scholarly journals Transversus Abdominis Plane Block in the Management of Acute Postoperative Pain Syndrome after Caesarean Section: A Randomized Controlled Clinical Trial

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. 583-591
Author(s):  
Emiliano Petrucci
Keyword(s):  
Postoperative Pain ◽  
Bowel Function ◽  
Postoperative Recovery ◽  
Transversus Abdominis ◽  
Controlled Clinical Trial ◽  
Tap Block ◽  
Acute Postoperative Pain ◽  
Double Blind ◽  
Analgesic Treatment ◽  
Randomized Controlled

Background: The international literature is unclear regarding the analgesic efficacy of the transversus abdominis plane block (TAPB) after a Caesarean section (CS). Objectives: The aim of this study was to determine whether a correctly performed ultrasound-guided TAPB (USG-TAPB) could provide better control of acute postoperative pain during the first 72 hours after CS and if it could provide a faster postoperative recovery. Study Design: A double-blind, randomized, controlled clinical trial on pregnant women who underwent CS. Setting: Pain clinic and Anesthesia and Intensive Care Unit in an academic hospital. Methods: A double-blind, randomized, controlled study was conducted with 96 patients who underwent CS. The patients in both groups received subarachnoid anesthesia (SAB) with 13 mg of 0.5% isobaric levobupivacaine. The patients were randomized so that some received USG-TAPB with local anesthetic, and the remainder received USG-TAPB with saline. The patients’ demographic information and data regarding anesthesia, hemodynamic changes, side effects, acute rest and incident postoperative pain, painkiller consumption, recovery time of bowel function, and the time of hospital discharge were recorded. Results: Our data reinforce the assumption that if TAP block is performed correctly and is part of a multimodal analgesic scheme, effective pain control is possible both for somatic and visceral acute pain. Furthermore, the need for painkillers is reduced, and their related side effects are moderate, yielding a positive benefit/cost ratio. Limitations: USG-TAPB provides good analgesia for acute postoperative somatic pain, but opiates were still needed for the management of visceral acute postoperative pain. Conclusions: These results could confirm the assumption that the correct performance of an USG-TAPB as part of a multimodal analgesic treatment could represent a viable alternative to common analgesic procedures performed for acute postoperative pain control after a CS. Key words: Bowel function, Caesarian section, incident pain, local anesthetics, multimodal analgesic treatment, postoperative recovery, rest pain, ultrasound-guided TAP block

A Clinical Trial of Adding Morphine to Levobupivacaine in TAP Block for Open Appendectomy

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Farouk Ibrahim ◽  
Kareem Youssef Kamal Hakim ◽  
Wael Sayed Ahmed Abdelghaffar Elgharabawy ◽  
Hebatullah Ramadan Muhammad
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Abdominal Wall ◽  
Postoperative Analgesia ◽  
Open Appendectomy ◽  
Transversus Abdominis ◽  
Controlled Clinical Trial ◽  
Tap Block ◽  
Nerve Blocks ◽  
Double Blind

Abstract Background Postoperative pain management is becoming an integral part of anaesthesia care. Various techniques of pain relief have been designed among which the most commonly practiced are peripheral nerve blocks. We have designed the study to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability, and total need of analgesics and opioids after adding morphine to levobupivacaine in TAP block for open appendectomy. A substantial component of the pain experienced by patients after major abdominal surgery is derived from the abdominal wall incision. The abdominal wall consists of three muscle layers, the external oblique, the internal oblique and the transversus abdominis, and their associated fascial sheaths. This muscular wall is innervated by nerve afferents that course through the transversus abdominis neuro-fascial plane. Different adjuvants have been studied to improve the quality and increase the duration of local anaesthetics during various nerve block techniques. Aim of the work The aim of this study is to assess the analgesic effect of peripherally administered morphine with levobupivacaine for ipsilateral TAP block in patients undergoing appendectomy under general anaesthesia. Patient and Methods Type of Study prospective, randomized and double blind controlled clinical trial. Study Setting Ain Shams University Hospitals. Study Period 6 months. Sampling Method randomized double blind clinical trial. suction evacuation for molar pregnancy, all cases were included in the study were agreed on a consent for inclusion in the current study after explanation for the details of the study. Conclusion TAP block was effective in reducing postoperative pain scores, lowering total 24-h postoperative analgesic consumption. Morphine as an adjunct to levobupivacaine in ipsilateral ultrasound guided transversus abdominis plane block as more effective postoperative analgesia with reduced analgesic requirement in patients undergoing appendectomy.

scholarly journals Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-18 ◽  
Author(s):  
Qiang Cai ◽  
Mei-ling Gao ◽  
Guan-yu Chen ◽  
Ling-hui Pan
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Adult Patients ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Wound Infiltration ◽  
Randomized Controlled

