Efficacy of Transversus Abdominis Plane (TAP) Block as Part of Multimodal Analgesia after Cesarean Section Delivery

Abstract Background: The transversus abdominis plane (TAP) block is used increasingly in parturients after caesarean delivery. This is a randomized controlled trial to evaluate the effectiveness of bilateral single-shot TAP blocks in patients who received multimodal oral analgesia for postoperative pain relief.Methods: Parturients who were scheduled for elective caesarean delivery under spinal anaesthesia were recruited and randomized to receive bilateral single-shot of TAP blocks or placebo in addition to multimodal oral analgesia which consisted of regular tramadol, celecoxib and paracetamol, with oral oxycodone used as rescue for breakthrough pain. Only parturients in TAP group would receive the TAP blocks with an injection of 15ml (0.25%) ropivacaine on each side under aseptic techniques. All the parturients were evaluated for pain or related complications in the first 24 hours after surgery. Primary outcome is the percentage of parturients who required oxycodone as rescue analgesia. Results: Eighty and seventy-nine parturients were allocated to TAP and placebo group respectively. Nine out of 79 (11.4%) parturients in TAP group and fifteen out of 73 (20.5%) parturients in placebo group required oxycodone for breakthrough pain, P = 0.122.Conclusions: Bilateral single-shot of TAP blocks confer little additional benefit when multimodal oral analgesic regimen is used for pain control after caesarean section under spinal anaesthesia.Trial registration:Clinical Trial Registry of China (http://www.chictr.org.cn, ChiCTR-INR-16010130). Retrospective registered on Dec 12, 2016

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Benefits of Transversus Abdominis Plane Block on Postoperative Analgesia after Bariatric Surgery: A Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.345 ◽

2021 ◽

pp. 345-358

Keyword(s):

Bariatric Surgery ◽

Postoperative Pain ◽

Length Of Stay ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Transversus Abdominis ◽

Hospital Length Of Stay ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Pain Scores

BACKGROUND: Patients undergoing bariatric surgery present unique analgesic challenges, including poorly controlled pain, increased prevalence of obstructive sleep apnea, and opioid-induced respiratory depression. The transversus abdominis plane (TAP) has been demonstrated to be a safe and effective component of multimodal analgesia for a variety of abdominal surgeries. OBJECTIVE: To determine the benefits of the TAP block on postoperative analgesia and recovery in patients undergoing bariatric surgery. STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies. METHODS: We conducted a comprehensive search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to April 2020 for studies using TAP block in bariatric surgeries and reporting postoperative pain, opioid consumption, and recovery-related outcomes. Primary outcomes included postoperative pain scores, opioid consumption, and recovery-related outcomes (e.g., length of stay, time to ambulation). Outcomes were pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). RESULTS: Twenty-one studies (15 RCTs [n = 1410] and 6 nonrandomized studies [n = 1959]) were included. Among RCTs, the TAP block group required fewer opioid rescues (RR 0.28; 95% CI 0.18 to 0.42, P < 0.001) (moderate quality); reduced total opioid use over 24 hours (MD –8.33; 95% CI –14.78 to –1.89, P = 0.01); decreased time to ambulation (MD –1.12 hours; 95% CI –1.50 to –0.73, P < 0.001) (high quality); and had significantly lower pain scores at 6 hours (MD –1.52; 95% CI –1.90 to –1.13, P < 0.01) and 12 hours (MD –0.95; 95% CI –1.34 to –0.56, P < 0.001) on a 0-10 pain scale (moderate quality). No difference was observed for nausea and vomiting, or hospital length of stay. Meta-analyzed outcomes from observational studies supported these results, suggesting decreased postoperative pain and opioid consumption. LIMITATIONS: Studies varied with respect to type of surgery and components of comparator multimodal analgesia, likely contributing to heterogeneity. Subgroup analyses by type of comparator group were conducted to address these differences. We were unable to extract data from all trials included due to variability in outcomes reporting, such as non-opioid drugs for postoperative pain management or invalid dosages. Pain-related outcomes may be affected by operative differences leading to variation in visceral pain. Observational studies have their inherent limitations, such as confounding due to lack of participant randomization and intervention blinding, potentially affecting subjective outcomes, such as pain scores, as well as provider-dependent outcomes, such as hospital length of stay. Lastly, there was significant variation of TAP block technique across all studies. CONCLUSION: TAP block is an effective, safe modality that can be performed under anesthesia. It decreases pain, opioid use, and time to ambulation after bariatric surgeries and should be considered in multimodal analgesia for enhanced recovery in this high-risk surgical population. KEY WORDS: Analgesia, bariatric surgery, enhanced recovery after surgery, multimodal analgesia, opioid-sparing analgesia, pain, postoperative, regional block, transversus abdominis plane block

