Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery

Abstract

SummarySubcostal transversus abdominis plane (TAP) catheters have been reported to be an effective method of providing analgesia after upper abdominal surgery. We compared their analgesic efficacy with that of epidural analgesia after major upper abdominal surgery in a randomised controlled trial. Adult patients undergoing elective open hepatobiliary or renal surgery were randomly allocated to receive subcostal TAP catheters (n = 29) or epidural analgesia (n = 33), in addition to a standard postoperative analgesic regimen comprising of regular paracetamol and tramadol as required. The TAP group patients received bilateral subcostal TAP catheters and 1 mg.kg−1 bupivacaine 0.375% bilaterally every 8 h. The epidural group patients received an infusion of bupivacaine 0.125% with fentanyl 2 μg.ml−1. The primary outcome measure was visual analogue pain scores during coughing at 8, 24, 48 and 72 h after surgery. We found no significant differences in median (IQR [range]) visual analogue scores during coughing at 8 h between the TAP group (4.0 (2.3–6.0 [0–7.5])) and epidural group (4.0 (2.5–5.3) [0–8.5])) and at 72 h (2.0 (0.8–4.0 [0–5]) and 2.5 (1.0–5.0 [0–6]), respectively). Tramadol consumption was significantly greater in the TAP group (p = 0.002). Subcostal TAP catheter boluses may be an effective alternative to epidural infusions for providing postoperative analgesia after upper abdominal surgery.

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

“…Only three studies [41][42][43] addressed the comparison between TAP block and epidural anesthesia, and none of them showed any significant differences between the two techniques ( Table 2). Only one RCT 43 investigated eight-hour pain score, and one trial 43 reported the 24-hr morphine consumption.…”

“…16,29,36,38,[40][41][42][43]52 Compared with the control group, TAP block showed no difference in reducing the six-hour pain score 16,29,36,38,41,43 (-0.1; 95% CI, -1.4 to 1.3; P = 0.95), 12-hr pain score 16,38,41,52 (1.9, 95% CI, -4.2 to 0.4; P = 0.11), 24-hr pain score 16,29,36,38,[41][42][43]52 (-0.8; 95% CI, -2.0 to 0.4; P = 0.18), or 24-hr morphine consumption 16,29,36,38,43,52 (-14.7 mg; 95% CI, -37.8 to 8.4; P = 0.21) ( Table 2). Only one trial 16 performed TAP block from inside the abdominal wall; consequently, it was not possible to perform subgroup analysis for this comparison.…”

Abdominal Surgery: Advances in the Use of Ultrasound-Guided Truncal Blocks for Perioperative Pain Management

“…Therapeutic failure rate was higher in the epidural group, and the incidence of hypotension was also greater (Kadam 2011). Niraj et al are also amongst the few having compared the new techniques versus the older and more established techniques (Niraj 2011). Dr. Niraj compared the analgesic efficacy of the subcostal TAP block catheter technique (very much resembling the technique described by Dr. Hebbard) with the epidural analgesia for patients undergoing elective open hepatobiliary or renal surgery.…”

Comparison of analgesic efficacy of oblique subcostal and lateral transversus abdominis plane block after laparoscopic cholecystectomy

“…Although laparoscopic cholecystectomy is less invasive than open cholecystectomy, it is still associated with significant moderate to severe pain during the first 24 hours after surgery, especially at trocar insertion sites [6,7]. During laparoscopic cholecystectomy these sites are innervated by nerves from T6 to L1 at the neurovascular plane of the abdominal wall [4,5], and thus, it might be expected that TAP blocks would be useful for controlling pain after laparoscopic cholecystectomy.…”