scholarly journals Comparative study of ropivacaine versus dexmedetomidine-ropivacaine combination in transversus abdominis plane block for postoperative pain control in plastic surgery patients undergoing abdominoplasty

2019 ◽  
Vol 6 (12) ◽  
pp. 4393
Author(s):  
Summaira Jan ◽  
Tawheed Ahmad ◽  
Saima Rashid
Keyword(s):  
Test Group ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Initial Onset

Background: Requirement of postoperative analgesic medication is decreased by the use of regional nerve blocks. Transversus abdominis plane (TAP) block is an effective way to provide postoperative analgesia in abdominal surgeries. TAP block using ropivacaine alone has not been consistently proven to be effective in alleviating pain after abdominal surgeries. The objective of the study was to compare the combination of dexmedetomidine and ropivacaine to ropivacaine alone in TAP block for abdominoplasty patients. Time to onset of post-operative pain and time interval for need of rescue analgesia were compared.Methods: Sixty ASA (American Society of Anesthesiology) grade I or II patients undergoing abdominoplasty were allocated to two groups with thirty patients in each group. In this randomized, controlled, double-blinded study, the test group received TAP block using 20 ml (100 mgs) 0.5 percent of ropivacaine mixed with 50 µg of dexmedetomidine while as Control group received TAP block with 20 ml (100 mgs) of 0.5 percent of ropivacaine alone. Patient demographics, time to initial reporting of post-operative pain, time to need of first rescue analgesia, quality of pain block and side effects were recorded.Results: Time to initial onset of pain and time to need of first rescue analgesia were significantly longer in the test group than control group. The two groups were similar in demographics and quality of pain block, with no significant difference in side effects.Conclusions: Addition of dexmedetomidine to ropivacaine for TAP block in abdominoplasty patients prolong the time to initial onset of pain and time to need for first rescue analgesia.

scholarly journals Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

2019 ◽  
Vol 4 (2) ◽  
pp. 755-758
Author(s):  
Roshan Pradhan ◽  
Seema Kumari Mishra ◽  
Lalit Kumar Rajbanshi ◽  
Kanak Khanal ◽  
Batsalya Arjyal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Visual Analogue Pain ◽  
Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

scholarly journals A prospective study of efficacy of ultrasound guided transversus abdominis plane block for postcesarean analgesia

2019 ◽  
Vol 8 (5) ◽  
pp. 1951
Author(s):  
Sravani Manam ◽  
R. N. V. Swetha ◽  
A. S. Kameswara Rao ◽  
S. G. K. Murthy
Keyword(s):  
Total Dose ◽  
Postoperative Period ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Group B

Background: The ultrasound guided transversus abdominis plane (TAP) block which provides effective analgesia after lower abdominal surgeries including caesarean section. It is a simple and reliable technique. In this prospective, randomized double-blind study, we determined the efficacy of TAP block using 0.25% Bupivacaine and 0.9N Saline with respect to VAS for pain, postoperative Tramadol consumption and post-operative ondansetron usage.Methods: This study was conducted on 100 adult patients of ASA physical status I and II in the   age group of 18 to 40 years undergoing elective lower segment cesarean section under spinal anaesthesia. Study group received TAP block with 0.25% Bupivacaine and control group received 10 ml of 0.9N saline on each side. Patients were analyzed for postoperative pain by pain score (at rest, on movement, on cough) using VAS was recorded at 0, ½, 1, 2, 4, 6, 12 and 24 hours postoperatively. Need for rescue analgesia was assessed by time to first dose of Tramadol requirement and total dose of Tramadol over 24 hours of postoperative period. Ondansetron (4 mg i.v.) was administered whenever nausea score was more than 2 or the patient vomited. All the data was noted using uniform performs.Results: Patients received TAP block with 0.25% Bupivacaine had better pain scores at first hour of postoperative period during rest, cough and movement which was statistically significant (p<0.0010) in comparison to group B. There was a statistically significant difference (p <0.001) in the requirement of total dose of Tramadol as a rescue analgesia in patients who received transversus abdominis block with 0.25% Bupivacaine (138.77 mg) in comparison with other group(240 mg).The mean time to first request for Tramadol was significantly longer in group A (5.8 hrs)  in comparison to group B (1.93 hrs) with p value <0.001. Patients received TAP block with 0.9N saline needed more dose of Ondansetron, however, the difference was not statistically significant (p >0.001).Conclusions: TAP block using ultrasound provides substantial reduction in Tramadol consumption, time to first dose of rescue tramadol when compared with control group. This study reinforces the recommendation for TAP as a part of multimodal post-operative analgesic regimen.

scholarly journals Comparing Intravenous Single Low Doses of Magnesium Sulphate versus Dexamethasone as Adjuvants to Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Prolongation of Postcesarean Analgesia