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Transversus Abdominis Plane Block Appears to Be Effective and Safe as a Part of Multimodal Analgesia in Bariatric Surgery: a Meta-analysis and Systematic Review of Randomized Controlled Trials

Obesity Surgery ◽

10.1007/s11695-020-04973-8 ◽

2020 ◽

Author(s):

Mária Földi ◽

Alexandra Soós ◽

Péter Hegyi ◽

Szabolcs Kiss ◽

Zsolt Szakács ◽

...

Keyword(s):

Bariatric Surgery ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Multimodal Analgesia ◽

Transversus Abdominis ◽

Controlled Trials ◽

Laparoscopic Bariatric Surgery ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Randomized Controlled

Abstract Purpose Pain after bariatric surgery can prolong recovery. This patient group is highly susceptible to opioid-related side effects. Enhanced Recovery After Surgery guidelines strongly recommend the administration of multimodal medications to reduce narcotic consumption. However, the role of ultrasound-guided transversus abdominis plane (USG-TAP) block in multimodal analgesia of weight loss surgeries remains controversial. Materials and Methods A systematic search was performed in four databases for studies published up to September 2019. We considered randomized controlled trials that assessed the efficacy of perioperative USG-TAP block as a part of multimodal analgesia in patients with laparoscopic bariatric surgery. Results Eight studies (525 patients) were included in the meta-analysis. Pooled analysis showed lower pain scores with USG-TAP block at every evaluated time point and lower opioid requirement in the USG-TAP block group (weighted mean difference (WMD) = − 7.59 mg; 95% CI − 9.86, − 5.39; p < 0.001). Time to ambulate was shorter with USG-TAP block (WMD = − 2.22 h; 95% CI − 3.89, − 0.56; p = 0.009). This intervention also seemed to be safe: only three non-severe complications with USG-TAP block were reported in the included studies. Conclusion Our results may support the incorporation of USG-TAP block into multimodal analgesia regimens of ERAS protocols for bariatric surgery.

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Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block in Post-Operative Pain Management after Cesarean Section

QJM ◽

10.1093/qjmed/hcab086.006 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Omar Mohamed Taha Elsafty ◽

Hanan Mahmoud Farag Awad ◽

Mohamed Saleh Ahmed ◽

Ahmed Elkholy Mahdy

Keyword(s):

Postoperative Pain ◽

Cesarean Section ◽

Pain Control ◽

Early Mobilization ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Ultrasound Guided ◽

Quadratus Lumborum

Abstract Background Cesarean section rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Objectives The aim of this study was to assess the analgesic efficacy of ultrasound-guided trans-muscular QLB compared with TAP block after cesarean section surgeryperiod regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, female patients were included in the study, and were divided into three groups (n = 20; each); group QLB and group TAP. Group QLB: Patients (n = 20) of this group received bilateral ultrasound-guided QLB after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%, Group TAP: Patients (n = 20) of this group received bilateral ultrasound-guided TAP block after induction of general anesthesia using 0.2 ml/kg bupivacaine 0.125%. Results The current study also measured and compared postoperative VAS score and firs time to rescue analgesia and the total amount of opioid (pethidine) given in the first 24 hours with the standard deviation for each of the two groups studied we found that TAP patients had the highest values compared to the QLB group. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after cesarean section without associated hemodynamic instability in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

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Multimodal analgesia for cesarean section: Evolving role of transversus abdominis plane block

Journal of Obstetric Anaesthesia and Critical Care ◽

10.4103/2249-4472.104729 ◽

2012 ◽

Vol 2 (2) ◽

pp. 67 ◽

Cited By ~ 3

Author(s):

Samina Ismail

Keyword(s):

Cesarean Section ◽

Multimodal Analgesia ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Transversus Abdominis Plane

