Comparison of Therapeutic Benefit of Bupivacaine HCl Transversus Abdominis Plane (TAP) Block as Part of an Enhanced Recovery Pathway versus Traditional Oral and Intravenous Pain Control after Minimally Invasive Colorectal Surgery: A Prospective, Randomized, Double-Blind Trial

2019 ◽  
Vol 85 (12) ◽  
pp. 1363-1368 ◽  
Author(s):  
Amir A. Damadi ◽  
Elizabeth A. Lax ◽  
Lauren Smithson ◽  
Ralph D. Pearlman
Keyword(s):  
Patient Satisfaction ◽  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Bowel Function ◽  
Transversus Abdominis ◽  
Gynecologic Surgery ◽  
Main Diagnosis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Quality Outcomes

Enhanced recovery pathways (ERPs), when combined with transversus abdominis plane (TAP) blocks, have been proven to reduce the length of stay (LOS) and improve quality outcomes. Nonopioid pain management is an essential component of this pathway, leading to a reduction in immobility, postoperative ileus, and an increase in patient satisfaction. TAP block variations have been studied in general and gynecologic surgery. This study evaluates the effectiveness of laparoscopic TAP blocks in conjunction with the benefit of an ERP. One hundred thirty-seven consecutive laparoscopic and robotic-assisted Colorectal Surgery patients received TAP blocks under laparoscopic guidance while under anesthesia, randomized to a placebo, bupivacaine TAP block, or bupivacaine TAP block with an ERP arm of the trial. Patient demographics, operative techniques, and postoperative outcomes were analyzed using statistical analysis software. Our main objective was to determine short-term benefits of TAP blocks on reducing total narcotic consumption. Secondary objectives included effects of TAP blocks on time to ambulation, time to bowel function, and LOS. To isolate the effect of the TAP blocks, no efforts were made to control nursing or patient education in patients managed without an ERP. Of 137 patients, 14 were withdrawn. All cases were elective, with the main diagnosis colon cancer or dysplastic polyps (47.1%). The median age in each group was comparable ( P = 0.12), with female majority in both groups (58.5%). Most procedures were segmental colon resections (74.7%). Thirty-one patients received a placebo, 41 bupivacaine TAP, and 51 bupivacaine TAP plus ERP. In terms of primary endpoints, the bupivacaine plus ERP arm used statistically significant less IV narcotics on postoperative day 1 and in total ( P = 0.001, P = 0.008). All patients ambulated on average within the first 24 hours postoperatively, with the TAP plus ERP group approximately 0.5 days sooner ( P = 0.001). The TAP plus ERP group also had a return of bowel function and LOS approximately 24 hours early ( P = 0.001 and P = 0.001). This study shows that a laparoscopically placed bupivacaine TAP block when used as part of an ERP can reduce LOS, postoperative narcotics, time to ambulation and bowel function, and LOS. Defined pain regimens with auxiliary staff teaching can add to the improvement in quality outcomes in laparoscopic colorectal surgery and, with the addition of the TAP block, can add to patient satisfaction and lower hospital costs.

scholarly journals 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

2020 ◽  
Vol 2020 ◽  
pp. 1-18 ◽  
Author(s):  
Qiang Cai ◽  
Mei-ling Gao ◽  
Guan-yu Chen ◽  
Ling-hui Pan
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Adult Patients ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Wound Infiltration ◽  
Randomized Controlled

Background. How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. Materials and methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores. Results. Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference=−0.32, 95% confidence interval (-0.87, 0.24), P=0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction. Conclusion. TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.

scholarly journals Open transversus abdominis plane block and analgesic requirements in patients following right hemicolectomy

2012 ◽  
Vol 94 (5) ◽  
pp. 327-330 ◽  
Author(s):  
RR Brady ◽  
NT Ventham ◽  
DM Roberts ◽  
C Graham ◽  
T Daniel
Keyword(s):  
Enhanced Recovery ◽  
Intervention Group ◽  
Right Hemicolectomy ◽  
Transversus Abdominis ◽  
Control Group ◽  
Complication Rates ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Post Operative Period ◽  
Early Return

INTRODUCTION Reducing exogenously administered opioids in the post-operative period is associated with early return of bowel function and decreased post-operative complication rates. We evaluated the effectiveness of a surgeon-delivered open transversus abdominis plane (TAP) block as a method to reduce post-operative opioid requirements, sedation and inpatient stay. METHODS The patient cohort was identified from those who had undergone a right hemicolectomy for colonic cancer. Patients received either an open TAP block and post-operative patient controlled anaesthesia (PCA) (n=20) or were part of a control group who received subcutaneous local anaesthetic infiltration and PCA (n=16). RESULTS PCA morphine use was reduced within the first 24 hours post-operatively in the TAP block group compared with controls (42.1mg vs 72.3mg, p=0.002). Sedation was also reduced significantly in the early post-operative period (p<0.04). There was a non-significant trend towards reduced length of stay in the intervention group (8.2 vs 8.73 days). There were no recorded complications attributable to the open TAP block. CONCLUSIONS Open TAP blocks are safe and reduce post-operative opioid requirements and sedation after right hemicolectomies. They should be considered as part of a multimodal enhanced recovery approach to patients undergoing abdominal surgery via a transverse incision.

