scholarly journals Analgesic Efficacy of Preemptive Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Colorectal Cancer Surgery

2020 ◽  
Vol 9 (5) ◽  
pp. 1577
Author(s):  
Kwan Young Hong ◽  
Duk Kyung Kim ◽  
Hue Jung Park ◽  
Woo Seog Sim ◽  
Won Gook Wi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Heart Rate ◽  
Mean Arterial Pressure ◽  
Cancer Surgery ◽  
Transversus Abdominis ◽  
Group Differences ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Colorectal Cancer Surgery ◽  
Pain Scores

Despite rapid advancements in laparoscopic surgical devices and techniques, pain remains a significant issue. We examined the efficacy of preemptive transversus abdominis plane (TAP) block for acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed 153 patients who underwent laparoscopic colorectal cancer surgery with or without TAP block; among them, 142 were allocated to the TAP or non-TAP group. We performed between-group comparisons of demographic, clinical, and anesthetic data and pain scores at a postoperative anesthesia care unit (PACU) and at postoperative days 1, 3, and 5. There were no significant between-group differences in demographic and clinical characteristics. The mean arterial pressure, heart rate, and minimum alveolar concentration (MAC) were significantly lower in the TAP group at the start and end of surgery. The post-extubation bispectral index was significantly higher in the TAP group. There were no significant between-group differences in the pain scores and opioid consumption at the PACU or at postoperative days 1, 3, and 5, or in the time to pass flatus, the hospital stay length, and postoperative complications. Preemptive TAP block showed an intraoperative, but not postoperative, analgesic effect, characterized by a low mean arterial pressure, heart rate, and MAC.

scholarly journals Analgesic efficacy of postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block for laparoscopic colorectal cancer surgery: a randomized, prospective, controlled study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yang Zhao ◽  
Han-Ying Zhang ◽  
Zong-Yi Yuan ◽  
Yi Han ◽  
Yi-Rong Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Side Effects ◽  
Cancer Surgery ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Colorectal Cancer Surgery ◽  
Pain Scores ◽  
Group Control

Abstract Background We assessed whether a postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane (TAP) block could reduce 24 h rescue tramadol requirement compared with placebo in patients undergoing elective laparoscopic colorectal cancer surgery. Methods Patients scheduled to undergo elective laparoscopic surgery following the diagnosis of colorectal cancer were included in this study and randomized into Group and Group Control. The patients received a postoperative bilateral, ultrasound-guided, posterior TAP block in either 20 mL of 0.5% ropivacaine (Group TAP) per side or an equivalent volume of normal saline (Group Control). The primary outcome was the cumulative consumption of rescue tramadol within 24 h after the surgery. Secondary endpoints included (1) resting and movement numerical rating scale (NRS) pain scores at 2, 4, 6, 12, 24, 48, and 72 h; (2) incidences of related side effects; (3) time to the first request for rescue tramadol; (4) patient satisfaction regarding postoperative analgesia; (5) time to restoration of intestinal function; (6) time to mobilization; and (7) the length of hospital stay. Results In total, 92 patients were randomized, and 82 patients completed the analysis. The total rescue tramadol requirement (median [interquartile range]) within the first 24 h was lower in Group TAP (0 [0, 87.5] mg) than in Group Control (100 [100, 200] mg), P < 0.001. The posterior TAP block reduced resting and movement NRS pain scores at 2, 4, 6, 12, and 24 h after surgery (all P < 0.001) but showed similar scores at 48 h or 72 h. A higher level of satisfaction with postoperative analgesia was observed in Group TAP on day 1 (P = 0.002), which was similar on days 2 (P = 0.702) and 3 (P = 0.551), compared with the Group Control. A few incidences of opioid-related side effects (P < 0.001) and a lower percentage of patients requiring rescue tramadol analgesia within 24 h (P < 0.001) were observed in Group TAP. The time to the first request for rescue analgesia was prolonged, and the time to mobilization and flatus was reduced with a shorter hospital stay in Group TAP as compared with Group Control. Conclusions A postoperative bilateral, ultrasound-guided, posterior TAP block resulted in better pain management and a faster recovery in patients undergoing laparoscopic colorectal cancer surgery, without adverse effects. Trial registration The study was registered at http://www.chictr.org.cn (ChiCTR-IPR-17012650; Sep 12, 2017).

