Ultrasound‐Guided Transversus Abdominis Plane Catheter for Chronic Abdominal Pain

Abstract Background and Objectives: Neural blockade of the thoracolumbar nerves supplying the anterior abdominal wall through transversus abdominis plane (TAP) has been investigated for different applications mainly for the acute pain management following abdominal surgical procedures. The role of this block for chronic pain syndromes is still to be discovered, and its value in chronic abdominal pain needs to be studied. We are presenting new application of the TAP technique for management of chronic abdominal pain syndrome using the continuous infusion. Case report: We present a case of an 18‐year‐old girl who underwent an uneventful laparoscopic cholecystectomy. Postoperatively, patient complained of chronic pain at the site of the surgery. All diagnostic and imaging studies were negative for a surgical or a medical cause. Multiple interventions including epidural blocks, transcutaneous electrical neural stimulation, and celiac plexus blocks had failed to relieve the pain. After discussion with the patient about the diagnostic nature of the procedure and the likelihood of recurrence of pain, TAP block was performed on the right side with significant improvement of pain for about 24 hours. The degree of pain relief experienced by the patient was very dramatic, which encouraged us to proceed with an indwelling TAP catheter to allow for continuous infusion of a local anesthetic. The patient was sent home with the continuous infusion through a TAP catheter for 2 weeks. From the day of catheter insertion and up to 9 months of follow‐up, patient had marked improvement of her pain level as well as her functional status and ability to perform her daily activities, after which our acute pain team stopped following the patient. Conclusion: A successful TAP block confirmed the peripheral (somatic) source of the abdominal pain and provided temporary analgesia after which an indwelling catheter was inserted, which provided prolonged pain relief.     

The Role of Preoperative and Postoperative Transversus Abdominis Plane and Rectus Sheath Block in Patients Undergoing Total Laparoscopic Hysterectomy

PurposeThis study was performed to assess the efficacy of a preoperative and postoperative transversus abdominis plane (TAP) and rectus sheath (RS) block compared with no TAP and RS block in patients undergoing total laparoscopic hysterectomy (TLH).DesignProspective observational cohort study.MethodsFrom January 2014 to December 2017, 195 women undergoing TLH were categorized into three groups based on their perioperative analgesia: no TAP + RS block (n = 88), preoperative TAP + RS block + systemic analgesia (n = 68), and postoperative TAP + RS block + systemic analgesia (n = 39). We evaluated use of nonsteroidal anti-inflammatory drugs (NSAIDs) and NSAID consumption within the first 12 hours postoperatively and the numerical rating scale score at 0, 12, and 24 hours postoperatively.FindingsWomen with a preoperative TAP + RS block had a significantly lower utilization rate of NSAIDs within the first 12 hours postoperatively (54.4% vs 75.0%; P = .007), lower postoperative flurbiprofen dose (45.5 vs 62.0 mg; P = .048), and lower numerical rating scale score at 12 hours postoperatively (1.63 vs 2.20; P = .002) compared with women with no TAP + RS block.ConclusionsA preoperative TAP + RS block provided superior postoperative analgesia in patients undergoing TLH and reduced analgesic consumption during the first 12 hours postoperatively.     

Comparative Effectiveness of Two Ultrasound‐Guided Regional Block Techniques for Surgical Anesthesia in Open Unilateral Inguinal Hernia Repair

Transversus abdominis plane (TAP) and ilioinguinal/iliohypogastric (II/IH) nerve blocks have been described as analgesic adjuncts for inguinal hernia repair, but the efficacy of these techniques in providing intraoperative anesthesia, either individually or together, is not known. We designed this retrospective cohort study to test the hypothesis that combining TAP and II/IH nerve blocks (“double TAP” technique) results in greater accordance between the preoperative anesthetic plan and actual anesthetic technique provided when compared to TAP alone. Based on this study, double TAP may be preferred for patients undergoing open inguinal hernia repair who wish to avoid general anesthesia.     

