microsurgical free flap reconstruction (three Deep Inferior Epigastric Perforator flaps, six Transverse Myocutaneous Gracilis flaps), two received reconstruction with a local flap (two Latissimus dorsi flaps), nine received implant based reconstruction, and two were treated with autologous free fat transfer only (17 in combination with other surgical methods). Conclusion: Free flap reconstruction with the TMG flap is a valid option for patients with low Body Mass Index (BMI), while Deep Inferior Epigastric Perforator flaps should be considered for patients with a higher BMI. Autologous free fat transfer proves to be a safe and efficient treatment option in mild cases of Poland syndrome for male and female patients, in combination with or without implant based reconstructive surgery. Multicentre studies should be conducted to achieve higher case numbers of this rare disease and support clinical decisions with more data.

scholarly journals Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitrios K. Manatakis ◽  
Nikolaos Stamos ◽  
Christos Agalianos ◽  
Michail Athanasios Karvelis ◽  
Michael Gkiaourakis ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Nerve Palsy ◽  
Ultrasound Guidance ◽  
Femoral Nerve ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversalis Fascia ◽  
Transversus Abdominis Plane ◽  
Femoral Nerve Palsy ◽  
A Minor

We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP) block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence.

scholarly journals Transversus Abdominis Plane Neurolysis with Phenol in Abdominal Wall Cancer Pain Palliation

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E325-E330
Author(s):  
Rodolfo Gebhardt
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Abdominal Wall ◽  
Transversus Abdominis ◽  
World Health ◽  
Intractable Pain ◽  
Pain Palliation ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Pelvic Cancer

Pain is commonly perceived by patients during cancer and its treatment. Although most patients respond to conservative management implemented according to the World Health Organization guidelines, a subset of patients with advanced disease develop intractable pain that may require additional interventions such as regional blocks and intrathecal therapy. Patients with terminal abdominal or pelvic cancer who have high tumor burdens are often offered a diagnostic visceral nerve block followed by neurolysis for pain palliation. Conventional visceral blocks usually require fluoroscopic guidance for correct needle placement in the vicinity of the neuroaxis or abdominal cavity. These techniques carry risks of injury to vessels, bowels, and nerves. Transversus abdominis plane (TAP) block is a technique that is easy to perform (particularly when ultrasonographic guidance is used), has a good safety record, and effectively reduces pain levels and opioid requirements after abdominal and gynecological surgery. Although numerous studies have demonstrated the effectiveness of TAP blocks in acute pain management, the role of TAP block in chronic pain management is very limited. We believe that chemical neurolysis with phenol can prolong the effects of analgesia in patients with terminal cancer. We describe a case of terminal abdominal sarcoma with intractable pain that responded well to a TAP block followed by TAP neurolysis. The patient tolerated the procedure well and demonstrated sustained analgesia for 45 days before dying of the disease. We also demonstrated that TAP block significantly reduces the total opioid requirement as demonstrated by the morphine equivalent daily dose score after the neurolytic procedure. This result supports our belief that TAP block with TAP neurolysis is an effective and inexpensive modality that can be used to palliate intractable abdominal wall pain in patients with terminal abdominal cancer. Key words: Cancer pain management, phenol neurolysis, chemical neurolysis, transversus abdominis plane block, cancer pain palliation, intractable abdominal pain, ultrasound guided

Transversus Abdominis Plane Block Versus Local Anesthetic in Postoperative Abdominoplasty Patients on Pain Control

2019 ◽  
Vol 37 (3) ◽  
pp. 118-123
Author(s):  
Vincent Gardner ◽  
Lindsay Sturm ◽  
Vanessa K. Pazdernik
Keyword(s):  
Treatment Group ◽  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Anterior Abdominal Wall ◽  
Pain Medication ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
The Mean

The transversus abdominis plane (TAP) block provides analgesia to the parietal peritoneum as well as the skin and muscles of the anterior abdominal wall. These same muscles and skin are operated on during an abdominoplasty. The purpose of this study was to determine whether the use of the TAP block will lead to reduced use of narcotics during the acute postoperative (PO) period (PO day 1 and PO 1 week). The study used a prospective, comparative design. Twenty women between 25 and 65 years of age who underwent abdominoplasty with core liposuction were recruited to participate in this study. All women were given the same PO pain medication Percocet 7.5/325 mg (1-2 tabs by mouth Q4-6 hours PRN pain #20) and Valium 2 mg (1-3 tabs by mouth Q4-6 hours PRN pain #40) at the time of surgery. The women were randomly divided into 2 groups: 10 women received local anesthetic infiltrated along the rectus plication and along the edges of the incision and 10 women received a TAP block (15 cc of 0.25% Bupivacaine with 8 mg of Decadron per side) placed under ultrasound guidance prior to the start of the procedure in conjunction with the local anesthetic along the rectus plication. Each woman was asked to record the number of narcotic pills consumed during the first 24 hours and during the first week. Data from the 2 groups were compared to determine the number of narcotics consumed during the acute PO period. The mean age of participants was 43.8 years (range: 31-63 years) in the treatment group and 38.8 years (range: 26-56 years) in the control group. The mean number of narcotics used during the first 24 hours in the treatment group was 1.95 (1.5) pills, with several women requiring no narcotics within the first 24 hours. The mean number of narcotics used during the first 24 hours in the control group was 4.6 (2.3) pills. The mean number of narcotics used during the first PO week in the treatment group was 7.15 (7.26) pills, with several women requiring no narcotics during the first PO week. The mean number of narcotics used during the first PO week in the control group was 18.7 (7.7), with 1 woman requiring 38 narcotic pills during that first PO week. Statistically significant differences were found between groups ( P = .006) at 24 hours PO and ( P = .01) at 1 week. Our results suggested that receiving a TAP block prior to the start of the procedure significantly reduced the number of narcotics used during the acute PO period.

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