A Comparison of effect of preemptive versus postoperative use of ultrasound-guided bilateral transversus abdominis plane (TAP) block on pain relief after laparoscopic cholecystectomy

Nowadays, there are various methods to manage pain after laparoscopic cholecystectomy. The aim of this study was to compare the effectof preemptive versus postoperative use of ultrasound-guided transversus abdominis plane (USG-TAP) block on pain relief after laparoscopic cholecystectomy. In this single-blinded randomized clinical trial, the patients who were candidates for laparoscopic cholecystectomy were randomly divided into the two groups (n = 38 per group). In the preemptive group (PG) after the induction of anesthesia and in the postoperative group (POG) after the end of surgery and before the extubation, bilateral ultrasound-guided transversus abdominis plane (TAP) block was performed on patients using 20 cc of ropivacaine 0.25%. Both groups received patient controlled IV analgesia (PCIA) containing Acetaminophen (20 mg/ml) plus ketorolac (0.6 mg/ml) as a standard postoperative analgesia and meperidine 20 mg q 4 h PRN for rescue analgesia. Using the numerical rating scales (NSR), the patients’ pain intensity was assessed at time of arrival to the PACU and in 2th, 4th, 8th, 12th, 24th h. Primary outcome of interest is NSR at rest and coughing in the PACU and in 2th, 4th, 8th, 12th, 24th h. Secondary outcomes of interests were the time to first post-surgical rescue analgesic and level of patients’ pain control satisfaction in the first 24 h. The USG-TAP block significantly decreased pain score in the POG compared to the PG, and also the pain was relieved at rest especially in 8 and 12 h (p value ≤ 0.05) after the surgery. Pain score after coughing during recovery at 2, 8 and 12 h after the operation were significantly decreased. (p value ≤ 0.05) The patient satisfaction scores in the POG were significantly higher in all times. There was a statistically significant difference between the two groups in terms of rate of postoperative nausea and vomiting (PONV), indicating that patients in the POG had significantly lower incidences of the PONV compared tothe PG. The time to first analgesic request was significantly shorterin the POG, which was statistically significant (p value = 0.089). There was no statistically significant difference between the two groups in terms of consumption of analgesics. The postoperative TAP block could offer better postoperative analgesia than preepmtive TAP block.

ĐÁNH GIÁ HIỆU QUẢ KÉO DÀI GIẢM ĐAU SAU MỔ LẤY THAI BẰNG GÂY TÊ MẶT PHẲNG CƠ NGANG BỤNG BẰNG HỖN HỢP THUỐC ROPIVACAIN PHỐI HỢP VỚI DEXAMETHASON

Một nghiên cứu thử nghiệm lâm sàng ngẫu nhiên có đối chứng được thực hiện nhằm đánh giá hiệu quả kéo dài giảm đau sau mổ lấy thai bằng gây tê mặt phẳng cơ ngang bụng bằng hỗn hợp thuốc ropivacain phối hợp với dexamethason. Nghiên cứu được thực hiện trên 100 bệnh nhân tại Bệnh viện Phụ sản Hà Nội. Kết quả nghiên cứu cho thấy, thời gian giải cứu cơn đau đầu tiên ngắn hơn đáng kể ở nhóm 1 (11,01 ± 3,62giờ) so với nhóm 2 (18,54 ± 4,15giờ) (p<0,05). Tổng nhu cầu morphin trong 24 giờ đầu sau phẫu thuật cao hơn đáng kể ở nhóm 1 (5,62± 2,1 mg) so với nhóm 2 (4,07± 1,9mg) (p <0,05). Điểm số VAS- S và VAS- V của cả hai nhóm khác nhau không đáng kể tại các thời điểm 1 giờ, 2 giờ và 4 giờ sau phẫu thuật, tuy nhiên ở nhóm 1 cao hơn đáng kể so với nhóm 2 tại các thời điểm 8 giờ, 12 giờ, 16 giờ và 24 giờ sau phẫu thuật.Tỷ lệ nôn ở nhóm 1 chiếm 20% cao hơn nhiều so với nhóm 2 chỉ chiếm 4%, p < 0,05. Các chỉ số lâm sàng liên quan đến tuần hoàn trong giới hạn bình thường và tương đương nhau giữa hai nhóm ở các thời điểm 1 giờ, 2 giờ ,4 giờ nghiên cứu. Nhịp tim, huyết áp trung bình lúc 8 giờ, 12 giờ, 16 giờ và 24 giờ sau phẫu thuật ở nhóm 1 cao hơn đáng kể so với bệnh nhân nhóm 2 (p <0,05). Các chỉ số lâm sàng liên quan đến hô hấp trong giới hạn bình thường và tương đương nhau giữa hai nhóm ở tất cả các thời điểm nghiên cứu. Trong nghiên cứu của chúng tôi không gặp bất kỳ tai biến nào liên quan đến gây tê TAP block.

