scholarly journals TRANSVERSUS ABDOMINIS PLANE BLOCK OR QUADRATUS LUMBORUM BLOCK FOR POSTOPERATIVE ANALGESIA AFTER TOTAL ABDOMINAL HYSTERECTOMIES: THE RETROSPECTIVE STUDY

2021 ◽  
pp. 57-61
Author(s):  
A.V. RYZHKOVSKYI ◽  
O.V FILYK ◽  
R.M. TROKHYMOVYCH
Keyword(s):  
Heart Rate ◽  
Postoperative Analgesia ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Multimodal Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Group I ◽  
Quadratus Lumborum ◽  
Duration Of Hospitalization

Background. Techniques of myofascial blockades are widely used after gynecological surgeries. The aim of study was to compare TAP block and QL block for postoperative analgesia of total abdominal hysterectomies. Materials and methods. We provided the retrospective single-center cohort study and included 51 patients 40-65 years old with complicated symptomatic uterus fibroids, who need total abdominal hysterectomy. Both groups underwent general anesthesia. In addition, in I group it was performed TAP block bilaterally via lateral access; in II group – QL block bilaterally via anterior (transmuscular) access. After surgery both groups` patients received multimodal analgesia with dexketoprofen, paracetamol, nefopam; in case of severe pain - nalbuphine. The stages of the study were 6 hours (h6), 12 hours (h12), 24 hours (h24), 48 hours (h48), 72 hours (h72) after surgery. We made the analysis pain level (with visual analogue scale - VAS), heart rate, mean arterial pressure, daily requirement of nalbuphine, duration of hospitalization. Results and discussion. It was found that the level of pain according to VAS in I group reached its maximum values on the stages h6 and h12 and was 4.8 [3,3; 5.8] points and 5.0 [3.9; 6.4] points, while in II group - 2.5 [2,3; 3.5] points and 2.1 [1.6; 4.1] points, respectively (p <0.05). We found significant differences in heart rate between groups on h12 stage when it was 86 [82; 90] beats / min in I group, and 72 [63; 79] beats / min in II group (p = 0.05). The daily requirement of nalbuphine on h12 stage had the tendency (p = 0.07) to be lower in II group (20.9 ± 1.1 mg / day), compared with the I group I (31.4 ± 2.9 mg / day). The need for nalbuphine use on h24 stage was significantly lower (p <0.05) in II group (5.8 ± 0.8 mg / day), compared with I group (22.5 ± 4.1 mg / day). The duration of hospitalization in I group was 7.8 ± 0.5 days, in II group - 6.2 ± 0.5 days (p>0,05). Conclusion. The use of QL block, compared with TAP block, showed a pain severity decreasing in 2 times (p <0.05), a tendency to reduce the need for nalbuphine use in 2.5 times (p> 0.05), and a tendency to reduce the duration of hospitalization by 1.6 days (p> 0.05).

scholarly journals TAP Block in Postoperative Analgesia, A First Time Clinical Trial In Bangladesh

2016 ◽  
Vol 27 (1) ◽  
pp. 3-11
Author(s):  
Bidhan Paul ◽  
Debashis Banik ◽  
AKM Shamsul Alam
Keyword(s):  
Postoperative Analgesia ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Analgesic Regimen ◽  
Time Period ◽  
Group A ◽  
Group B

Background: In perioperative care, a reliable pain management is a vital appeal. Over recent years, Transversus Abdominis Plane (TAP) block is introduced as an important component of multimodal analgesia.Objective: To evaluate efficacy of TAP block in postoperative analgesia for Total Abdominal Hysterectomy (TAH) with subarachnoid block (SAB) in comparison of morphine consumption and VAS score.Methods: 60 patients were randomly allocated into 2 groups (TAP group-A & control group-B). Standard SAB was applied to all patients for elective TAH. Immediate after operation classical TAP block was performed through both Lumber Triangle Of Petit (LTOP) of group A patients. Both groups were placed in Post Anesthesia Care Unit (PACU), arranged a common standard postoperative analgesic regimen for all, observed periodically and documented it accordingly in pre-designed data sheet.Results: TAP block prolonged the mean time of 1st required I/V morphine (TAP vs control, mean±SD 271.23±40.34 vs 195.33±22.16 min., p=0.001HS). Morphine requirement was also reduced (17.4±5.4 vs 26.2±4.4 mg, p=0.001HS). Pain VAS scores at rest and movement were also reduced at all time period (p? 0.01 to 0.001). There was no complication attributed to the TAP block.Conclusion: TAP block provided considerably effective postoperative analgesia in first 24 hours after major abdominal surgery like TAH.Journal of Bangladesh Society of Anaesthesiologists 2014; 27(1): 3-11

scholarly journals Bilateral Ultrasound-Guided Erector Spinae Plane Block Versus Transversus Abdominis Plane Block on Postoperative Analgesia after Total Abdominal Hysterectomy

