Comparison of Efficacy of 0.25 % Ropivacaine with Dexmedetomidine versus 0.25 % Ropivacaine Alone for Transversus Abdominis Plane Block for Post-Operative Analgesia in Patients Undergoing Lower Segment Caesarean Section - A Prospective Randomized Clinical Study

BACKGROUND Regional anaesthesia is an armamentarium in the hands of the anaesthesiologist to provide swift, effective and safe condition for surgery. However, local anaesthetics are characterised by slower onset and shorter duration of action, when used in larger doses can cause systemic toxicity. Hence, adjuvants are used to better the quality of blocks. Here, I have used dexmedetomidine as an adjuvant in transversus abdominis plane (TAP) block to assess duration of action, hemodynamic effects and side-effects. METHODS Our study is randomised double blinded comparative study, in which we have compared two groups, one received ropivacaine alone and another received ropivacaine with dexmedetomidine as an adjuvant. Assessment was done for duration of action, visual analog scale (VAS) scores, analgesic drug usage, sedation scoring and incidence of side-effects and complications. This study was conducted on 94 parturients with 47 patients in each group. RESULTS Dexmedetomidine has a statistically significant prolonged action and has given excellent analgesia post-operatively. Additional analgesics were required in a lesser number than the control group. There were no hemodynamic disturbances and complications. CONCLUSIONS Dexmedetomidine added to ropivacaine for ultra-sound guided TAP block is associated with prolonged and excellent analgesia with lesser requirement for additional analgesic usage, lower VAS scores, hemodynamic stability, and minimal sedation. KEYWORDS Caesarean Section, Dexmedetomidine, Analgesia, Post-Operative, Ropivacaine, Transversus Abdominis Plane Block

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EFFICACY OF TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POST CESAREAN DELIVERY ANALGESIA

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.5.5 ◽

2018 ◽

Vol 8 (5) ◽

pp. 37-41

Author(s):

Minh Nguyen Van ◽

Nga Bui Thi Thuy ◽

Thinh Tran Xuan

Keyword(s):

Caesarean Section ◽

Visual Analogue Scale ◽

Analogue Scale ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Morphine Consumption ◽

Block Group ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Pain Scores

Background: The transversus abdominis plane block (TAP block), a regional block, provides effective analgesia after lower abdominal surgeries. The objective of this study was to assess whether transversus abdominis plane block is effective as part of multimodal pain management following Cesarean section. Materials and Method: Totally, 60 ASA I and II parturients for Cesarean section via Pfannenstiel incision under spinal anesthesia were randomly allocated to either the TAP block group or the control. The TAP block group received a landmark-orientated, bilateral TAP block with 0.25% levobupivacain 17,5ml each side in the triangle of Petit. Postoperative pain treatment followed the same protocole for both groups with 1gram paracetamol intravenously and received patrient-controlled analgesia with intravenous morphine. The time to first request of analgesic, morphine consumption, visual analogue scale (VAS) pain scores and side effects were scored at 2, 4, 6, 8, 12 h postoperatively. Results: The time to first request of analgesic was longer, morphine consumption was lower in TAP group than in the control (p < 0.05). Visual analogue scale (VAS) pain scores at rest and on mouvement were similar in two groups at 2h, but lower in TAP group from 4h (p < 0.05). No severe adverse effects were detected in two groups. Conclusion: TAP block prolonged the time to fisrt request of analgesic and reduced morphine consumption, the VAS pain scores significantly both at rest and on mouvement. Therefore, TAP block is feasible and effective as part of a multimodal analgesia regimen after Caesarean section. Key words: Caesarean section, multimodal pain management, transversus abdominis plane block

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Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia in Abdominal Surgery: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-16057/v1 ◽

2020 ◽

Author(s):

Junheng Chen ◽

Chao Chen ◽

Guoliang Sun ◽

Chunming Guo ◽

Weifeng Yao

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Side Effects ◽

Abdominal Surgery ◽

Meta Analysis ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Transversus Abdominis Plane ◽

Quadratus Lumborum ◽

Vas Scores

Abstract Background: The aim of this systematic review and meta-analysis was to compare the analgesic efficacy of the quadratus lumborum block (QLB) and transversus abdominis plane block (TAPB). Methods: We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Only trials comparing QLB with TAPB were included. The primary outcomes were visual analog scale (VAS) scores at rest and at movement during the first 48 h after surgery and postoperative analgesic requirements. Secondary outcomes included rates of side effects, such as postoperative nausea and vomiting (PONV) and dizziness, and patient satisfaction. Results: A total of 15 controlled trials, including 1013 patients, were identified. VAS scores at rest at 0–1, 2, 4, 6, 8, 12, and 24 h and at movement at 24 and 48 h were significantly lower in patients who underwent QLB when compared with those in patients who underwent TAPB. QLB performed better in terms of postoperative analgesic requirements, with patients requiring lower levels of intravenous morphine and sufentanil over the first 24 h, fewer patients requiring rescue analgesics, and longer times to first rescue analgesic. Among patients who underwent QLB, rates of PONV and dizziness were lower and the Bruggemann comfort scale (BCS) scores were higher. Conclusion: QLB leads to significantly better outcomes in terms of postoperative VAS scores, opioid consumption, incidence of side effects, and patient satisfaction when compared with TAPB following abdominal surgery.

