A Randomized Trial Comparing Surgeon-administered Intraoperative Transversus Abdominis Plane Block With Anesthesiologist-administered Transcutaneous Block

Abstract

(Int J Obstet Anesth. 2018;35:26–32) Traditionally, transversus abdominis plane (TAP) blocks are performed percutaneously by anesthesiologists using ultrasound guidance to prevent damage to intra-abdominal structures or injection into the incorrect plane. However, ultrasound-guided blocks pose potential problems, particularly in obese patients or patients with poor muscular tone, where visualization may be difficult. There have been reports of puncturing intraperitoneal structures during the performance of these blocks. In addition, ultrasound-guided blocks may be time consuming. An alternative to this method is surgeon-administered intraoperative TAP blocks, which eliminate the risk of intraperitoneal injury since they are performed under direct visualization. This study aimed to compare surgical TAP blocks with conventional TAP blocks in patients undergoing cesarean delivery.

PROSPECT guideline for elective caesarean section: updated systematic review and procedure‐specific postoperative pain management recommendations

“…This approach also resulted in reduced need for rescue analgesia [90]. Comparison between surgeon‐administered and anaesthetist‐administered TAP blocks did not show any differences in postoperative analgesia [91].…”

“…A total of 145 studies were included, of which 126 were randomised controlled trials and 19 were systematic reviews and meta‐analyses (Fig. 1) [9–153]. The methodological quality assessments of the 126 randomised controlled trials included in the final qualitative analysis are summarised in online Supporting Information Table S1.…”

Transversus Abdominis Plane Block

“…However the surgical technique resulted in a 60 to 80% decrease in performance time. 56,58 In contrast, in one trial investigating minimally invasive colorectal surgery, surgical lateral transversus abdominis plane blocks resulted in similar pain scores but 17.2-mg-lower intravenous morphine consumption at 48 h than their anesthesiologist-performed counterparts. 59 In summary, based on the current knowledge, we suggest foregoing landmark guidance in favor of ultrasound for the performance transversus abdominis plane blocks.…”

“…To date, four randomized controlled trials (Jadad scores of at least 3) have compared surgeon-and anesthesiologist-performed transversus abdominis plane blocks. [56][57][58][59] In three studies investigating subcostal transversus abdominis plane blocks performed for laparoscopic cholecystectomy, 56 and lateral transversus abdominis plane blocks performed for Cesarean delivery 58 or laparoscopic colorectal surgery, 57 surgical and anesthesiologist-driven transversus abdominis plane blocks provided similar postoperative analgesia and breakthrough opioid consumption. However the surgical technique resulted in a 60 to 80% decrease in performance time.…”

In reply: Comment on the editorial relating to: Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis

“…3 Furthermore, a surgeonplaced TAP block is another equally effective alternative. 4 As highlighted in our editorial, there are multiple inherent limitations of catheter techniques compared with a singleshot technique that are hard to argue against.…”