A randomised controlled trial of bilateral dual transversus abdominis plane blockade for laparoscopic appendicectomy

Abstract

SummaryWe investigated the effects of pre-operative ultrasound-guided bilateral dual transversus abdominis plane blocks on pain when sitting up and pain at rest after laparoscopic appendicectomy. We allocated 28 participants to injection with 60 ml ropivacaine 0.375% and 28 participants to 60 ml isotonic saline.

Essentials of Our Current Understanding

“…97 In adults, the same intervention produced a modest reduction in pain scores but not postoperative opioid consumption over the first 12 hours. 98 …”

Reply to Drs Hamilton and Manickam

“…3 Third, it reduces needle puncture of vessels, as well as the dose required for effective block, and thus the incidence of local anesthetic systemic toxicity. 4 This has led to the recommendation, in the most recent practice advisory from the American Society of Regional Anesthesia and Pain Medicine on local anesthetic systemic toxicity, 5 to use ultrasound guidance in order to improve patient safety by reducing the risk of systemic toxicity, a suggestion that has been significantly strengthened in comparison to the prior version of the guidelines. Despite the disclaimer in the guidelines that states that they are "not intended to represent a standard of care," their influence and frequent citation have a profound influence on the specialty.…”

Is a Thoracic Fascial Plane Block the Answer to Upper Abdominal Wall Analgesia?

“…We did not use these blocks in our study and cannot comment on their efficacy for providing analgesia or anesthesia in obese patients undergoing breast surgery. 4 In the original description of the oblique subcostal TAP block, Hebbard 2 proposed that oblique subcostal TAP block would provide effective analgesia of the abdominal wall above the umbilicus. Since then, the oblique subcostal TAP block has been used for major upper abdominal surgery 3 and in conjunction with bilateral TAP block for laparoscopic surgery covering the entire abdominal wall.…”

“…Since then, the oblique subcostal TAP block has been used for major upper abdominal surgery 3 and in conjunction with bilateral TAP block for laparoscopic surgery covering the entire abdominal wall. 4 Recently, Ma et al 5 mapped the analgesic efficacy of subcostal TAP block, observing that the technique produces effective analgesia in the anterior abdominal wall with the exception of the upper lateral abdomen.…”