Efficacy Of Bilateral Dual Transversus Abdominis Plane (TAP) Block For Postoperative Analgesia After Open Abdominal Aortic Aneurysm (AAA) Surgery PDF Download

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Background and Goal of Study: Patients scheduled for abdominal aortic aneurysm (AAA) surgery carry a high risk of cardiac, renal or respiratory comorbidities. The post-operative pain control is essential in this population. Transversus abdominis plane (TAP) block has been described as an effective technique to reduce postoperative pain and morphine consumption after gynecologic and lower abdominal surgery but not in open AAA surgery.The aim of this study was to demonstrate the postoperative analgesic efficacy of bilateral dual TAP block by reducing the amount of morphine consumption during the first 24 hours postoperative.Materials and Methods: This randomized, double-blind, controlled, prospective trial approved by the local ethics committee enrolled 60 adult patients with AAA or Leriche syndrome scheduled for an aortic surgery through midline laparotomy. Patients were randomized to receive bilateral dual TAP block using 4 x 10 mL of 0.375% ropivacaine (= 150 mg) (TAP group = 30 patients) or not (CONTROL group = 30 patients). Anaesthetic technique (Remifentanil, Sevoflurane) and postoperative analgesia were standardized. All patients received IV morphine via a morphine patient-controlled analgesia device and IV paracetamol every 6 hours for postoperative analgesia. Postoperative assessments were conducted every hour for the first 48 hours after surgery. Postoperatively pain scores at rest and with movement, total morphine consumption and opioid related side effects were recorded. The primary outcome of the study was total morphine (mg) consumption at 24 hours postoperatively.Results and Discussion: Both groups were comparable as to gender, age, body mass index (BMI), creatinine clearance and ASA physical status. Nine patients (64,3%) in the TAP group had a BMI > 30 kg/m2 and 5 (35,7%) in the CONTROL group. Total morphine consumption at 24 hours was 35,5 mg (+/- 24,2) in the TAP group and 33,3 mg (+/- 19,5) in the CONTROL group (P=0,71). Total morphine consumption at 48 hours was also similar in both groups (58,4 +/- 39 mg vs 60 +/- 35 mg, P=0,85). This non-significant result could be explained by the fact that the dose of ropivacaine wasnu2019t sufficient.Conclusion(s): In our study, bilateral dual TAP block performed in open AAA surgery doesnu2019t show a reduction of morphine consumption during the first 24 hours postoperative. A study with different doses of ropivacaine in this type of surgery could be interesting and refine this work.

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TITLE: EFFICACY OF ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK FOR REDUCING POST-OPERATIVE PAIN AND PERI-OPERATIVE ANALGESIC REQUIREMENT IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERY.ABSTRACT -BACKGROUND AND AIMS: Ultrasound-guided TAP block helps deposit local anaesthetic between the internal oblique and transversus abdominis muscles . Its role as a part of multimodal analgesic technique for gynaecological abdominal surgeries needs to be clearly defined. The objective of this study was to assess TAP block for post-operative analgesia and peri-operative fentanyl requirement.METHODS: After ethics committee approval and obtaining written informed consent, 30 ASA 1 and 2 patients scheduled for Total abdominal hysterectomy and bilateral salpino-oopherectomy using infraumbilical midline vertical incision were recruited. They were randomly divided to receive bilateral pre-incisional TAP block with ropicavaine (group R) or normal saline (group S) using ultrasound guidance. RESULTS: The VAS scores both at rest and movement were less in group R at 0, 4, 8, 12 and until 24 hours post-surgery (p

Author: Danilo Canzio
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BACKGROUND The use of loco-regional anesthesia aims at providing an adequate intra- and/or post-operative pain management for a broad spectrum of surgical interventions which historically have relayed on the use of opiod drugs. On this fashion, the aim of our study is to prove that the use of bilateral continuous subcostal TAP block, in a multimodal opiod-sparing analgesic approach, provides a successful post-operative pain management for major abdominal surgical interventions. We adopted the NRS score as a reference and u2264 6 as an acceptable response. METHODS We enrolled (16) patients undergoing major abdominal surgery. A primer infusion of 1gr paracetamol + 30 mg ketoralac was administered 30 minutes prior to the end of the intervention. Moreover, in the immediate post-operative period, via US guidance, a 20 ml bolus of 0.5% levobupivacaine was administered bilaterally. Then, a permanent catheter was placed on both sides with a 2ml/h infusion of 0.5% levobupivacaine (20 ml in 28 ml of 0.9% NaCl). RESULTS In the 30-minutes post-operative period, the NRS score was u2264 4 for all of our patients. Then u2264 3 in the 6, 12 and 24-hour post-operative period. None of our patients requested any supplementary analgesics. CONCLUSIONS The major drawback of this study is the small size of our sample. Further studies might encourage the spread of this procedure as a new gold-standard for laparoscopic interventions (e.g. right hemicolectomy and laparocele) and its non-inferiority to epidural analgesia, the current gold-standard for laparotomic surgeries (especially left hemicolectomy).