2021 ◽  
Vol 15 (1) ◽  
pp. 22-29
Author(s):  
Tamer N. Abdelrahman ◽  
Rasha G. Abu-Sinna
Keyword(s):  
Magnesium Sulphate ◽  
Transversus Abdominis ◽  
Anesthetic Technique ◽  
Control Group ◽  
Time Interval ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Group D

Introduction: The TAP block is a regional anesthetic technique, which blocks neural afferents between T6 and L1, which provide anterior abdominal walls and therefore help to alleviate postoperative pain. Aim: The aim is to compare the efficacy of preoperative single low dose of intravenous MgSO4 versus intravenous dexamethasone as adjuvants to ultrasound guided TAP block for prolongation of postcesaren analgesia. Materials and Methods: A total 60 pregnant females were selected undergoing elective caesarean sections under general anesthesia with ultrasound-guided transversus abdominis plane (TAP) block done at the end of surgery. Patients were randomly and equally allocated into three groups of 20 patients each. The first group of patients were classified as magnesium sulphate group (M)who received 50 mg/Kg IV, the second group of patients were classified as dexamethasone group (D) who received 2 mg IV and the third group was classified as the placebo group (C) who received IV saline. Results: Comparison of the VAS at 6 and 12 hours postoperatively showed statistically significantly lower values in group (M) and group (D) compared to group (C) and also group (M) was significantly lower than group (D) as well. The time interval until first rescue analgesia (Nalbuphine) needed by the patients (VAS ≥ 50) was significantly longer in group (M) compared to group (D) and group (C) consecutively. Additionally, it was significantly longer in group (D) than in the control group(C). The total dose of rescue analgesia consumed during the first 24 hours postoperatively was significantly lower in groups (M) than in group (D) and both groups showed lesser doses compared to group (C) Conclusion: We concluded that both MgSO4 and dexamethasone could prolong the postoperative duration and analgesic efficiency provided by the TAP block in cesarean sections. This further reduced the demands for postoperative rescue analgesia, with MgSO4 found to be more efficient than IV dexamethasone. Clinical Trial Registration Number: NCT04223128

scholarly journals Evaluation of efficacy of bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia: a prospective, randomized, double blind, comparative study

2017 ◽  
Vol 5 (10) ◽  
pp. 4588 ◽  
Author(s):  
Tauqeer Anjum Mir ◽  
Aabid Hussain Mir ◽  
Tantry Tariq Gani ◽  
Abida Yousuf ◽  
Sheikh Irshad Ahmad
Keyword(s):  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
P Value ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Group I ◽  
Group Ii ◽  
The Difference

Background: Pain is the commonest symptom encountered postoperatively and hence multimodal analgesia is tried to overcome it. In this study, we have compared bupivacaine and bupivacaine plus clonidine in transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing lower abdominal surgeries under spinal anaesthesia.Methods: Sixty ASA I and II patients in the age range of 18-60 years undergoing various lower abdominal surgeries were randomly divided into two groups, who were operated after giving spinal block using 2.5 ml of 0.5% hyperbaric bupivacine and 25ug of fentanyl. At the end of surgical procedure tranversus abdominis plane (TAP) block was given by giving 25 ml of injection bupivacaine 0.25% in group I and 25 ml of 0.25% of bupivacaine with 1 ug.kg-1 of clonidine in group II. Quality of analgesia was assessed by visual analogue scale (VAS), categorical pain scoring system and frequency of rescue analgesia given and duration was assessed with the time at which first rescue analgesia was given. Side effects of clonidine such as sedation, bradycardia and hypotension were also noted. The hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were noted for both the groups.Results: Demographic characteristics like age, weight, sex, ASA class and type of surgeries were comparable in both groups. SBP, DBP and HR were less in group II than in group I and was statistically significant (p-value<0.05). The overall mean VAS score in group I was 3.03 ± 1.57 and group II was 1.72 ± 1.02 with p-value of 0.0005 and hence better quality of analgesia in group II. Categorical pain scoring system also showed statistically better scores in group II than group I. The duration of analgesia which was calculated by mean time for first rescue analgesia in group I was 6.38 ± 2.56 hours and group II was 14.23 ± 4.63 hours with a p-value of <0.0001 and the difference was statistically significant. The mean number of doses of rescue analgesia in group I for the first 24 hours was 1.37 ± 0.89 and in group II was 0.60 ± 0.62 with a p-value of 0.0003 and the difference was statistically significant. Group II patients showed more sedation scores than group I patients (p-value <0.05). None of the patients had any episode of bradycardia or hypotension.Conclusions: Addition of clonidine 1 ug.kg-1 to 25 ml of 0.25% bupivacaine compared to 25 ml of 0.25% bupivacaine alone in tranverse abdominis plane (TAP) block improves quality of analgesia, increases duration of postoperative analgesia and decreases postoperative analgesic requirements with minimal side effects.

