Ultrasound guided transversus abdominis plane block versus local wound infiltration in children undergoing appendectomy: A randomized controlled trial

BackgroundThe transversus abdominis plane block (TAP) has been described for pain management following abdominal surgery in adults, but there are only few reports on its use in pediatrics. The aim of this study was to evaluate the analgesic effect of ultrasound guided TAP block in patients scheduled for open appendectomy versus an active comparator (wound infiltration).MethodsForty-four children aged 4–16 years (ASA 1–2) were enrolled. Patients were randomized into two groups (22 in each). Patients in group (T) were assigned to receive ultrasound guided TAP block using 0.4 ml/kg of bupivacaine 0.25%, and those in group (L) were assigned to receive local infiltration by the surgeon. Maximum pain scores, the time to the first analgesic requirement and the number of analgesic requirements were recorded over 48 h.ResultsThe ultrasound guided TAP block increased the mean time to the first analgesic requirement (10.4 ± 1.5 h) in comparison with the local infiltration group (5.4 ± 1.5). The cumulative number of doses of analgesic was significantly lower in TAP group than in local infiltration group (3.7 ± 1.1 versus 5.3 ± 2.1) and the Pain Scale score was significantly lower in the TAP group over the study period. Besides, there were no complications attributable to the ultrasound guided TAP block.ConclusionUltrasound-guided TAP block with (0.4 ml/kg) 0.25% bupivacaine provides prolonged postoperative analgesia and reduced analgesic use without any clinical side-effects after appendectomy in children.     

Postoperative continuous transversus abdominis plane block vs continuous wound infusion of levobupivacaine in females undergoing open gynecologic procedures

IntroductionTransversus abdominis plane (TAP) block is used as a part of multimodal analgesia in decreasing pain of lower abdominal wall incision. Local anesthetic instillation of wounds through subcutaneous or subfascial catheters is used to treat postoperative pain in different types of surgery. The aim of this randomized controlled trial was to study the opioid-sparing effect of these two techniques (if any) compared to placebo in women undergoing gynecologic procedures through transverse lower abdominal incisions.MethodsSeventy-eight ASA I–III patients planned to undergo gynecologic procedures through a transverse lower abdominal incision were randomly divided into three equal groups: Control (C) group (n = 26), Continuous Wound Infusion (CWI) group (n = 26), and continuous transversus abdominis plane block (TAP) group (n = 26). After standardized general anesthetic and before extubation, the patients were given the allocated treatment. A morphine patient-controlled analgesia (PCA) was started postoperatively alongside with the local anesthetic (or placebo) infusion. Cumulative dose of morphine PCA in the first postoperative 48 h was the primary outcome. Secondary outcomes included visual analog pain score (VAS) at rest and on movement and complications of morphine PCA.ResultsThe cumulative dose of morphine PCA in the first postoperative 48 h was higher in control group than in groups CWI and TAP (P < 0.001). However, no significant difference was found between groups CWI and TAP. No significant differences were found among the three groups regarding VAS during rest but TAP group showed less pain scores than groups C and CWI on movement. The three groups were similar regarding morphine side effects.ConclusionContinuous bilateral TAP block and CWI can decrease PCA morphine consumption in the first postoperative 48 h when compared to placebo in women undergoing gynecologic surgery through transverse lower abdominal incision. Continuous TAB block might give better analgesia with movement than CWI.     

Children with spinal dysraphism: transversus abdominis plane (TAP) catheters to the rescue!

Transversus abdominis plane (TAP) block catheters may offer an alternative to a central neuraxial blockade for patients undergoing major abdominal surgery (Paediatr Anaesth 19: 2009; 296). This case series consists of two children with spinal dysraphism in whom bilateral TAP block catheters were placed for postoperative pain relief. Administration of low dose, low concentration local anesthetic provided both children with excellent postoperative analgesia.     

腹横肌平面阻滞对阑尾切除术术后镇痛及患者恢复情况的影响

目的观察腹横平面(transversus abdominis plane,TAP)阻滞对阑尾切除术术后镇痛及患者恢复情况的影响。方法选择行阑尾切除术患者40例,ASAⅠ或Ⅱ级,随机均分为:TAP阻滞组和对照组,术后1h内在B超定位下行单侧TAP阻滞,两组分别注射0.25%罗哌卡因20ml、生理盐水20ml。观察并记录患者术后4h(T0)、8h(T1)、12h(T2)、24h(T3)、48h(T4)时疼痛VAS评分;记录术后48h内满意度VAS评分和需追加哌替啶的例数。患者胃肠道恢复时间、下床时间及该阻滞腹部脏器损伤、穿刺部位感染等并发症的发生。结果与对照组比较,T0~T2时TAP阻滞组疼痛VAS评分明显降低(P0.05)。术后48h内TAP阻滞组追加哌替啶的例数明显少于对照组。两组患者术后胃肠道恢复时间和下床时间差异均无统计学意义。与对照组比较,TAP阻滞组患者需追加哌替啶例数明显减少、满意度明显升高(P0.05)。无一例患者发生腹部脏器损伤、穿刺部位感染等并发症。结论 TAP阻滞在阑尾切除术术后镇痛中,降低患者术后疼痛,减少术后镇痛药物需求,是一种安全有效的镇痛方式。     

Efficacy and safety of transversus abdominis plane blocks versus thoracic epidural anesthesia in patients undergoing major abdominal oncologic resections: A prospective,randomized controlled trial

Background

The purpose of this study was to compare patient outcomes for thoracic epidural anesthesia (TEA) with transversus abdominis plane (TAP) blocks.