Improving Pain Management After Cesarean Birth Using Transversus Abdominis Plane Block With Liposomal Bupivacaine as Part of a Multimodal Regimen

As educators, advocates, and champions for women’s health, nurses play pivotal roles throughout a woman’s pregnancy and childbirth journey. Most women experience postsurgical pain after cesarean birth and are prescribed opioids. Caution around opioid use warrants opioid-reducing strategies, particularly because exposure to opioids exacerbates risk for developing persistent postsurgical opioid use. Multimodal approaches can help address this concern. Regional anesthesia using transversus abdominis plane blocks with aqueous formulations of local anesthetics can reduce opioid consumption and pain but has a short duration of action. Liposomal formulation of bupivacaine prolongs its release, overcoming this obstacle. Transversus abdominis plane blocks with liposomal bupivacaine can reduce opioid use and pain after cesarean birth, improving recovery. These findings represent numerous implications for nursing practice to improve postcesarean pain management.     

Ultrasound‐Guided Serratus Plane Block for Treatment of Postmastectomy Pain Syndromes in Breast Cancer Patients: A Case Series

Postmastectomy pain syndrome is common after surgical treatment for breast cancer and may be challenging to manage. Currently, there are a wide variety of approaches to treat this type of pain, including medications, physical therapy, and interventional procedures. However, because of the complexity of innervation of the breast, the serratus plane block may better target the web of nerves innervating the anterior chest wall including the breast. We present a case series of 8 patients who were successfully treated with serratus plane block for pain after treatment for breast cancer. We feel that this particular application for the serratus plane block deserves further investigation, as it is relatively easy to perform and has good clinical utility for this type of pain.     

运用压力生物反馈行腹横肌及多裂肌协同训练治疗下背痛

目的：研究运用压力生物反馈行腹横肌及多裂肌协同训练对下背痛的近远期疗效。方法：将符合诊断标准的60例下背痛患者随机分为研究组和对照组各30例,2组均按常规给予物理治疗。研究组在此基础上加用压力生物反馈行腹横肌及多裂肌协同训练;对照组配合五点支撑法及飞燕点水法等功能训练。治疗前后采用疼痛视觉模拟评分（VAS）和SF-36健康状况调查问卷评定疼痛程度及日常生活活动能力,1年后跟踪随访复发率。结果：与治疗前比较,治疗1、6个月及1年时2组VAS评分与治疗前比较逐步下降明显,SF-36逐渐上升（P〈0．05,0．01）;与对照组比较,研究组表现更明显（P〈0．05,0．01）。1年后跟踪随访,研究组复发率明显低于对照组（10．0％与33．3％,P〈0．01）。结论;配合运用压力生物反馈行腹横肌及多裂肌协同训练可有效减轻下背痛患者的疼痛程度,改善其功能障碍,并明显降低复发率,其远期疗效巩固。     

An Investigation of the Association between Transversus Abdominis Myofascial Structure and Activation with Age in Healthy Adults using Ultrasound Imaging

BackgroundBecause of their importance in core stability, training the deep abdominal muscles, fascial structures and particularly the transversus abdominis, is a key component of many sport and physical therapy programs. However, there are gaps in knowledge about age-related changes in the structure and activation capacity of these muscles.Hypothesis/PurposeThis study investigated the association between deep abdominal muscles and fascial structures and transversus abdominis activation with age in healthy adults.Study designA cross-sectional study.MethodsEighty-six adults aged 18 to 77 participated in this study. An ultrasound image of their transversus abdominis, internal oblique, external oblique and associated fasciae was first captured at rest, then during a contraction of the transversus abdominis. Bivariate correlation analyses and hierarchical analyses were performed (significance level: p < 0.05).ResultsThe thickness of these three muscles decreases with age (ρ = -0.66 for external oblique, -0.51 for internal oblique and -0.58 for transversus abdominis), whereas the thickness of their fasciae increases (ρ = 0.39 for the fascia of external oblique, 0.54 for the fascia between internal oblique and external oblique, and 0.74 for the fascia between internal oblique and transversus abdominis). Transversus abdominis activation decreases with age (r =-0.44). Age accounts for 19.5% of the variance in transversus abdominis activation.ConclusionThese results demonstrate that normal aging is associated with changes in deep abdominal myofascial structures and transversus abdominis activation. Assessment of these metrics can provide valuable baseline information for physical therapists involved in rehabilitation and strengthening programs targeting older individuals.Level of evidenceLevel 2     

Ultrasound‐Guided Proximal Suprascapular Nerve Block With Radiofrequency Lesioning for Patients With Malignancy‐Associated Recalcitrant Shoulder Pain

The classic suprascapular nerve block has limitations, such as postural requirements and lack of direct nerve visualization. This series investigated the analgesic effect of ultrasound‐guided supraclavicular suprascapular nerve blocks in patients with malignancy‐associated shoulder pain. Ablative radiofrequency lesioning of the suprascapular nerve in 6 patients provided substantial pain relief. The mean distance from the suprascapular nerve to the brachial plexus was 8.05 mm, and the mean angle of needle entry was 20.6°. This approach appears to be effective in relieving malignancy‐associated shoulder pain and is tolerated by patients unable to sit or lie prone.     