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial

Background: This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries.Methods: Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric pain scale (NPS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded.Results: Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NPS than those in group C (P < 0.05). The highest difference in the postoperative NPS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores.Conclusions: In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NPS and reduced analgesic requirements than port site LAI.

Ultrasound-Guided Regional Analgesia for Post-Cesarean Pain

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.

A Comparative Study between Analgesic Efficacy of Intrathecal Buprenorphine and USG-Guided Transversus Abdominis Plane Block in Patients Undergoing Cesarean Section under Spinal Anesthesia

Objective The aim of this study was to evaluate and compare the postoperative analgesic efficacy of intrathecal buprenorphine with ultrasonography (USG)-guided transversus abdominis plane (TAP) block in patients of cesarean section. Materials and Methods: Sixty American Society of Anesthesiologists grade I and II pregnant women aged between 20 and 40 years requiring lower segment cesarean section were included in this study. Study Design A prospective randomized comparative study. Study Groups Group A received intrathecal hyperbaric bupivacaine 0.5% 1.8 mL with 60 µg buprenorphine. Group B received intrathecal hyperbaric bupivacaine 0.5% 1.8 mL with 0.2 mL sterile normal saline and at the end of surgery USG-guided bilateral TAP block was given with 20 mL 0.25% bupivacaine on each side of abdomen. Results The mean ± standard deviation of time to first rescue analgesia in Group A and group B was 9.17 ± 0.64 hours and 5.59 ± 0.50 hours, respectively. Distribution of mean time to first rescue analgesia among the cases studied is significantly higher in group A compared with group B. The distribution of paracetamol and tramadol requirement in first 24 hours among the cases studied was significantly higher in group B compared with group A. Conclusion The addition of buprenorphine to intrathecal hyperbaric bupivacaine has advantages over USG-guided TAP block for postoperative analgesia after cesarean section—longer duration of postoperative analgesia, lower analgesic requirements over first 24 hours, and cost–effectiveness.

Bloqueio locorregional do plano transverso abdominal em gata submetida a ovariohisterectomia e cistotomia: Relato de caso

O bloqueio do plano transverso abdominal (Tap Block) é uma técnica de anestesia locorregional que consiste na aplicação do anestésico local no plano inter-neurofascial, promovendo bloqueio da pele, músculos e peritônio parietal da parede abdominal ventral nos animais. O objetivo do trabalho foi relatar o uso do bloqueio do plano transverso abdominal em gata submetida à ovariohisterectomia e cistotomia. Foi atendida na Clínica Veterinária Universitária uma gata para atendimento pré-cirúrgico de castração. O tutor relatou que aplicava vacina anti-cio e desde então observou aumento de volume abdominal. Realizaram-se exames laboratoriais de hemograma, bioquímicos (Alanina Amino Trasnferase-ALT, fosfatase alcalina, ureia e creatinina), proteínas totais e frações e ultrassonografia abdominal, sendo que neste observou-se cálculo em vesícula urinária e piometra/hemometra/mucometra. O paciente foi encaminhado para realizar ovariohisterectomia terapêutica e cistotomia. A medicação pré-anestésica consistiu em midazolam (0,2 mg/kg), cetamina (2 mg/kg), metadona (0,3 mg/kg) e acepromazina (0,03mg/kg) todos por via intramuscular. Vinte minutos após MPA, inseriu-se o cateter 22G na veia cefálica direita e em seguida o animal foi encaminhado para a sala de ultrassonografia para realizar o bloqueio locorregional. Posicionou-se o animal em decúbito dorsal e realizou-se a anestesia locorregional do plano transverso do abdômen guiada por ultrassom, com bupivacaína (0,2 ml/kg) diluída 1:2 em água para injeção distribuída em quatro pontos do abdômen. No centro cirúrgico, efetuou-se a indução anestésica com propofol dose efeito e para manutenção da anestesia, optou-se pelo sevofluorano. Durante a monitoração anestésica não se observou alterações hemodinâmicas que revelassem nocicepção no animal, devido ao uso do bloqueio locorregional. A recuperação se deu de maneira rápida, sem observar-se sinais de dor no comportamento animal, mostrando a eficácia analgésica do bloqueio e a importância do mesmo na rotina anestésica.

