scholarly journals Ultrasound-Guided Regional Analgesia for Post-Cesarean Pain

2022 ◽  
Author(s):  
Pablo Santillán Roldan ◽  
Andrés Cepeda Mora ◽  
Pablo Armas Cruz ◽  
Lorena Guacales Zambrano ◽  
Geraldine Paredes ◽  
...  
Keyword(s):  
Pain Management ◽  
Visceral Pain ◽  
Intrathecal Morphine ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Regional Analgesia ◽  
Methodologic Quality ◽  
Severe Postoperative Pain ◽  
Contradictory Evidence ◽  
Long Acting

Pain management after a surgical intervention is one of the fundamental pillars for optimal patient recovery. In obstetric patients, this management may affect the mother and the newborn. The gold standard for analgesic management is the use of intrathecal morphine due to its long-lasting effect; however, adverse effects related to the use of opioids are evidenced, whether administered intrathecally or systemically in case of contraindication to the neuraxial approach or if a long-acting opioid is not available. Cesarean sections have been associated with moderate-to-severe postoperative pain. Multimodal analgesic management seeks to minimize the undesirable effects on the mother-newborn binomial in order to increase maternal satisfaction. The most studied regional blocks for this surgery are the transversus abdominis plane block and the ilioinguinal-iliohypogastric block, which shows contradictory evidence at the time of evaluate pain where there is no significant difference compared with intrathecal morphine, but there were fewer side effects with the TAP block group when assessing pruritus, nausea, and vomiting. Quadratus lumborum and erectus spinae plane block demonstrate its usefulness with better pain management compared with TAP block regardless of them having a higher level of complexity due to the visceral pain control; but there is no evidence with methodologic quality enough that demonstrates better outcomes compared with intrathecal morphine.

scholarly journals Treatment of Acute Flares of Chronic Pancreatitis Pain with Ultrasound Guided Transversus Abdominis Plane Block: A Novel Application of a Pain Management Technique in the Acute Care Setting

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Daryl I. Smith ◽  
Kim Hoang ◽  
Wendy Gelbard
Keyword(s):  
Care Setting ◽  
Visceral Pain ◽  
Anterior Abdominal Wall ◽  
Transversus Abdominis ◽  
Management Technique ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Complete Control ◽  
Long Duration ◽  
Effective Analgesia

The use of transversus abdominis plane (TAP) block to provide either analgesia or anesthesia to the anterior abdominal wall is well described. The technique yields high analgesic effectiveness and is opioid sparing and potentially of long duration with reported analgesia lasting up to 36 hours. When compared to neuraxial analgesia, TAP blocks are associated with a lower incidence of hypotension and motor blockade. TAP blocks are typically described as providing somatic analgesia only without any effect on visceral pain. There may be, however, certain conditions in which TAP blocks can provide effective analgesia in pain of visceral or mixed somatic and visceral origin. We describe two cases in which TAP blockade provided complete control of pain considered to be of visceral origin.

scholarly journals Low Concentration Epidural Anesthesia Combined with Transversus Abdominis Plane Block -- A Case Report in A High-risk Colostomy Operation

2020 ◽  
Keyword(s):  
High Risk ◽  
Epidural Anesthesia ◽  
Visceral Pain ◽  
Test Dose ◽  
Skin Incision ◽  
Transversus Abdominis ◽  
Severe Malnutrition ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Low Concentration

We report a high-risk cachexia patient receiving special regional anesthesia in a colostomy operation. Because of multiple underlying diseases and severe malnutrition status, we combined epidural anesthesia (EA) with transversus abdominis plane (TAP) block. Low concentration EA (Lidocaine 1% as test dose and rescue dose; Bupivacaine 0.2% as loading and maintenance dose) aimed for visceral pain; subcostal TAP block (Bupivacaine 0.25%) focused on the skin incision. The colostomy was done completely without any complication. Our case showed that low concentration EA combined with TAP block provided stable and sufficient anesthesia and could be a sole anesthesia technique in a colostomy.