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Background and Goal of Study:Effective postoperative analgesia is very important in reducing postoperative morbidity, accelarating recovery and avoding chronic postoperative pain. Ultrasound guided transversus abdominis plane(TAP) block is done as a part of multimodal analgesia for pain relief after surgeries.This study was conducted to evaluate postoperative analgesic efficacy of unilateral TAP Block using different concentration of bupivacaine in patients undergoing inguinal hernia surgeries.Materials and Methods:After ethical approval and patient informed consent, seventy-five patients scheduled for inguinal hernia repair surgery were divided into three equal groups.Group-I(GI) TAP block with 20ml 0.25% bupivacaine, Group-II(GII) TAP block with 20ml 0.125% bupivacaine and Group-III(GIII) no TAP block. After standart induction, anesthesia was maintained with general anesthesia.TAP Blocks were performed with ultrasound guidance. 20ml 0.25% or 0.125% bupivacaine applied between internal oblique and transversus abdominis muscles before the surgery start. Postoperative pain scores were evaluated with visual analog scale(VAS) at 30th and 60th min on recovery room, at 2nd,4th,8th,12th and 24th hour in the ward. An additional and a rescue analgesics were applied when VAS scoresu22654.First analgesic application time, the number of additional and rescue analgesic, postoperative nausea-vomiting and patient satisfaction were recorded.Results and Discussion:The postoperative pain scores were statistically lower in GI and GII than GIII in recovery room and in the ward(P

Author: Teal Hickey
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Category : Analgesics
Languages : en
Pages : 59

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"Introduction: Perioperative pain management and attenuation of the sympathetic stress response is important in achieving positive patient outcomes. Opioids have been at the frontlines of analgesia plans. The untoward side effects of opioids lead practitioners to explore alternative analgesia methods with strategies including use of multimodal pain management, NSAIDs, and peripheral and neuraxial nerve blockade. While single injection bilateral transversus abdominis plane (TAP) blocks prove efficacious in pain management and opioid reduction, there is little evidence on the use of continuous TAP blocks. The purpose of this study is to explore the effects of continuous bilateral TAP blocks on opioid consumption after laparoscopic colorectal surgery. Methods: IRB approval was obtained for a retrospective chart analysis of elective laparoscopic colorectal procedures in a single medical center. All cases received intrathecal narcotics preoperatively. The experimental group received continuous bilateral TAP blocks placed before emergence and continued through postoperative day (POD) 2 while the control group did not. Thirty-four charts were reviewed. Demographics including age, sex, BMI, and ASA classification were collected and analyzed. The dependent variable, perioperative opioid consumption, was collected and analyzed. Secondary outcome measures, including length of stay, readmission, and complications (ileus and respiratory depression), were collected and analyzed. Results: Using a one-tailed t-test, statistical analysis was conducted to establish the significance of the data. Demographic analysis yielded no statistical significance between the control and experimental groups. No statistical significance was found in total morphine equivalents consumed during POD 1 or POD 2. There was no statistical difference in the length of stay, readmission rate, or rate of complications. There was significantly less opioid consumption in the experimental group in the post anesthesia care unit (p = 0.049), during POD zero (p = 0.006), and when comparing total opioid use from surgery through POD two (p = 0.031). Discussion: The use of continuous bilateral TAP blocks has been demonstrated to be an opioid reducing analgesic tool that is effective in patients recovering from laparoscopic colorectal surgery. When added to an enhanced recovery after surgery protocol, we believe that continuous bilateral TAP blocks will serve as an opioid sparing technique that will provide analgesia while allowing patients to return to normal physiological function as quickly as possible. We project that this will translate to fewer complications, a shorter length of stay, greater patient satisfaction, and fewer readmissions. Several theories warrant exploration as to why this study failed to show a significant decrease in opioid use during POD 1 and POD 2 despite the overall decrease in opioid consumption"--Page i.