scholarly journals Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

2014 ◽  
Vol 96 (8) ◽  
pp. 579-585 ◽  
Author(s):  
F Ris ◽  
JM Findlay ◽  
R Hompes ◽  
A Rashid ◽  
J Warwick ◽  
...  
Keyword(s):  
Anterior Resection ◽  
Enhanced Recovery ◽  
Postoperative Pain Management ◽  
Bowel Function ◽  
Transversus Abdominis ◽  
Opioid Use ◽  
Patient Controlled Analgesia ◽  
Transversus Abdominis Plane ◽  
Pain Scores ◽  
Intravenous Morphine

Introduction Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection. Methods This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0–3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool). Results There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, p<0.001) and morphine requirements (8mg vs 15mg, p=0.01) than the group receiving PCA alone at 12 hours and 24 hours. Earlier passage of flatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen. Conclusions Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural.

scholarly journals Preoperative Versus Postoperative Use of Transversus Abdominis Plane Block With Nonliposomal Bupivacaine on Postoperative Narcotic Use: A Retrospective Study.

2021 ◽  
Author(s):  
Richard Kalu ◽  
Peter Boateng ◽  
Lauren Carrier ◽  
Jaime Garzon ◽  
Amy Tang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Tertiary Care ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Readmission Rates ◽  
Recovery Protocols ◽  
Opioid Medications ◽  
Colorectal Resections

Abstract Background: Enhanced recovery protocols optimize pain control via multimodal approaches that include transversus abdominis plane (TAP) block. The aim of this study was to evaluate the effect of preoperative vs postoperative nonliposomal bupivacaine TAP block on postoperative narcotic use after colorectal surgery.Methods: A retrospective cohort study comparing postoperative narcotic use in patients who received preoperative (n = 240) vs postoperative (n = 22) nonliposomal TAP blocks. The study was conducted in a single tertiary care institution and included patients who underwent colorectal resections between August 2018 and January 2020. The study measured narcotics use in the postoperative and follow-up periods, operative details, length of stay, reoperation, and readmission rates.Results: Patients who received postoperative nonliposomal bupivacaine TAP blocks were less likely to require postoperative patient-controlled analgesia (PCA) (59.1% vs 83.3%; p = 0.012) and opioid medications on discharge (6.4% vs 16.9%; p = 0.004) relative to patients who received preoperative TAP. When needed, a significantly smaller amount of opioid was prescribed to the postoperative group (84.5 vs 32.0 mg, p = 0.047). No significant differences were noted in the duration of postoperative PCA use, amount of oral narcotic use, and length of stay.Conclusions: Nonliposomal bupivacaine TAP block administered postoperatively was associated with significantly lower need for postoperative PCA and discharge narcotics. Given the overall short length of stay for the 2 groups, further study is needed to justify the additional cost of liposomal bupivacaine TAP blocks for patients undergoing colorectal resections.

Transversus abdominis plane block by landmark technique with ropivacaine versus bupivacaine for post-operative analgesia in patients undergoing lower segment caesarean section deliveries

2021 ◽  
Vol 8 (4) ◽  
pp. 551-555
Author(s):  
Aishwarya M Chavan ◽  
Geetha R Acharya ◽  
Jyoti V Kale ◽  
Nidhi R Dabral
Keyword(s):  
Patient Satisfaction ◽  
Caesarean Section ◽  
Postoperative Period ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Lower Segment ◽  
Rescue Analgesia ◽  
Lower Segment Caesarean Section ◽  
Group B

Transversus Abdominis Plane (TAP) Block is an efficacious abdominal field block which is widely used component of multimodal analgesia. Compare the efficacy of Inj. Ropivacaine 0.2% and Inj. Bupivacaine 0.2% when used in TAP block for post-operative analgesia in lower segment caesarean section deliveries(LSCS) done under spinal anaesthesia. Randomized double blinded prospective study conducted after institutional ethics committee in our institute. We have recruited sixty patients scheduled for an elective LSCS which were enrolled into two groups to receive TAP block with bupivacaine 0.2% 15ml Group B (n=30) versus ropivacaine 0.2% 15ml Group R (n=30) + dexamethasone 2mg bilaterally. TAP block was administered on completion of surgery. Primary objective was to compare time to rescue analgesia in postoperative period. Secondary Objectives wereto compare hemodynamic response during postoperative period, measure the intensity of pain using visual analogue scale (VAS), number of analgesic doses in first 24 hours, patient satisfaction with pain management and complications if any.SPSS software 16 version. Time for rescue analgesia was shorter in Group B (6.7 hour) than in Group R (9.47 hour) (p = 0.00). VAS was lower in Group R. Higher dose of analgesics was required in Group B (p=0.008). All this led to higher patient satisfaction score in Group R. This study concludes that 0.2% ropivacaine provided a longer duration of analgesia compared to 0.2% bupivacaine when used in TAP block for post-operative analgesia in LSCS deliveries.