scholarly journals P1184TRANSVERSUS ABDOMINIS PLAIN BLOCK RELIEVES PERIOPERATIVE PAIN ON PERITONEAL DIALYSIS CATHETER INSERTION: A RANDOMISED CONTROLLED STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Kenji Harada ◽  
Hidetoshi Kanai
Keyword(s):  
Peritoneal Dialysis ◽  
Pain Management ◽  
Therapeutic Option ◽  
Catheter Insertion ◽  
Transversus Abdominis ◽  
Controlled Study ◽  
Peritoneal Dialysis Catheter ◽  
Block Group ◽  
Tap Block ◽  
Perioperative Pain

Abstract Background and Aims The effectiveness of Transversus Abdominis Plain (TAP) block has been reported in the pain control at abdominal operation. However, its usefulness in pain management remains unclear in peritoneal dialysis (PD) patients undergoing catheter insertion. We investigated the effectiveness and safety of TAP block for perioperative on PD catheter insertion. Method The present study is a single-centred, prospective, randomised study of initiated PD patients between from October 2017 to January 2020. VAS (Visual Analogue Scale), which is often used around anesthesiology and pain management area, was measured as pain assessment. VAS was measured at five points, right after and 1, 3, 6, 24 hours after operation, using t-test with P values. Results Overall, 106 PD patients were included (mean age; 63.8 years old, male/female; 81/25, average eGFR 7.54±2.64). Patients were divided into two groups TAP block (n=50) and non-TAP block (n=56). There were significantly low VAS in TAP block group right after operation (1.39 vs 2.88, p=0.0035) and 1 hour after operation (1.86 vs 3.19, p=0.0078). Furthermore, total five points of VAS were significantly low VAS in TAP block group (10.59 vs 13.85, p=0.028). There were no cases needed for ventilation and anesthetic drug such as morphine. TAP block-related adverse events were not found. Conclusion TAP block technique was significantly associated with relief from post-operative pain in PD catheter insertion. This treatment procedure might be a minimally invasive and effective therapeutic option for perioperative pain management on PD catheter insertion.

Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review

2019 ◽  
Vol 44 (11) ◽  
pp. 1035-1037 ◽  
Author(s):  
Jacob Cole ◽  
Scott Hughey ◽  
Jason Longwell
Keyword(s):  
Postoperative Pain ◽  
Cesarean Section ◽  
Retrospective Review ◽  
Intrathecal Morphine ◽  
Opioid Consumption ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Opioid Use ◽  
Transversus Abdominis Plane ◽  
Pain Scores

ObjectivesCesarean delivery is an extremely common surgical procedure practiced worldwide. It is an open abdominal surgery, and is associated with significant postoperative pain. One modality that helps alleviate this pain is the transversus abdominis plane (TAP) block. This analysis sought to evaluate postoperative pain when this block was used in conjunction with intrathecal morphine.MethodsA retrospective review was performed of 142 patients who underwent cesarean section at our institution. Of those, 43 patients had a TAP block performed. The primary outcome for this analysis was the time to first opioid administration following discharge from the operating room. Secondary outcomes included differences in postoperative pain scores, and overall opioid consumption.ResultsThe average time to first opioid use postoperatively decreased in the TAP group when compared with the No-TAP group, 23.3 versus 12.1, respectively (difference of 48.2% (95% CI 74.0% to 24.3%); p<0.001) and opioid consumption was significantly decreased within the first 24 hours following surgery from 4.55 intravenous morphine equivalents (IVME) to 2.67 IVME, respectively (difference of 107.1% (95% CI 145.1% to 69.2%); p=0.006). Visual analog pain scores were significantly decreased in the TAP group versus the No-TAP group up to 36 hours postoperatively.ConclusionsTAP blocks performed in conjunction with intrathecal morphine may decrease opioid use in the first 24 hours and improve pain scores for at least 36 hours following cesarean section. Because of the favorable safety profile, TAP blocks may contribute meaningfully to multimodal anesthesia for cesarean sections.

scholarly journals Intrathecal Morphine Versus Transversus Abdominis Plane Block for Caesarean Delivery: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Tao-ran Yang ◽  
Xue-han Li ◽  
Xue-mei He ◽  
Ru-rong Wang
Keyword(s):  
Pain Score ◽  
Cesarean Delivery ◽  
Subgroup Analysis ◽  
Intrathecal Morphine ◽  
Transversus Abdominis ◽  
Morphine Consumption ◽  
Tap Block ◽  
Analgesic Effects ◽  
Cesarean Deliveries ◽  
Significant Difference