Ultrasound‐Guided Paravertebral Neurolytic Block: A Report of Two Cases

Paravertebral block is commonly used in the treatment for acute and chronic pain. The duration of paravertebral block could theoretically be prolonged with neurolytic agents. We report two cases of ultrasound‐guided neurolytic paravertebral blocks in patients suffering from intense cancer‐related thoracic pain. Ultrasound was used to identify the space and plane of injection at the mid‐thoracic level. Absolute alcohol was used to block the nerves at different segments. The two patients had great pain relief. Neurolytic paravertebral block can be a useful technique in patients with intractable cancer pain. Because of the risk of complication, it is recommended that this technique should be limited to relief of intractable pain in cancer patients with a poor prognosis.     

右美托咪定腹横肌平面阻滞对腹腔镜结肠根治术后恢复的影响

目的观察腹腔镜下结肠根治术后右美托咪定超声引导下腹横肌平面(TAP)阻滞的镇痛效果,及其对早期恢复的影响。方法腹腔镜下结肠癌根治术患者40 例均分为右美托咪定组(DEX组)和对照组(CON组)。手术结束后在超声引导下行TAP阻滞。DEX组予右美托咪定1 μg/kg+0.25%罗哌卡因至20 ml,CON组予0.25%罗哌卡因20 ml。记录术后2 h、6 h、12 h、24 h、48 h静息状态、咳嗽时疼痛视觉模拟评分(VAS)和Ramsay 评分,记录最高感觉阻滞平面、感觉阻滞维持时间、术后首次镇痛泵按压时间和术后第一天总按压次数和舒芬太尼用量,患者术后首次排气时间、进食时间和住院时间。结果术后2 h、6 h、12 h,DEX组VAS 评分显著低于CON 组(P<0.001),Ramsay 评分明显高于CON 组(P<0.01);DEX 组较CON 组感觉阻滞维持时间显著延长(P<0.001),首次镇痛泵按压时间显著较晚(P<0.001),镇痛泵按压次数显著减少(P<0.001),舒芬太尼用量显著减少(P<0.001);DEX组术后首次排气时间、进食时间和出院时间显著早于CON组(P<0.001)。结论右美托咪定能显著增强罗哌卡因的TAP阻滞效果,减轻术后疼痛,促进术后恢复。     

Ultrasound‐Guided Continuous Superficial Peroneal Nerve Block below the Knee for the Treatment of Nerve Injury

(CRPS) describes a constellation of symptoms including pain, trophic changes, hyperesthesia, allodynia, and dysregulation of local blood flow often following trauma. It is often confined to the extremities. Treatment of this disorder consists of a variety of modalities including systemic pharmacotherapy, local anesthetic injections or infusions, psychological nonpharmacotherapy, physical rehabilitation, and surgical intervention. Chronic pain not related to CRPS can also be treated with similar interventions. Despite the array of available therapies, it can still be difficult to manage. We report a case of a 19‐year‐old patient diagnosed by her surgeon as having CRPS Type II, secondary to foot trauma, which was treated with a continuous infusion of local anesthetic at the superficial peroneal nerve (SPN). While placement of peripheral nerve block catheters to augment chronic pain therapy is not novel, the application of a perineural catheter at the SPN has not been previously described.     

Ultrasound‐Guided Posterior Antebrachial Cutaneous Nerve Block: Technical Description and Block Distribution in Healthy Volunteers

The posterior antebrachial cutaneous nerve branches from the radial nerve proximal to the elbow and supplies sensation to the posterior aspect of the forearm. With a high‐frequency linear transducer, the posterior antebrachial cutaneous nerve was identified in 8 healthy volunteers. Under aseptic conditions and with an ultrasound‐guided in‐plane technique, 1% lidocaine was injected circumferentially around the nerve. In each participant, the block was successful, and neither incidental blocks of other nerves nor any other complications were observed. These results demonstrate that the posterior antebrachial cutaneous nerve can be blocked to provide anesthesia or analgesia to the posterior forearm.