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Comparison of ultrasound guided transversus abdominis plane block and quadratus lumborum block for postoperative pain in cesarean section: A prospective, randomized-controlled studyU Caglayan1, C Yilmaz1, D Karasu1, SE Ozgunay1, F Ata1, S Cansabuncu11 University of Health Sciences Bursa Yuksek Ihtisas Training and Education Hospital Departmentt of Anesthesiology and Reanimation, Bursa,TurkeyIntroductionNeuroaxial anesthesia methods are preferred In cesarean section. General anesthesia is performed when the regional anesthesia is contraindicated or when the patient does not want regional anesthesia. Effective analgesia after cesarean section is important for faster recovery and prevention complications.Transversus abdominis plane block (TAP) and Quadratus lumborum block (QL) are used for postoperative analgesia in lower and upper abdominal surgeons (1-4). However, studies comparing the analgesic efficacy of truncal blocks after cesarean section under general anesthesia are inadequate.The aim of this study is to compare the postoperative analgesic efficacy of TAP Block and QL Block administered by ultrasound (US) guidance under the general anesthesia for cesarean section.Materials and MethodsThe study protocol was approved by the Local Ethics Committee and Australian New Zealand Clinical Trials Registry (Ref: ACTRN12617000842369). A written informed consent was obtained from each patient. The study was carried out in accordance with The Code of Ethics of the Declaration of Helsinki. 99 pregnant women aged 18-49 years who refused or contraindicated to regional anesthesia were included in study. In this prospective, randomized, and double blinded study, patients that scheduled for elective cesarean section, were randomly allocated in two groups (Group TAP n=49, Group QL n=50). Standard monitorization and general anesthesia was performed. After surgery was completed, TAP or lateral QL Block (QL1 Block) was applied bilaterally with US guidance.All patients received tenoxicam (20 mg) iv as a multimodal analgesic component. Patient-controlled analgesia (PCA) pump was used for all patients (no loading dose, 25 mg tramadol bolus, 20 minutes of lock out time). The severity of postoperative pain was measured by VAS scale (0=no pain, 10=the worst possible pain). Patients were asked to score the pain at different times after the operation, both at rest and during coughing, 0. 2. 6. 12. and 24 h later. ResultsDemographics, intraoperative hemodynamic changes, duration of surgery and intraoperative fentanyl consumption were similar in both groups (p>0,05). Duration of anesthesia was statistically longer in the Group QL (p=0.044). Primary Outcomes Total tramadol consumption was 227u00b197 mg in Group TAP and 166u00b1101 mg in Group QL (p=0.003). However, no significant difference was found statistically regarding to demand of rescue analgesics (p=0.876). First analgesic administration with PCA was later in Group QL (0,43u00b10,76h vs 1,74u00b12,36 h, p0,001). VAS scores at rest and movement were found in Table 1-2.Secondary OutcomestThere was no statistically significant difference between groups in terms of postoperative side effects (p 0,05). Patient satisfaction in Group QL was significantly higher (p = 0.013).Table 1: Resting VAS scores according to groups VAStGroup TAP (n=49)tGroup QL (n=50)tp0th h#t2,65 u00b11,01t2,00u00b10,96t0,001*2nd h#t1,53u00b10,64t1,18 u00b10,69t0,011*6th h#t1,35 u00b10,72t0,94u00b10,62t0,003*12th h#t1,57 u00b10,76t1,30u00b10,78t0,08524th h#t0,94u00b10,45t0,70u00b10,54t0,022*VAS: Visual Analog scale #: Meanu00b1Standard Deviation, *p

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Background: Transversus abdominis plane (TAP) block is a safe and effective analgesia technique for paediatric patients (1). This study is designed to compare the analgesic efficacy of different bupivacaine concentrations in paediatric patients undergoing ultrasound-guided TAP blocks for unilateral inguinal hernia repair surgery.Materials and Methods: Seventy-four patients aging between 1 and 8 years, undergoing unilateral inguinal hernia surgery, were enrolled for this study after obtaining Institutional Ethics Committee approval and written informed consents from parents or legal guardians (2016/1281). Group 1 (n:37) received 1 mg/kg bupivakain 0.25% and Group 2 (n: 37) received 1 mg/kg bupivakain 0.125% for ultrasound-guided TAP block following standard general anaesthesia induction (Figure 1). All patients received remifentanil 0,1 u03bcg/kg/h infusion and paracetamol 15 mg/kg intraoperatively, andparacetamol 4x15 mg/kg per day postoperatively. FLACC (Face, Legs, Activity, Cry, Consolability) behavioral pain assessment scale was used for evaluating patientsu2019 postoperative pain levels at 15-, 30-, 45-minute and 1-, 2-, 6-, 24-hour. Tramadol 1 mg/kg was administered intravenously as rescue analgesic when FLACC score was u22654. Total analgesic requirement, length of hospital stay and side effects were recorded.Results: Sixty-four patients, Group 1 (n:30) and Group 2 (n:34), completed the study. Demographic data were similar in both groups (p>0.05). FLACC pain scores at all time points (Figure 2), total analgesic requirement and length of hospital stay were all comparable in both groups (p>0.05). None of the patients reported FLACC score u22654 orasked for rescue analgesic after postoperative 6th hour. No perioperative and/or postoperative complication was observed.Conclusion: This study demonstrated that higher and lower concentrations of bupivacaine do not have any superiority over each other when the doses are kept equal in TAP blocks. TAP blocks are effective regional analgesic techniques for pediatric patients undergoing inguinal hernia repair surgery.References: Sahin L, Sahin M, Gul R et al. Ultrasoundguided transversus abdominis plane block in children: a randomised comparison with wound infiltration. Eur J Anaesthesiol 2013;30:409-14.