Transversus Abdominis Plane Block Vs. Paravertebral Block for Post-Operative Analgesia Following Inguinal Herniorrhaphy - A Cross-Sectional North Indian Sub-Population Study

2021 ◽  
Vol 8 (31) ◽  
pp. 2880-2884
Author(s):  
Trilok Chand ◽  
Amrita Gupta ◽  
Avanish Kumar Saxena ◽  
Pulkit Agarwal ◽  
Shanu Maheshwari
Keyword(s):  
Inguinal Hernia ◽  
Demographic Data ◽  
Paravertebral Block ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Inguinal Herniorrhaphy ◽  
Vas Score ◽  
Post Operative Pain

BACKGROUND Inguinal hernia is a frequently encountered surgical problem. General anaesthesia carries the risk of possible airway complications. Regional blocks improve acute post-operative pain, decrease post-operative visual analogue scale (VAS) score and patient can mobilise early. The purpose of this study was to compare the effectiveness of transversus abdominis plane (TAP) block vs. paravertebral (PVB) block for post-operative analgeia in inguinal hernia surgeries. METHODS We conducted a research on 64 patients of age > 18 years with American society of Anaesthesiologists (ASA I – III) to undergo unilateral inguinal herniorrhaphy. Patients were randomized into two groups. Group T received TAP block in which 20 ml of 0.25 % bupivacaine was injected and Group P underwent PVB in which 5 ml of bupivacaine (0.25 %) at each segment from T10-L1 was injected slowly (total dose of 20 ml). Post-operative VAS score, time for first rescue analgesia, total diclofenac requirement, total anti-emetic requirement and complications if any was noted. RESULTS The demographic data of both the groups were comparable. Also, pre and postoperative heart rate, blood pressure, IV fluids, ephedrine use, operative time and complications were statistically insignificant. As compared to group T, group P had lower VAS score from 2nd – 12th hour which was statistically significant (P < 0.05). Although more time is required to perform paravertebral block but the time for request of first rescue analgesia was quite prolonged in paravertebral block. Time of ambulation in group P was significantly lower than group T. CONCLUSIONS PVB requires more time to perform due to multiple site of injection, the comparison of both techniques in the present study revealed that PVB showed relatively higher efficacy in the management of post-operative pain, early ambulation and had significant reduction in dose requirement of additional analgesia (diclofenac) and antiemetics (ondansetron) over tap block. KEYWORDS Paravertebral Block, Transversus Abdominis Block, Inguinal Hernia

scholarly journals A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Poupak Rahimzadeh ◽  
Seyed Hamid Reza Faiz ◽  
Kaveh Latifi-Naibin ◽  
Mahzad Alimian
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Significant Difference

AbstractNowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

BUPIVACAINE WITH MAGNESIUM SULPHATE VS BUPIVACAINE ALONE IN TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POSTOPERATIVE ANALGESIA IN TOTALABDOMINAL HYSTERECTOMY PATIENTS: A RANDOMISED CONTROL TRIAL.

2021 ◽  
pp. 36-38
Author(s):  
Suresh Babu R ◽  
Sivakumar Pillai ◽  
Syam Sankar
Keyword(s):  
Magnesium Sulphate ◽  
Blood Pressure Response ◽  
Transversus Abdominis ◽  
Randomised Control Trial ◽  
Control Group ◽  
Sensory Level ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Hyperbaric Bupivacaine ◽  
Rescue Analgesia

Background: Postoperative (PO) pain relief following major surgeries had been a challenging task. Adequate pain control is essential for early mobilisation and wellbeing of surgical patients. Incidence of PO pain following abdominal surgeries is higher when transverse lower abdominal incisions are done as in Total Abdominal Hysterectomy (TAH). Performing Transversus Abdominis Plane (TAP) block reduces the PO pain. Various adjuvants like clonidine, epinephrine and magnesium sulphate have been added to local anaesthetics to prolong the duration of TAPblock. The aim of this study was to investigate the effects of adding MgSO4 as an adjuvant to bupivacaine in TAP block for PO analgesia in patients undergoing TAH under spinal anaesthesia. Methods: 100 patients belonging to ASA1 or 2 scheduled for TAH under Sub Arachnoid Block (SAB) were randomly assigned into two groups- BM and B. All patients were given SAB with 15 mg of 0.5% hyperbaric Bupivacaine and TAH was done. USG guided TAPblock was given once SAB sensory level regressed to T8 dermatome. Group BM received 16ml 0.25% Bupivacaine (40mg) with 150 mg magnesium sulphate injected on each side while Group B received 16 ml 0.25% Bupivacaine only. Patients were asked to rate their pain on a 10 cm VAS scale at time 0 (time of completion of TAPblock),2,4,6,12 and 24 hours. Rescue analgesia with Inj. morphine was provided whenever VAS score was > 3. Results: Patients in magnesium sulphate group had prolonged analgesia as compared to the control group. The heart rate and blood pressure response were signicantly lower in that group. Morphine requirement for PO analgesia was also signicantly reduced in group BM. No complications were seen in either group. Conclusion: Adding Magnesium sulphate to Bupivacaine in TAP block in TAH patients prolonged the duration of PO analgesia.