The Analgesic Efficacy of Postoperative Bilateral, Ultrasound-Guided, Posterior Transversus Abdominis Plane Block for Laparoscopic Colorectal Cancer Surgery: A Randomized, Prospective, Controlled Study

2020 ◽  
Author(s):  
Yang Zhao ◽  
Han-Ying Zhang ◽  
Zong-Yi Yuan ◽  
Yi Han ◽  
Yi-Rong Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rating Scale ◽  
Transversus Abdominis Plane Block ◽  
Cancer Surgery ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Colorectal Cancer Surgery ◽  
Pain Scores ◽  
Group Control

Abstract Background: The study aimed to observe whether a postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block offers more benefits than placebo in patients undergoing elective laparoscopic colorectal cancer surgery in the enhanced recovery after surgery program.Methods: Patients scheduled to undergo elective laparoscopic surgery following the diagnosis of colorectal cancer were included in this study and randomized into Group TAP and Group Control. The patients received a postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block either 20 mL of 0.5% ropivacaine (Group TAP) per side or an equivalent volume of normal saline (Group Control). The primary outcome was the cumulative consumption of rescue tramadol within 24 h after the surgery. Secondary endpoints included numerical rating scale (NRS) pain scores at rest and movement at 2, 4, 6, 12, 24, 36, 48, and 72 h. The related side effects, time to the first request for rescue tramadol, patient satisfaction on postoperative analgesia, time to the intestinal function return, time to mobilization, and the length of hospital stay were recorded.Results: In total, 92 patients were randomized, and 82 completed the trial. The posterior TAP block reduced numeric rating scale pain scores at rest and movement at 2, 4, 6, 12, and 24 h after surgery but showed similar scores at 48 or 72 h. The total rescue tramadol requirement within the first 24 h reduced in Group TAP. A higher level of satisfaction with postoperative analgesia was observed in Group TAP on day 1 which was similar on days 2 and 3, compared with the Group Control. There were no complications due to the TAP block. A few incidences of opioids related side effects and a lower percentage of patients needing rescue tramadol analgesia within 24 h were observed in Group TAP. The time to the first request for rescue analgesia was prolonged, and the time to mobilization and flatus was reduced with a shorter hospital stay in Group TAP.Conclusions: A postoperative bilateral, ultrasound-guided, posterior transversus abdominis plane block resulted in better pain relief and a faster recovery in patients undergoing laparoscopic colorectal cancer surgery, without adverse effects. Trial registration: The study was registered at http://www.chictr.org.cn (ChiCTR-IPR-17012650，12, Sep 2017).

EFFICACY OF TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POST CESAREAN DELIVERY ANALGESIA

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

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.

Comparison between Ultrasound Guided Transversus Abdominis Plane Block versus Ultrasound Guided IlioInguinal/Iliohypogastric Nerves Block for Postoperative Analgesia in Patients Undergoing Unilateral Oblique Inguinal Hernia Repair Under General Anesthesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Shrouk Ayman Mohamed Soliman Faramawy ◽  
Samia Abdel-Mohsen Abdel-Latif ◽  
Mohamed Abdel-Salam Menshawe Abdel-Atte ◽  
Ibrahim Mohammed El Sayed Ahmed
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
General Anesthesia ◽  
Inguinal Hernia Repair ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Rescue Analgesia ◽  
Pain Scores

Abstract Background Inguinal hernia considered the third common disease in surgeries for adults 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. Objectives The aim of this study is to assess the postoperative analgesic efficacy of transversus abdominis plane (TAP) block compared to ilioinguinal/iliohypogastric nerves block after unilateral inguinal hernia repair regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods The study was conducted on 70 randomly chosen patients aged 21 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia, in Ain Shams University Hospitals after approval of the medical ethical committee. Results The results of the study revealed that there is Patients receiving TAP block had significantly lower pain scores at 4 h and 6 h after operation, delay time for rescue analgesia and decrease total need of analgesic in first 24 h post operative compared with patients who received ilioinguinal/ iliohypogastric nerves block. Conclusion TAP block was effective in reducing postoperative pain scores for 4-6 hours, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to ilioinguinal/iliohypogastric nerves block. This technique can be a promising mode of postoperative analgesia when epidural catheter insertion is contraindicated.

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

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

scholarly journals Postoperative Analgesic Efficacy of Nalbuphine vs Dexmedetomidine as Adjuvants to Ropivacaine in Ultrasound Guided Transversus Abdominis Plane Block for Abdominal Hysterectomies: A Randomised Clinical Study

2021 ◽  
Author(s):  
Sumanth Tarigonda ◽  
Vishnuvardhan Voleti ◽  
Dinesh Krishnamurthy ◽  
Sheela Shikaripura Rangappa
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
P Value ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Pain Scores ◽  
Patient Reported ◽  
Group D