Author: Agnes Kraujelytu
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Methods: A prospective survey study on different analgesia methods after C-section was conducted at Vilnius University Hospital Santaros klinikos. Randomized assignment to TAP block or RPA was performed. TAP block was performed by administering 75 mg of 0,375% in 20 ml ropivacaine at the each side (total dose 150mg) of ropivacaine. Analgesic efficacy using VAS pain scores, adverse events and postoperative pain localization were measured following 24-hours and 48-hours after delivery. Results: 53 women, mean age 31.98u00b14.44 years, participated in the study. 84.9% and 15.1% women underwent spinal and epidural anaesthesia, respectively. 11 (20.8%) patients were randomly assigned to TAP group, while RPA analgesia was performed to 42 (79.2%) women. VAS pain scores on movement were statistically significantly lower in the TAP block group compared to RPA patients following 24-hours after C-section (5.54;7.14,p=0.016). VAS pain scores at rest were statistically significantly lower in the TAP block group compared to patients who received RPA following 48-hours after C-section (1.55;3.19,p=0.007). Adverse events, including nausea, back pain, headaches, pruritus, urinary retention, diarrhoea, tremble, cumulative postoperative doses and pain localization did not differ between groups. Conclusion: TAP block can provide an effective analgesia in women undergoing C-section as a part of multimodal pain management regime. TAP block was superior to RPA by providing lower VAS pain scores on movement and at rest following 24-hours, 48-hours after C-section. TAP block was non-inferior to RPA regarding adverse events, cumulative postoperative analgesia doses and pain localization.

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AbstractBackground and Objectives: Living donor hepatectomy is a major surgery requiring a long upper abdominal incision. Various regional and systemic analgesic approaches have been used to tackle postoperative pain in these patients. The objectives of this study were to evaluate the efficacy and feasibility of subcostal Transverse Abdominis Plane (TAP) block and bilateral rectus sheath blocks as an adjunct to Patient controlled Analgesia (PCA) using Morphine.Methods: The study was planned as a prospective randomized double blind study. 50 consecutive liver donors belonging to age group 18-50 years were randomized into two groups of 25 each. Patients in both the groups received a standard general anesthetic. All patients were given right subcostal TAP block and bilateral rectus sheath blocks under ultrasound guidance at the end of surgery. Group R patients received the blocks with 50 ml of 0.3% Ropivacaine; with 10 ml each for rectus sheath blocks and 30ml for subcostal TAP block using under ultrasound guidance. Group S patients received the same blocks with 50 ml of Normal Saline at the end of surgery. Patients in both the groups had access to morphine PCA.Results: Median morphine consumption was found to be significantly less (28 mg vs. 43 mg, p=0.020) in Group I patients. The Numerical Rating Scores (NRS) were comparable in both the groups. No major block related complications were observed. Conclusions: We found subcostal TAP block in combination with bilateral rectus sheath blocks a safe and effective adjunct for pain management in patients undergoing donor hepatectomy.

Author: Veena Gyaneshwar Enagandula
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Background and Aims:Multimodal analgesia comprising opioid, paracetamol and non-steroidal anti-inflammatory drugs is used for managing postoperative surgical pain after ileostomy closure(IC). We investigated the efficacy of unilateral dual transversus abdominis plane(TAP) block with to reduce morphine consumption in first 24 hrs along with a reduction in visual analogue score and postoperative nausea/vomiting.Methods :This is a single-centre, investigator-initiated, prospective, parallel-group, placebo-controlled randomised study involving patients undergoing IC under general anaesthesia. After approval from Ethics Committee, we recruited 55 patients in 2 groups; 28 in TAP group and 27 in NS group. In TAP group, patients received 30 ml of 0.375% bupivacaine: 15 ml by a posterior TAP approach and 15 ml by subcostal approach using ultrasound(US) . In group B, patients received 30 ml normal saline (placebo) with same approaches. Blocks were administered at the end of surgery before extubation. Patients were be shifted to HDU for monitoring . 24 hrs morphine consumption in either groups was the primary outcome and secondary outcome was to compare postoperative nausea/vomiting in both groups.Results: The demographic data , gender distribution, ASA physical status , duration of surgery and 1st morphine dose was comparable in both groups. 24 hrs morphine consumption in TAP group was 3.29+/- 2.78 mg and in NS group was 9.23+/- 2.94 mg which was statistically significant(p=0.001).Conclusion:Dual TAP block reduces opioid consumption in first 24 hrs after an IC and can facilitate early recovery with less adverse effects seen with opioids and NSAIDs.