Ultrasound guided transversus abdominis plane block in pediatric patients undergoing laparoscopic surgery

ObjectiveTo assess safety and effectiveness of ultrasound-guided TAP block in children undergoing laparoscopic surgery for undescended testis.Subjects and methodsThis randomized controlled trial involved 108 children, 3–7 years old, randomly allocated into one of two equal groups; TAP Group and Control Group. All children received general anesthesia using propofol 1.5–2.5 mg/kg, atracurium 0.5 mg/kg and fentanyl 2 μg/kg. TAP Group received 0.5 ml/kg of ropivacaine 0.375% bilaterally under ultrasound guidance and control group received regular analgesics. Quality of analgesia was assessed using Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) and Objective behavioral pain score (OPS). The primary outcome measures were hemodynamic parameters and degree of pain. Secondary outcome measures were intraoperative fentanyl requirement, postoperative rescue analgesia (time and dose), complications, hospital stay and degree of satisfaction of patients and their parents.ResultsTAP block group had significantly lower intraoperative fentanyl dose (p < 0.001), significantly longer time to first postoperative request of analgesic (p < 0.001), lower analgesic dose during the first postoperative 24 h (p < 0.001) and lower pain scores along the whole 24 postoperative hours. Mean arterial pressure and heart rate were within the clinically accepted range in the two groups. Parents’ satisfaction was significantly higher (p < 0.001) in the TAP block group.ConclusionTAP block under ultrasound guidance was easy, safe, reliable and effective analgesic in children undergoing laparoscopic surgery for undescended testis.     

右美托咪定作为佐剂用于肝癌手术患者腹横肌平面阻滞的效果评估

目的 评估右美托咪定作为佐剂用于肝癌手术患者腹横肌平面（TAP）阻滞的临床效果。方法 选择择期行开腹肝癌切除术患者60例,根据局麻药液中右美托咪定剂量的大小,随机分为R、D0.5和D1.0三组,每组20例。所有患者均在局麻下行超声引导双侧肋缘下TAP阻滞,R组注入0.5%罗哌卡因40 mL,D0.5组注入等量的局麻药和右美托咪定0.5 μg/kg,D1.0组注入等量的局麻药和右美托咪定1.0 μg/kg。观察TAP阻滞的起效时间、持续时间、患者意识深度（NI）和血流动力学的变化,记录术后苏醒速度、镇痛药用量和并发症的发生情况。结果 R、D0.5、D1.0三组TAP阻滞的起效时间分别为13.1±2.9 min、11.6±2.3 min、7.7±2.1 min,持续时间分别为10.7±3.0 h、13.6±3.1 h、17.3±4.2 h,以上指标组间两两比较有统计学差异（P<0.05）。TAP阻滞后,三组的NI、平均动脉压和心率的变化趋势一致：D1.0组结论 右美托咪定与局麻药混合后用于TAP阻滞能加快起效和延长作用时间,同时通过右美托咪定的缓慢吸收入血而发挥镇静和稳定循环的作用。     

Clinical implications of the transversus abdominis plane block in pediatric anesthesia

Optimal perioperative analgesia for infants and children after major abdominal surgery poses a challenge when central neuraxial techniques are contraindicated. As a regional anesthesia technique, the transversus abdominis plane (TAP) block has been shown to reduce opioid consumption and improve pain scores compared to traditional perioperative pain strategies. Accordingly, TAP blocks may be considered as an alternative to central neuraxial analgesia to optimize perioperative pain control. Advancements in ultrasound technology have further improved the reliability and safety profile of this technique. Despite growing recognition of the diverse clinical scenarios where TAP blocks may be of benefit, its use among pediatric anesthesiologists remains limited. This article describes the history, anatomy, and a review of the current literature on TAP blocks with an emphasis on outcomes in pediatric patients.     