Background. How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. Materials and methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores. Results. Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference=−0.32, 95% confidence interval (-0.87, 0.24), P=0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction. Conclusion. TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.

scholarly journals Effect of Transversus Abdominis Plane Block on Postoperative Pain after Colorectal Surgery: A Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 27 (2) ◽  
pp. 158-165 ◽  
Author(s):  
Lin Liu ◽  
Yan-Hu Xie ◽  
Wei Zhang ◽  
Xiao-Qing Chai
Keyword(s):  
Postoperative Pain ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Analgesic Efficacy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Objectives: To assess the analgesic efficacy of transversus abdominis plane (TAP) block in patients undergoing colorectal surgery (CRS). Materials and Methods: The databases of PubMed, ISI Web of Science, and Embase were searched, and randomized controlled studies (RCTs) that compared TAP block to control for relief of postoperative pain in patients who underwent CRS were included. Outcomes, including postoperative pain at rest and with movement, morphine use, postoperative nausea and vomiting, and the length of hospital stay, were analyzed using STATA software. The weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) or relative risk with 95% CI were used to present the strength of associations. Results: A total of 7 RCTs with 511 patients were included. The results of this study suggested that TAP block significantly relieved postoperative pain during postanesthetic recovery after CRS at rest and during movement (WMDs were –0.98 [95% CI –1.57 to –0.38] and –0.68 [–1.07 to –0.30], respectively), and also decreased pain intensity during movement 24 h after CRS (WMD: –0.57 [95% CI –1.06 to –0.08]). TAP block significantly reduced opioid consumption within 24 h when compared to controls, with a WMD of 15.66 (95% CI –23.93 to –7.39). However, TAP block did not shorten the length of hospital stay. Conclusions: TAP block was an effective approach for relief of postoperative pain and reduced postoperative consumption of morphine. More RCTs with large sample sizes are required to confirm these findings.

scholarly journals 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

2020 ◽  
Author(s):  
YANG YU ◽  
Shenshan GAO ◽  
Vivian Manying YUEN ◽  
Wai Siu CHOI ◽  
Xuebing XU
Keyword(s):  
Postoperative Pain ◽  
Caesarean Delivery ◽  
Breakthrough Pain ◽  
Controlled Trial ◽  
Multimodal Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Randomized Controlled ◽  
Oral Analgesia

Abstract Background: The transversus abdominis plane (TAP) block is used increasing in parturients after caesarean delivery. This is a randomized controlled trial to evaluate the effectivenss of TAP in patients who received multimodal oral analgesia for postoperative pain relief.Methods: Parturient who were scheduled for elective caesarean delivery under spinal anaesthesia were recruited and randomized to receive TAP block 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 parturient in TAP group would have an injection of local anaesthesia under aseptic techniques. All the parturient were evaluated for pain or related complications in the first 24 hours after surgery. Results: Eighty and 79 parturients were allocated to TAP and placebo group respectively. Nine out of 79 (11.4%) and 15 out of 73 (20.5%) parturients required oxycodone for breakthrough pain, P = 0.122. There was no difference in postoperative pain score and patient satisfactory score between the two groups. Conclusions: TAP block confers little additional benefit when multi-modal oral analgesic regimen is used for postoperative 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

scholarly journals Low-Dose Ketamine Infusion Versus Morphine Infusion During Abdominoplasty to Change the Postoperative Pain Profile

2020 ◽  
Vol 10 (6) ◽  
Author(s):  
Hassan Ali ◽  
Ahmed Abdelaziz Ismail ◽  
Amr Samir Wahdan
Keyword(s):  
Side Effects ◽  
Postoperative Pain ◽  
Low Dose ◽  
Controlled Clinical Trial ◽  
Randomized Controlled Clinical Trial ◽  
Double Blind ◽  
Ketamine Infusion ◽  
Randomized Controlled ◽  
Morphine Infusion ◽  
Effective Drugs

Background: With the increased number of abdominoplasty all over the world, and the need to manage postoperative pain, it is a must to find proper and effective drugs to decrease opioid consumption in the postoperative period. Objectives: In this double-blind randomized controlled clinical trial, we assumed that low-dose ketamine infusion will reduce the postoperative pain profile than the conventional method of morphine. Methods: The scheduled patients for abdominoplasty under general anesthesia were recruited in two groups: group (K) with low-dose ketamine infusion intra-operatively (80 patients) and group (M) with morphine infusion intra-operatively (80 patients). Both groups were monitored intraoperatively and postoperatively for rescue doses of fentanyl, visual analogue scale (VAS), and side effects. Results: There were no statistical differences between both groups regarding the fentanyl rescue doses intra- and postoperative with no remarkable side effects. Conclusions: Low-dose ketamine has a useful analgesic effect in abdominoplasty similar to morphine without remarkable side effects, such as sedation or hallucinations.

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