Introduction: Transversus Abdominis Plane (TAP) block has been practised as an effective alternative to systemic analgesics to achieve adequate postoperative analgesia, with minimal systemic side effects. Dexmedetomidine, an alpha-2 agonist and nalbuphine, an opioid, have been studied as adjuvants to local anaesthetics to improve the analgesic profile of regional anaesthetic blocks. Aim: To compare the duration and quality of postoperative analgesia of dexmedetomidine and nalbuphine when used as adjuvants to ropivacaine for TAP block. Materials and Methods: This was a randomised double blinded study conducted on 60 patients undergoing total abdominal hysterectomies under spinal anaesthesia. Patients were randomly distributed into two groups of 30 patients each, to receive either 39 mL of 0.2% ropivacaine+50 μg dexmedetomidine (1 mL) (group D) or 39 mL of 0.2% ropivacaine+10 mg nalbuphine (1 mL) (group N), for bilateral TAP block. Postoperative pain scores, time for first rescue analgesic request and incidence of side effects were compared. Results: Duration of postoperative analgesia was similar in both groups (409.14±48.92 minutes in group D vs 419.03±54.11 minutes in group N) (p-value=0.462). Postoperative pain scores and total amount of rescue analgesic requirement (105.17±42.98 vs 106.45±46.08) was also similar in both the groups (p=0.912). In Nalbuphine group, 16.7% reported pruritis (p-value=0.02) and 13.3% reported nausea (p-value=0.213). However, in group D only one patient reported nausea two hours postoperatively. Conclusion: Nalbuphine when compared to dexmedetomidine, as an additive to ropivacaine for TAP block, provides similar postoperative analgesic duration and efficacy, but increases the incidence of pruritus and nausea.

scholarly journals Evaluation of the Intraoperative Perfusion Index for Correlation with Acute Postoperative Pain in Patients Undergoing Laparoscopic Colorectal Cancer Surgery

2019 ◽  
Vol 8 (9) ◽  
pp. 1299
Author(s):  
Ji Hye Kwon ◽  
Hue Jung Park ◽  
Woo Seog Sim ◽  
Joo Hyun Park ◽  
Kang Ha Jung ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Diagnostic Value ◽  
Cancer Surgery ◽  
Perfusion Index ◽  
Acute Postoperative Pain ◽  
Colorectal Cancer Surgery ◽  
Clinical Issue ◽  
Index Change ◽  
Pain Scores

Despite technical advancements in the perioperative management of cancer surgery, postoperative pain remains a significant clinical issue. We examined the diagnostic value of the intraoperative perfusion index for predicting acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed data for 105 patients who had undergone laparoscopic colorectal cancer surgery. Patients with pain scores <7 and ≥7 on a 10-point scale upon arrival in the postoperative anesthesia care unit (PACU) were categorized into the N and P groups, respectively. The perfusion index value was extracted prior to intubation, at the start and end of surgery, and after extubation. To minimize individual variance in the absolute value of the perfusion index, we calculated the perfusion index change ratio. A total of 98 patients were examined. Among them, 50 (51.0%) and 48 (49.0%) patients reported pain scores of <7 and ≥7 upon arrival at the PACU, respectively. Fentanyl consumption during the intraoperative and PACU periods was significantly higher in Group P than in Group N (p < 0.001). The perfusion index change ratios did not significantly differ between the groups. The intraoperative perfusion index change ratios do not correlate with acute postoperative pain following laparoscopic colorectal cancer surgery.

scholarly journals Comparison of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Çağdaş Baytar ◽  
Canan Yılmaz ◽  
Derya Karasu ◽  
Serra Topal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Pain Scores ◽  
Quadratus Lumborum ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Analgesia Requirement

Background. The aim of this study was to compare the effectiveness of ultrasound-guided (USG) subcostal transversus abdominis plane (TAP) block and quadratus lumborum (QL) block as preventive analgesia methods after laparoscopic cholecystectomy. Methods. A total of 120 patients, 18–75 years of age, were separated into 2 groups preoperatively. Patients in group TAP (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral subcostal TAP block; patients in group QL (n = 60) received 0.3 ml/kg bupivacaine with USG bilateral QL block. Patients were assessed 24 h postoperatively, and pain scores, time to first analgesia requirement, total analgesia dose, and postoperative complications during the first 24 h were recorded. Results. Fifty-three patients in group TAP and 54 in group QL were ultimately evaluated. No statistically significant difference was found in at rest and dynamic visual analog scale scores between the groups. There was also no statistically significant difference between the groups with regard to total analgesia consumption. Although the duration of anesthesia was significantly longer in group QL, no statistically significant difference was found in the duration of surgery between the groups (p<0.05). Conclusions. Results of this study demonstrated that USG subcostal TAP and QL blocks similarly reduced postoperative pain scores and analgesia consumption, with high patient satisfaction. However, subcostal TAP block could be considered preferable to QL block because it can be applied easily and in a shorter time.

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