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A Comparative Study Between Magnesium Sulfate Versus Morphine Added to Bupivacaine in Ultra-Sound Guided Transversus Abdominis Plane Block for Post-Operative Analgesia after Inguinal Herniorraphy

QJM ◽

10.1093/qjmed/hcaa039.045 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M Kamaly ◽

A M Khamies ◽

R M Hassan ◽

H A H Tawfik

Keyword(s):

Inguinal Hernia ◽

Magnesium Sulfate ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Ultra Sound ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Rescue Analgesia ◽

Group I ◽

Inguinal Herniorraphy

Abstract Background Inguinal hernia considered the third common disease in surgeries for adult after acute appendicitis and proctologic disorders. About 20 millions of inguinal hernia repairs are performed globally. Inguinal herniorrhaphy is frequently associated with persistent postoperative pain. A significant proportion of pain experienced by patients undergoing abdominal surgeries is related to somatic pain signals derived from the abdominal wall. Aim of the Work The aim of this study is to assess the postoperative analgesic efficacy of Magnesium sulfate added to Bupivacine verus Morphine to Bupivacaine in ultrasound guided transversus abdominis plane (TAP) block after inguinal herniorraphy regarding the pain relief and the amount of rescue analgesia used postoperative. Patients and Methods The study was conducted on 45 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in three groups of 15 patients each: Group - I (B): received TAP block with Bupivacaine only as a “Control Group”. Group - II (B-MO): received TAP Block with Bupivacaine plus Morphine. Group - III (B-Mg): received TAP block with Bupivacaine plus Magnesium Sulfate. The three groups were adequately monitored and assessed intra- and post-operatively and they were compared regarding analgesic outcome by using the visual analogue scaling system, besides, recording time for first call for rescue analgesia and total consumption of it in the 1st 24 postoperative hours. Demographic data and post-operative hemodynamics were also assessed. Results The results of the study revealed that Magnesium added to bupivacaine better than Morphine added to Bupivacaine in transversus abdominis plane block regarding the postoperative analgesia after inguinal Herniorraphy. Conclusion In Conclusion the addition of MgSo4 as an adjuvant to bupivacaine in TAP block has shown superiority over either mono-therapy with bupivacaine or bupivacaine-Morphine combination in many aspects such as postoperative analgesic outcome assessed by VAS score, 1st time of rescue analgesia and without the pronounced side effects of the conventional postoperative opioids and less side effect than Morphine.

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Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01392-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tao-ran Yang ◽

Xue-mei He ◽

Xue-han Li ◽

Ru-rong Wang

Keyword(s):

Sensitivity Analysis ◽

Side Effects ◽

Pain Score ◽

Caesarean Delivery ◽

Intrathecal Morphine ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Transversus Abdominis Plane ◽

Analgesic Effects ◽

Registration Number

Abstract Background The number of caesarean deliveries has been increasing. Although intrathecal morphine (ITM) can relieve pain and is widely applied in caesarean deliveries, it is associated with many side effects. Transversus abdominis plane block (TAPB), a new analgesic technology, has also began playing a certain role after caesarean delivery, with fewer adverse effects. This study mainly compares the analgesic and adverse effects of ITM and TAPB in caesarean delivery. Methods We systematically searched PubMed, Cochrane Library, EMBASE, and Web of Science, for randomised controlled trials (RCTs) published before 9 October, 2020 to compare the effects of ITM and TAPB. Primary outcome of the study was the pain score at rest 24 h after caesarean delivery, whereas the secondary outcomes were the pain score at movement 24 h after operation, postoperative nausea and vomiting (PONV), itching, and morphine consumption. For the outcome assessment, we conducted a sensitivity analysis. Result Six RCTs involving 563 patients and meeting the study inclusion criteria were included in this study. Results indicated no significant difference in the pain score between ITM and TAPB at 24 h of rest or movement. The sensitivity analysis results indicated that the resting pain score (95% CI = − 1.27 to − 0.28; P = 0.002) and 24-h moving pain score (95% CI = − 1.8 to − 0.07; P = 0.03) of the ITM group were lower than those of the TAPB group. The consumption of morphine in the ITM group was lower than in the TAPB group (95% CI = 1.92 to 4.87; P < 0.00001); however, in terms of adverse reactions, the incidence of pruritus (95% CI = 1.17 to 8.26; P = 0.02) and PONV (95% CI = 1.92 to 4.87, P < 0.00001) in the ITM group was higher than in the TAPB group. Conclusion Parturients in the ITM and TAPB groups exhibited similar analgesic effects. However, in the sensitivity analysis performed by eliminating the studies causing heterogeneity, the ITM group was found to have superior analgesic effects compared with the TAPB group, with less morphine consumption. Differently, the TAPB group displayed less side effects such as PONV. Therefore, TAPB is still a valuable analgesia option for patients who cannot use ITM for analgesia after caesarean delivery or those having a high risk of PONV. Trial registration Registration number: Registered on Prospero with the registration number of CRD42020210135.

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Pharmacokinetics of Levobupivacaine With Epinephrine in Transversus Abdominis Plane Block for Postoperative Analgesia After Caesarean Section

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000547329.63084.bf ◽

2018 ◽

Vol 38 (4) ◽

pp. 226-227

Author(s):

H.J. Lacassie ◽

A. Rolle ◽

L.I. Cortínez ◽

S. Solari ◽

M.A. Corvetto ◽

...

Keyword(s):

Caesarean Section ◽

Postoperative Analgesia ◽

Transversus Abdominis Plane Block ◽

Transversus Abdominis ◽

Transversus Abdominis Plane

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

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i2.25460 ◽

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.

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