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. 375-382
Author(s):  
Alshaimaa Abdel Fattah Kamel
Keyword(s):  
Postoperative Analgesia ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis Plane Block ◽  
Erector Spinae ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Erector Spinae Plane Block

Background: Transversus abdominis plane (TAP) blocks provide postoperative pain relief after various abdominal surgeries. Recently, erector spinae plane (ESP) block has obtained vast attention due to its simplicity and usage in truncal procedures. Objectives: This study aims to compare the ultrasound-guided bilateral ESP block versus bilateral TAP block on postoperative analgesia after open total abdominal hysterectomy. Study Design: A prospective, double-blinded, randomized, controlled, clinical trial. Setting: Zagazig University Hospitals. Methods: After ending of surgical procedure and before reversing of the muscle relaxant, 48 women were randomly allocated into 2 equal groups: erector spinae (ES) group received bilateral ultrasound-guided ESP block with 20 mL of bupivacaine 0.375% plus 5 ug/mL adrenaline (1:200000) in each side at the level of T9, and transversus abdominis (TA) group received bilateral ultrasound-guided TAP block with the same volume of bupivacaine plus adrenaline. Results: Visual Analog Scale scores at 30 minutes, 2, 4, 6, 8, 12, 16, 20, and 24 hours were statistically significantly lower in the ES group compared with the TA group. The time for requirement of first morphine was highly statistically significantly prolonged in the ES group (14.81 ± 3.52 hours) compared with the TA group (10.58 ± 2.35 hours). The total amount of morphine consumption in 24 hours postoperatively was statistically significantly decreased in the ES group; P = 0.01. Incidence of postoperative nausea and vomiting was higher but statistically insignificant in the TA group than the ES group. There were statistically significant numbers of unsatisfied patients (4) in the TA group compared with the ES group (no patient). Limitations: Sensorial evaluation of patients was not performed because both blocks had been done under general anesthesia but did not affect outcome. Therefore we recommend further studies comparing between both blocks. Conclusions: Bilateral ultrasound-guided ESP block provides more potent and longer postoperative analgesia with less morphine consumption than TAP block after open total abdominal hysterectomy. Key words: Abdominal hysterectomy, transversus abdominis plane block, erector spinae plane block, postoperative 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.

scholarly journals Ultrasound-guided quadratus lumborum block verses transversus abdominis plane block for post-operative analgesia in patients undergoing total abdominal hysterectomy: A prospective observational study

2021 ◽  
Vol 12 (11) ◽  
pp. 119-124
Author(s):  
Mohammad Sadiq Malla ◽  
Sameena Ashraf ◽  
Rayees Najib ◽  
Abdul Hakeem
Keyword(s):  
Spinal Anesthesia ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Post Operative Pain ◽  
Quadratus Lumborum ◽  
Group A ◽  
Group B

Background: Total abdominal hysterectomy (TAH) is a major surgical procedure associated with significant post-operative pain and discomfort. Ultrasound-guided (USG) quadratus lumborum (QL) and transversus abdominis plane (TAP) block are regional analgesic techniques that have role in post-operative pain management after TAH. Aims and Objectives: This study aims to compare quality of post-operative analgesia and analgesic consumption in USG-guided QL block and TAP block in patients undergoing TAH under spinal anesthesia. Materials and Methods: Hundred patients scheduled for TAH were observed over a period of 2 years. The patients who had received either TAP block or QL block were assigned in two groups. Patients who received TAP block after spinal anesthesia were labeled as Group A and patients who received QL block after spinal anesthesia were labeled as Group B. Postoperatively, VAS score, rescue analgesia, analgesic consumption, and hemodynamic parameters were observed at 0, 1, 3 6, 9, 12, 18, 24, and 48 h. Statistical Analysis: Student’s independent t-test was employed for comparing continuous variables. Chi-square test or Fisher’s exact test, whichever appropriate, was applied for comparing categorical variables. P<0.05 was considered statistically significant. Results: Time for rescue analgesic requirement was higher in the Group B than the Group A (mean±SD: 16.5±3.096 h vs. 8.5±1.998 h) (P<0.001). Group B had significantly less analgesic demand (P<0.001) at 12, 24, and 48 h postoperatively. The VAS at rest and movement was significantly reduced in Group B at all times. Hemodynamic parameters and post-operative side effects between two groups remained insignificant. Conclusion: USG-guided quadratus lumber block provided prolonged analgesia as compared to TAP block in patients undergoing TAH after spinal anesthesia. USG-guided quadratus lumber block provides better multimodal post-operative analgesia relief in patients.