scholarly journals Optimal concentration of the transversus abdominis plane block in enhanced recovery after surgery protocols for patients of advanced age undergoing laparoscopic rectal cancer surgery

2018 ◽  
Vol 46 (11) ◽  
pp. 4437-4446 ◽  
Author(s):  
Ping-Chen ◽  
Qing-Song Lin ◽  
Xian-Zhong Lin
Keyword(s):  
Rectal Cancer ◽  
General Anesthesia ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Cancer Surgery ◽  
Optimal Concentration ◽  
Transversus Abdominis ◽  
Rectal Cancer Surgery ◽  
Tap Block ◽  
Transversus Abdominis Plane

Objective The transversus abdominis plane (TAP) block ameliorates visual analogue scale scores and decreases morphine requirements, but its role remains unclear. Patients of advanced age are susceptible to local anesthetic intoxication. We aimed to identify an optimal concentration that can be used in enhanced recovery after surgery (ERAS) without compromising analgesic efficacy. Methods In total, 120 patients aged ≥65 years undergoing laparoscopic rectal cancer surgery received general anesthesia combined with a TAP block using 0.25% ropivacaine (Group A), 0.50% ropivacaine (Group B), or 0.75% ropivacaine (Group C) in a 40-mL volume. Group D only received general anesthesia. Epinephrine, plasma cortisol, interleukin-6, and tumor necrosis factor-α were measured at baseline, skin incision, celiac exploration, and tracheal extubation. The proportions of CD4+ and CD4+/CD8+ cells were measured at baseline and postoperative days 1 and 3. Results The TAP block relieved the stress response and accelerated intestinal functional recovery as shown by significant reductions in VAS scores and anesthetic requirements. However, there was no significant difference between Groups B and C. Conclusion The TAP block plays an important role in ERAS in older patients undergoing laparoscopic rectal cancer surgery, and 0.5% ropivacaine is an optimal concentration that can reduce toxicity without undermining analgesia.

scholarly journals Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy- A RCT

2021 ◽  
Author(s):  
Usha Shukla ◽  
Pratima Kumari ◽  
Jay Brijesh Singh Yadav ◽  
Atit Kumar
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Analgesia ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Analgesic Requirement ◽  
Patient Satisfaction Score ◽  
Quadratus Lumborum ◽  
Vas Scores

Introduction: Abdominal Hysterectomy (AH) is one of the most common surgeries performed in gynaecology and is associated with a medium to high pain level. Newly discovered peripheral blocks such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum (QL) block have gained immense popularity as an adjunct to regional and general anaesthesia for postoperative pain management and reducing analgesic requirements. Aim: To compare the analgesic efficacy of QL block with TAP block in patients undergoing total AH. Materials and Methods: This was a double-blinded Randomised Clinical Trial (RCT). The study population comprised of 105 patients posted for elective total AH under spinal anaesthesia. They were randomly allocated into three groups of 35 patients each. Group Q received bilateral QL block with 40 mL of 0.25% bupivacaine divided on either side, Group T received bilateral TAP block with 40 mL of 0.25% bupivacaine divided on either side and in Group C no block was given. Patients were monitored for Visual Analogue Scale (VAS) scores at 0, 15 minutes, 30 minutes, 1st, 2nd, 6th, 12th and 24th hour postoperatively, time for first analgesic requirement, total analgesic requirement in 24 hours and patient satisfaction score after 24 hours and also adverse effects, if any. Data were analysed using Statistical Package For The Social Sciences (SPSS) version 16 (Chicago, IL, USA) with independent t-test and Chi-square test as appropriate. The p<0.05 was considered statistically significant. Results: There were significantly lower VAS scores in group Q than group T at 2nd and 6th hour with p-value of 0.003 and 0.001, respectively. The time for first analgesic was early in group C with mean value of 1.37±0.74 hours and it was 4.63±0.97 hours in group T and 7.77±1.51 hours in group Q. The total analgesic requirement was lesser in group Q when compared to group C and T. Patient satisfaction score was comparable between group Q and T (p=0.97). No significant difference in complications among the three groups was observed (p=0.51). Conclusion: QL block is a better postoperative analgesic technique than TAP block for postoperative analgesia in hysterectomy patients.

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