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

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).

The use of perineural dexamethasone and transverse abdominal plane block for postoperative analgesia in cesarean section operations under spinal anesthesia: an observational study

Background During transverses abdominal plane block (TAP) procedure to provide analgesia in cesarean section (CS) operation, the use of perineural dexamethasone as an additive agent may improve pain relief and may cause a prolonged block duration. This study aims to investigate whether perineural dexamethasone, when added to bupivacaine local anesthetic agent during a TAP block, may provide adequate pain relief without adverse events. Methods This is a prospective cohort study of fifty-eight patients undergoing elective CS with spinal anesthesia. We hypothesized to perform bilateral TAP block using perineural dexamethasone as an additive agent. The patients were randomly divided into two groups using a systematic random sampling method. While one group of patients received perineural dexamethasone of 8 mg additive agent together with bupivacaine 0.25% 40 ml (Group TAPD), the other group received only bupivacaine 0.25% 40 ml in TAP block (Group TAPA). The primary outcomes are the period for the first request of postoperative pain relief medication and the numerical rating scale (NRS) pain intensity scores at 2, 6, 12, and 24 h after surgery. The secondary outcomes are comparing the 24-h tramadol and diclofenac analgesic requirements and the incidences of side effects on postoperative day one. A p-value of < 0.05 is statistically significant. Results The time to first analgesic request was 8.5 h (8.39–9.79) in the TAPD group versus 5.3 h (5.23–5.59) in the TAPA group, respectively. (p < 0.001) The median NRS scores were significantly reduced in the TAPD group compared to the TAPA group at 6, 12, and 24 h after surgery (p-values < 0.001). The total analgesics consumption over 24 h postoperatively was lower in Group TAPD compared to Group TAPA (p < 0.05). Conclusion An additive agent of perineural dexamethasone at a dose of 8 mg during bilateral TAP block for elective CS operation under spinal anesthesia provided better pain relief on postoperative day 1.

Does the Transversus Abdominis Plane Block Reduce Morbidity Following Iliac Crest Bone Harvest in Pediatric Patients With Alveolar Clefts?

Objective The purpose of this study is to determine whether a Transversus Abdominis Plane (TAP) block can reduce donor site morbidity among pediatric patients undergoing iliac crest bone grafting for repair of their alveolar cleft. Design This retrospective cohort study was carried out at the Division of Dentistry at the Montreal Children's Hospital. Medical charts of patients who underwent alveolar cleft bone grafting between January 2011 and January 2021 were reviewed and they were divided into two groups, intraoperative TAP block and intraoperative local anesthesia infiltration (control group). The outcomes measured were patients’ post-operative pain at the donor site, in-hospital narcotics requirements and length of stay. Results A total of 66 patients were included. There were no significant differences in pain scale among the TAP group and control group [1.9 (SD 2.5) and 1.3 (SD 2.1), respectively ( p = 0.23)]. The mean length of stay for both groups was 1 day. Interestingly, there was a significant higher proportion of patients who required in-hospital opioids (morphine) in the TAP block group when compared to the control group ( p = 0.03). Conclusions The results of our study suggest there may be no role for a TAP block in reducing pain and improving opioid stewardship.