Abstract Background: In recent years, the number of cesarean deliveries is on the rise. Although intrathecal morphine (ITM) can relieve pain and is widely applied in cesarean deliveries, it is also associated with many side effects. As a new analgesic technology, transversus abdominis plane (TAP) block has also begun to play a certain role after cesarean delivery, with fewer adverse effects. This article mainly compares the analgesic and adverse effect of ITM and TAP block in cesarean delivery.Methods: We systematically searched PubMed, Cochrane library, Embase and Web of Science, for randomized controlled trials before October 5, 2020 to compare ITM and TAP block. Our main result is the pain score at rest 24 hours after cesarean delivery, and the secondary result is the pain score at movement 24 hours after operation, postoperative nausea and vomiting (PONV), itching, and morphine consumption. We conducted a subgroup analysis based on economic development.Result: Six articles with 563 sample sizes were included. The results showed there was no significant difference between ITM and TAP block in the pain score at rest 24 hours after surgery (95% CI: -1.33 to 0.40; P=0.29). After subgroup analysis based on economic development, Parturients in the ITM group have lower rest pain score than those in the TAP group (95% CI: -1.27 to -0.28; P=0.002) in the developed area. There was no significant difference in the 24h moving pain score (95% CI:-1.47 to 0.29;P=0.19）and incidence of pruritus (95% CI:0.87 to 8.85;P=0.08). The ITM group showed less morphine consumption when compared with the TAP group (95% CI:-13.12 to -2.95;P=0.002）. The incidence of PONV was lower in the TAP group as compared to the ITM group (95% CI:1.92 to 4.87; P<0.00001).Conclusion: We found that Parturients in the ITM and TAP block groups had similar analgesic effects. However, after subgroup analysis, in developed countries, Parturients in the ITM group has better analgesic effects than those in the TAP block group with less morphine consumption. Differently, TAP block had low side effects such as nausea, vomiting. Therefore, if patients cannot use ITM for analgesia after cesarean delivery, or patients have high risk of PONV, then TAP is still a valuable analgesia option.Registration number: Registered on Prospero with the registration number of CRD42020210135

scholarly journals Transversus Abdominis Plane Neurolysis with Phenol in Abdominal Wall Cancer Pain Palliation

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E325-E330
Author(s):  
Rodolfo Gebhardt
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Abdominal Wall ◽  
Transversus Abdominis ◽  
World Health ◽  
Intractable Pain ◽  
Pain Palliation ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Pelvic Cancer

Pain is commonly perceived by patients during cancer and its treatment. Although most patients respond to conservative management implemented according to the World Health Organization guidelines, a subset of patients with advanced disease develop intractable pain that may require additional interventions such as regional blocks and intrathecal therapy. Patients with terminal abdominal or pelvic cancer who have high tumor burdens are often offered a diagnostic visceral nerve block followed by neurolysis for pain palliation. Conventional visceral blocks usually require fluoroscopic guidance for correct needle placement in the vicinity of the neuroaxis or abdominal cavity. These techniques carry risks of injury to vessels, bowels, and nerves. Transversus abdominis plane (TAP) block is a technique that is easy to perform (particularly when ultrasonographic guidance is used), has a good safety record, and effectively reduces pain levels and opioid requirements after abdominal and gynecological surgery. Although numerous studies have demonstrated the effectiveness of TAP blocks in acute pain management, the role of TAP block in chronic pain management is very limited. We believe that chemical neurolysis with phenol can prolong the effects of analgesia in patients with terminal cancer. We describe a case of terminal abdominal sarcoma with intractable pain that responded well to a TAP block followed by TAP neurolysis. The patient tolerated the procedure well and demonstrated sustained analgesia for 45 days before dying of the disease. We also demonstrated that TAP block significantly reduces the total opioid requirement as demonstrated by the morphine equivalent daily dose score after the neurolytic procedure. This result supports our belief that TAP block with TAP neurolysis is an effective and inexpensive modality that can be used to palliate intractable abdominal wall pain in patients with terminal abdominal cancer. Key words: Cancer pain management, phenol neurolysis, chemical neurolysis, transversus abdominis plane block, cancer pain palliation, intractable abdominal pain, ultrasound guided

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