Comparison of epidural analgesia with transversus abdominis plane analgesia for postoperative pain relief in patients undergoing lower abdominal surgery: A prospective randomized study

Abstract

Background:Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques.Materials and Methods:Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally. Group E received 10 ml 0.125% bupivacaine stat and 10 ml 8th hourly for 48 h. Group T received 20 ml 0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8th hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded.Results:Analgesia at rest was comparable between the groups in the first 16 h. At 24 and 48 h, Group E had significantly better analgesia at rest (P = 0.001 and 0.004 respectively). Patients in Group E had significantly higher number of patients with nil or mild pain on coughing at all times. Paracetamol consumption was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h (P = 0.001).Conclusion:For lower abdominal surgeries, analgesia provided by intermittent boluses of 0.125% is comparable for first 16 h between epidural and TAP catheters. However, the quality of analgesia provided by the epidural catheter is superior to that provided by TAP catheters beyond that both at rest and on coughing with reduced opioid consumption.

The analgesic efficacy compared ultrasound-guided continuous transverse abdominis plane block with epidural analgesia following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials

“…We excluded 217 records that were duplicates and a further 738 records for other reasons. After review of the remaining 22 articles in full, 8 RCTs [13,15,[22][23][24][25][26][27] ultimately met the inclusive criteria and 7 RCTs [13,15,[22][23][24][25][26] were included in the meta-analysis. A flowchart of this process, including the reasons for excluding studies, is shown in Fig.…”

Efficacy of ultrasound-guided transversus abdominis plane block in breast reconstruction surgery with abdominal myocutaneous flap

“…However, we detected that the incidence of mild, moderate and severe pain was greater on movement, especially in the first four post-operative hours, which is in line with the fact that complete relief of pain on movement is not commonly achieved with local or systemic techniques but through neuraxial techniques. 18,19 To our knowledge, there aren't any studies comparing epidural with TAPB in TRAM surgery.…”

Efek Ultrasound-Guided Transversus Abdominis Plane (Tap) Blok Terhadap Kebutuhan Analgetik Pasca Operasi Seksio Sesarea

“…TAP blok tidak selalu dapat memberikan efek analgetik yang jelas, terutama pada pasien-pasien yang di anestesi dengan subarachnoid blok dengan obat long-acting opioid (Kanazi, et al, 2010;Marappa P, et al, 2017). TAP blok juga masih kalah dibandingkan dengan teknik epidural analgesia (Iyer, et al, 2017). Keterbatasan ini terjadi karena kerja analgetik TAP blok rata-rata 9-12 jam (Baeriswyl, et al,2015).…”