scholarly journals Efficacy of Magnesium Sulfate Added to Local Anesthetic in a Transversus Abdominis Plane Block for Analgesia Following Total Abdominal Hysterectomy: A Randomized Trial

2017 ◽  
Vol 7 (20;7) ◽  
pp. 641-647
Author(s):  
Ahmad M. Abd El-Rahman
Keyword(s):  
Side Effects ◽  
Magnesium Sulfate ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Group I ◽  
The Mean ◽  
Group Ii ◽  
Double Blinded

Background: Major abdominal surgeries are associated with severe pain, which can affect respiratory and cardiac functions if insufficiently treated; this increases postoperative morbidity. Objective: We aim at evaluating the efficacy of magnesium sulfate as an adjuvant to local anesthetic in an ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in total abdominal hysterectomy. Study Design: A prospective, randomized, double-blinded clinical trial. Setting: An academic medical center. Methods: This study is registered at https://clinicaltrials.gov (no.: NCT02930707). This randomized, double-blinded clinical trial included 60 women undergoing total abdominal hysterectomy that were divided into 2 groups (30 patients per group). Group I received a TAP block with 20 mL per side of 0.25% bupivacaine plus 2 mL magnesium sulphate 10% (200 mg). Group II received a TAP block with 20 mL per side of 0.25% bupivacaine. Visual analog scale (VAS) scores, the time of the first analgesic request, total morphine consumption, and any side effects were assessed and recorded. Results: The mean postoperative VAS score was significantly reduced in group I compared to group II in all of the time-points except after 10 hours. The mean time of the first request for rescue analgesia was significantly prolonged in group I (15.67 hrs.) compared to group II (7.33 hrs.) (P < 0.001), and the mean total morphine consumption, over the first 24 hours postoperatively, was significantly lower in group I (7.63 ± 2.93 mg) than in group II (16.20 ± 3.24 mg) (P < 0.001). No significant difference in side effects was observed. Limitations: Sample size. Conclusion: The addition of 200 mg of magnesium sulfate to bupivacaine in an ultrasound-guided TAP block significantly reduced postoperative opioid requirements, prolonged the duration of analgesia, and reduced the VAS score in patients who underwent abdominal hysterectomy, without significant side effects. Key words: Magnesium sulfate, TAP block, postoperative pain, total abdominal hysterectomy

scholarly journals Ultrasound-Guided Quadratus Lumborum Block as A Postoperative Analgesia for Total Abdominal Hysterectomy: A Case Report

2021 ◽  
Author(s):  
Haytham El Sayed Mohamed ◽  
Fadheela Al Najar ◽  
Mohamed Nasr Awad ◽  
Faten M Hassan
Keyword(s):  
Side Effects ◽  
Abdominal Surgery ◽  
Analgesic Effect ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Multimodal Analgesia ◽  
Ultrasound Guided ◽  
Quadratus Lumborum Block ◽  
Quadratus Lumborum ◽  
Obstructive Sleep

Abstract Background and aim: Total Abdominal Hysterectomy is a major invasive abdominal surgery which is accompanied with severe postoperative pain. Multimodal analgesia techniques can provide efficient analgesics coverage with minimal side effects, Quadratus Lumborum Block is an abdominal wall block which gives a good analgesic effect for abdominal surgery with lower pain score and less opioids requirements.Case presentation: A 67 years old female was scheduled to undergo total abdominal hysterectomy surgery, she had comorbidities; morbid obesity, bronchial asthma, obstructive sleep apnea, and hypothyroidism. We performed General Anesthesia and by the end of surgery, a Quadratus Lumborum Block was done ultrasound-guided technique.Conclusion: We successfully performed Quadratus Lumborum Block bilaterally which was able to provide a sufficient analgesic effect for Total Abdominal Hysterectomy surgery, giving our patient the opportunity of early ambulation and avoiding opioids side effects especially the respiratory adverse effect.

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.

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