Transversus abdominis plane block using a short-acting local anesthetic reduces pain and opioid consumption after laparoscopic bariatric surgery: a meta-analysis

BackgroundTransversus abdominis plane (TAP) block is a form of regional anesthesia that has been increasingly employed in minimally invasive surgery. The data regarding its use in laparoscopic bariatric surgery, however, are still limited and at times controversial.ObjectivesThe aim of this meta-analysis was to assess the efficacy of TAP block after laparoscopic bariatric surgery.SettingSoba University Hospital, Sudan.MaterialsA systematic search was conducted through the Embase, Cochrane Collaboration, and PubMed databases for randomized controlled trials evaluating the effects of TAP block in patients undergoing laparoscopic bariatric surgery. Meta-analysis was performed using a random effects model. Primary endpoints were late (24 hr) pain scores at rest and on movement. Secondary endpoints included early (0–3 hr) pain scores at rest and on movement, opioid consumption, time to ambulation, length of hospital stay, and adverse events.ResultsTen randomized controlled trials met our inclusion criteria, with 404 patients in the TAP block groups and 413 patients in the control groups. TAP block was associated with significantly improved late pain scores (at rest, standardized mean difference [SMD] −.95, P < .001; on movement, SMD −1.04, P = .01) and early pain scores (at rest, SMD −1.81, P < .001; on movement, SMD −1.80, P < .001), reduced postoperative opioid consumption at 24 hours (SMD −2.23 mg intravenous morphine, P < .001), a shorter time to ambulation (SMD −1.07 hours, P < .001), and reduced incidence of postoperative nausea and vomiting (OR .20, P = .01). No significant difference was noted regarding length of hospital stay (P = .70). Postoperative TAP block administration resulted in greater effects on opioid consumption at 24 hours compared with preoperative block administration. Finally, none of the studies reported any adverse effect of local anesthetic.ConclusionGiven the significant effect on early and late postoperative pain, opioid consumption, and postoperative recovery and the low risk profile, TAP block using a short-acting anesthetic should be encouraged in routine practice in patients undergoing laparoscopic bariatric surgery.     

Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

Background

Both the transversus abdominis plane (TAP) block and the anterior quadratus lumborum block (QLB) have been shown effective in reducing postoperative pain after laparoscopic inguinal hernia repair. Our hypothesis was that there is no difference in analgesic effect between the two blocks for this procedure.

Methods

In this prospective, double-blind, randomised controlled study, 60 adult patients undergoing laparoscopic inguinal hernia repair were equally randomly assigned to either a preoperative TAP block or an anterior QLB. The primary outcome was oral morphine equivalent (OME) consumption at 4 h postoperatively. Secondary outcomes were OME consumption at 24, 48 h and 7 days, pain scores at rest and when coughing, nausea, and level of sedation measured at 1, 2, 3, 24, and 48 h and 7 days postoperatively.

Results

Fifty-three patients completed the study. There was no significant difference in OME consumption at 4 h postoperatively, TAP group (10.3 ± 7.85 mg) (mean ± SD) versus the anterior QLB group (10.9 ± 10.85 mg) (p = .713). The pain scores were similar at rest and when coughing during the 7 day observation period, as were the level of sedation and incidence of nausea. There were no cases of serious side-effects or muscle weakness of the thigh on the same side as the block.

Conclusion

There is no difference in OME consumption, pain, nausea or sedation between the TAP and the anterior QLB. Thus, the choice between the two blocks in a clinical setting of laparoscopic inguinal hernia repair should be based on other aspects, such as skills, practicalities, and potential risks.     

A triple‐blind,placebo‐controlled randomised trial of the ilioinguinal‐transversus abdominis plane (I‐TAP) nerve block for elective caesarean section

This study investigated the efficacy of a new ilioinguinal‐transversus abdominis plane block when used as a component of multimodal analgesia. We conducted a prospective, triple‐blind, placebo‐controlled randomised study of 100 women undergoing elective caesarean section. All women had spinal anaesthesia with hyperbaric bupivacaine, 15 μg fentanyl and 150 μg morphine, as well as 100 mg diclofenac and 1.5 g paracetamol rectally. Women were randomly allocated to receive the ilioinguinal‐transversus abdominis plane block or a sham block at the end of surgery. The primary outcome was the difference in fentanyl patient‐controlled analgesia dose at 24 h. Secondary outcomes included postoperative pain scores, adverse effects and maternal satisfaction. The cumulative mean (95%CI) fentanyl dose at 24 h was 71.9 (55.6–92.7) μg in the ilioinguinal‐transversus abdominis group compared with 179.1 (138.5–231.4) μg in the control group (p < 0.001). Visual analogue scale pain scores averaged across time‐points were 1.9 (1.5–2.3) mm vs. 5.0 (4.3–5.9) mm (p = 0.006) at rest, and 4.7 (4.1–5.5) mm vs. 11.3 (9.9–13.0) mm (p = 0.001) on movement, respectively. Post‐hoc analysis showed that the ilioinguinal‐transversus abdominis group was less likely to use ≥ 1000 μg fentanyl compared with the control group (2% vs. 16%; p = 0.016). There were no differences in opioid‐related side‐effects or maternal satisfaction with analgesia. The addition of the ilioinguinal‐transversus abdominis plane block provides superior analgesia to our usual multimodal analgesic regimen.