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The analgesic efficacy of ultrasound-guided transversus abdominis plane (TAP) block combined with oral multimodal analgesia in comparison with oral multimodal analgesia after caesarean delivery: a randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-020-01223-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yang Yu ◽

Shenshan Gao ◽

Vivian Man-ying Yuen ◽

Siu-Wai Choi ◽

Xuebing Xu

Keyword(s):

Caesarean Delivery ◽

Breakthrough Pain ◽

Controlled Trial ◽

Multimodal Analgesia ◽

Transversus Abdominis ◽

Single Shot ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Randomized Controlled ◽

Oral Analgesia

Abstract Background The transversus abdominis plane (TAP) block is used increasingly in parturients after caesarean delivery. This is a randomized controlled trial to evaluate the effectiveness of bilateral single-shot of TAP blocks in patients who received multimodal oral analgesia for postoperative pain relief. Methods Parturients who were scheduled for elective caesarean delivery under spinal anaesthesia were recruited and randomized to receive bilateral single-shot of TAP blocks or placebo in addition to multimodal oral analgesia which consisted of regular tramadol, celecoxib and paracetamol, with oral oxycodone used as a rescue for breakthrough pain. Only parturients in the TAP group would receive the TAP blocks with an injection of 15 ml (0.25%) ropivacaine on each side under aseptic techniques. All the parturients were evaluated for pain or related complications in the first 24 h after surgery. The primary outcome is the percentage of parturients who required oxycodone as a rescue analgesia. Results Eighty and 79 parturients were allocated to the TAP and placebo group respectively. Nine out of 79 (11.4%) parturients in the TAP group and 15 out of 73 (20.5%) parturients in the placebo group required oxycodone for breakthrough pain, P = 0.122. Conclusions Bilateral single-shot of TAP blocks confer little additional benefit when a multimodal oral analgesic regimen is used for pain control after caesarean section under spinal anaesthesia. Trial registration Clinical Trial Registry of China (http://www.chictr.org.cn) identifier: ChiCTR-INR-16010130, retrospectively registered on Dec 12, 2016.

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Comparative assessment of efficacy of various anesthesia options after cesarean section

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2019-16-6-54-59 ◽

2020 ◽

Vol 16 (6) ◽

pp. 54-59

Author(s):

O. V. Ryazanova ◽

Yu. S. Аleksandrovich ◽

Yu. N. Gorokhova

Keyword(s):

Cesarean Section ◽

Postoperative Analgesia ◽

Stress Hormones ◽

Comparative Assessment ◽

Transversus Abdominis ◽

Visual Analogue Pain Scale ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Visual Analogue Pain ◽

Ropivacaine Hydrochloride

The article describes the comparative assessment of efficacy of transversus abdominis plane block as a component of multimodal analgesia during cesarean section.Subjects and methods. 165 primiparous women were enrolled into the study, their average age made 30.5 years. Operative delivery was performed under spinal anesthesia. All patients were divided into five groups. In the patients in Groups 1 and 3, postoperative analgesia was performed using transversus abdominis plane (TAP) block without ultrasound guidance, while in Groups 2 and 4, TAP block was guided by ultrasound. In Groups 1 and 2, ropivacaine hydrochloride was used at a concentration of 0.2%, in Groups 3 and 4 - 0.375%. In Group 5, paracetamol in combination with narcotic analgesics was used for analgesia. Pain intensity was assessed every hour using a visual analogue pain scale at rest and during movement during the 1st day after delivery. To assess the severity of the stress response and metabolic status of patients, concentrations of cortisol, prolactin and glucose in blood plasma was tested. The levels of cortisol and prolactin were tested in 4 stages: before surgery, 1 hour after surgery, 6 and 24 hours after delivery. Plasma glucose was tested in 3 stages: before surgery, 1 hour and 6 hours after surgery.Results. TAP block in combination with paracetamol provided adequate postoperative analgesia, reduced the consumption of analgesics, and also contributed to the earliest activation of new mothers after cesarean section. The use of 0.2% ropivacaine hydrochloride solution with TAP block was equally effective as the use of 0.375% solution of ropivacaine hydrochloride. Ultrasound guided TAP block significantly improved the quality of postoperative pain management. TAP block reduced the level of stress hormones in patients but in 24 hours, the levels of stress hormones in all groups of patients receiving and not receiving TAP block did not differ.