scholarly journals Assessment of Transversus Abdominis Plane Block in Abdominal Surgery by Total Requirement of Diclofenac as a Post-Operative Analgesia Drug

2020 ◽  
Vol 5 (1) ◽  
pp. 41-46
Author(s):  
Jigna R Shah ◽  
Apoorva Moghe ◽  
Maulik Humbal
Keyword(s):  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Abdominal Wall ◽  
Surgical Procedures ◽  
Transversus Abdominis ◽  
Control Group ◽  
Study Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia

Background: Amongst various techniques of TAP block, landmark technique via the triangle of Petit seems to hold considerable promise for patients undergoing surgical procedures involving abdominal wall incisions. The aim of this study is to evaluate transversus abdominis plane [TAP] block in abdominal surgery by total requirement of diclofenac as postoperative analgesia drug.Subjects and Methods:Present study was carried out at Department of Anesthesia, GMERS medical college, Sola, Ahmedabad, Gujarat, India from May 2014 to May 2015. According to formula based nomogram, sample size for proposed study would be: Study group (n=30): patient received TAP block with injection bupivacaine (0.25%) 20 ml. Control group (n=30): patient not received TAP block and was given injection diclofenac on demand for post-operative analgesia as per institute protocol for routine surgery. Sensory block was assessed by sterile pin prick method in the midaxillary line on both sides of chest. Postoperative pain was assessed by using the visual analogue scale.Results:Majority of the patient were in age group of 30 to 50 in both group. VAS score was significantly higher in control group as compared to the study group at all the time. First dose of rescue analgesia required in study group was at 669.66± 346 min and in control group was 220.33 ± 139.24 min which was statistically significant. Diclofenac requirement in study group was one time in 22 patient and two time in 8 patient which was significantly less as compare to control group in which diclofenac requirement was one time in 2 patient and two time in 5 patient and three time in 23 patient in 24 hour.Conclusion:TAP block is a promising new technique for postoperative pain management in surgery involving the anterior abdominal wall as a part of multimodal analgesia. Further studies are warranted to support this finding before establishing it in routine clinical practice in different type of surgical procedures.

scholarly journals Efficacy of Double Pop Blind TAP Block – Double-Blinded Randomized Controlled Study

2020 ◽  
Vol 9 (2) ◽  
pp. 1-3
Author(s):  
Simon Richard ◽  
Sharad Goel ◽  
Akhilesh Mishra ◽  
S. Ali Imam ◽  
Samir El Said ◽  
...  
Keyword(s):  
Perioperative Period ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Controlled Study ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia

Background: The transversus abdominis plane block (TAP block) in the petit triangle is being used since 2001 for analgesia by blocking      the T6 to T12 nerves, which is devoid of the sympathetic blockade and has opioid-sparing effect during and after abdominal operations.       The appropriateness and efficacy of using double pop blind transversus abdominis plane block were studied in abdominal surgeries using bupivacaine with butorphanol as additive. Subjects and Methods: A total of 78 adult patients of ASA I and II were included, who were to undergo laparoscopic cholecystectomy under general anesthesia. The control group patients received tramadol, diclofenac, and paracetamol in the perioperative period. The study group patients received TAP block by double pop blind technique after induction of anesthesia but before surgical incision as preemptive analgesia. The p-value, the mean and the confidence interval were calculated by using Student t-test with the use of online software by graphpad.com. Results: Each of the two groups had 39 patients, and none met the exclusion criteria. Patients of the study (TAP) group remained pain-free for a longer time by 439 (416 – 463) minutes more than the control (IV, Intravenous) group. Rescue analgesia in the study group was required 640 minutes after the end of the surgery, but in the control group, rescue analgesia was required earlier at 200 minutes only after the surgery. Conclusion: Double pop blind technique for TAP block is appropriate and without complications if done with carefulness as to avoid penetration of the blunted green needle beyond the fascia between the internal oblique and the transversus abdominis muscle.

scholarly journals Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

2021 ◽  
Vol 10 (3) ◽  
pp. 394
Author(s):  
Jannis Löchel ◽  
Viktor Janz ◽  
Vincent Justus Leopold ◽  
Michael Krämer ◽  
Georgi I. Wassilew
Keyword(s):  
Postoperative Pain ◽  
Periacetabular Osteotomy ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Control Group ◽  
Block Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Pain Scores

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

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