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The Analgesic Efficacy of Ultrasound-guided Transversus Abdominis Plane (TAP) Block Combined With Oral Multimodal Analgesia In Comparison With Oral Multimodal Analgesia After Caesarean Delivery: A Randomized Controlled Trial

10.21203/rs.3.rs-50223/v4 ◽

2021 ◽

Author(s):

Yang Yu ◽

Shenshan Gao ◽

Vivian Manying Yuen ◽

Wai Siu Choi ◽

Xuebing Xu

Keyword(s):

Caesarean Delivery ◽

Breakthrough Pain ◽

Controlled Trial ◽

Multimodal Analgesia ◽

Transversus Abdominis ◽

Single Shot ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Randomized Controlled ◽

Oral Analgesia

Abstract Background: The transversus abdominis plane (TAP) block is used increasingly in parturients after caesarean delivery. This is a randomized controlled trial to evaluate the effectiveness of bilateral single-shot of TAP blocks in patients who received multimodal oral analgesia for postoperative pain relief.Methods: Parturients who were scheduled for elective caesarean delivery under spinal anaesthesia were recruited and randomized to receive bilateral single-shot of TAP blocks or placebo in addition to multimodal oral analgesia which consisted of regular tramadol, celecoxib and paracetamol, with oral oxycodone used as a rescue for breakthrough pain. Only parturients in the TAP group would receive the TAP blocks with an injection of 15ml (0.25%) ropivacaine on each side under aseptic techniques. All the parturients were evaluated for pain or related complications in the first 24 hours after surgery. The primary outcome is the percentage of parturients who required oxycodone as a rescue analgesia. Results: 80 and 79 parturients were allocated to the TAP and placebo group respectively. 9 out of 79 (11.4%) parturients in the TAP group and 15 out of 73 (20.5%) parturients in the placebo group required oxycodone for breakthrough pain, P = 0.122. Conclusions: Bilateral single-shot of TAP blocks confer little additional benefit when a multimodal oral analgesic regimen is used for pain control after caesarean section under spinal anaesthesia.Trial registration: Clinical Trial Registry of China (http://www.chictr.org.cn) identifier:ChiCTR-INR-16010130, retrospectively registered on Dec 12, 2016.

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Combination of Transversus abdominis plane block and Serratus plane block anesthesia in dogs submitted to masctetomy

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-5007 ◽

2018 ◽

Vol 38 (2) ◽

pp. 315-319 ◽

Cited By ~ 2

Author(s):

Luciana G. Teixeira ◽

Diego M. Pujol ◽

Aline F. Pazzim ◽

Renata P. Souza ◽

Leandro Fadel

Keyword(s):

Arterial Pressure ◽

Multimodal Analgesia ◽

Pain Scale ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Rescue Analgesia ◽

Colorado State University ◽

Recovery From Anesthesia

ABSTRACT: This paper pretends to demonstrate the effect of the combination of transversus abdominis plane block (TAP block) and Serratus plane block (SP block) techniques in analgesia of 4 dogs undergoing total unilateral mastectomy. Dogs were premedicated with methadone (0.5mg.kg-1) intramuscularly. Anesthesia was induced with propofol (6mg.kg-1) and midazolam (0.3mg.kg-1) and maintained with isoflurane. SP and TAP block were performed unilaterally using ultrasound by the injection of bupivacaine 0.25% (0.3mL kg-1) diluted with NaCl solution 1:1. Heart rate (HR), respiratory rate (f), non-invasive arterial pressure, esophageal temperature (T), oxygen saturation (SpO2) and electrocardiogram were monitored continuously. Animals were monitored for two and four hours after extubation for pain by using the Canine Acute Pain Scale from Colorado State University. Two hours after extubation, tramadol (4mg.kg-1) and dipyrone (25mg.kg-1) was administered to all dogs. It was not observed any alteration on cardiac rhythm. HR, f, T and mean arterial pressure remained below the preincisional values for all dogs. No dog required intraoperative rescue analgesia. Recovery from anesthesia was without any complication. All animals scored 0 (0/5) at pain scale, two and four hours after extubation and none of them expressed concern over the surgical wound. Dogs were able to walk before two hours after extubation. The combination of both techniques is effective in anesthetic blocking the thoracic and abdominal walls and it is suggested both may be included in the multimodal analgesia protocols for this type of surgery.

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