Effect of Ultrasound-Guided Transversus Abdominis Plane Block Combined with Patient-Controlled Intravenous Analgesia on Postoperative Analgesia After Laparoscopic Cholecystectomy: a Double-Blind, Randomized Controlled Trial

Abstract

Purpose To compare the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with patient-controlled intravenous analgesia (PCIA) and PCIA alone on analgesia after laparoscopic cholecystectomy (LC). Methods In this double-blind, randomized controlled trial, 160 patients undergoing LC were randomized into the TAPB group (n = 80) and PCIA group (n = 80). Bilateral ultrasound-guided TAPB was performed with 20 mL 0.5% ropivacaine and the PCIA pump was given after LC in the TAPB group. The PCIA group received the PCIA pump alone as a control group. The primary outcome was postoperative pain, assessed by the visual analog scale (VAS). Results VAS pain (including abdominal wall pain or visceral pain) scores at rest and coughing were significantly lower in the TAPB group at 1, 4, 12, 24, 36, and 48 h after LC (P < 0.05). Postoperative additional analgesic needs, analgesic pump compressions, and PCIA analgesic dosages, and total morphine equivalents were significantly reduced in the TAPB group, and postoperative hospital stay, total hospitalization expenses, expenses within 24 h or 48 h (from analgesia and adverse reactions), and patient satisfaction were significantly higher in the TAPB group than the PCIA group (all P < 0.05). No significant between-group differences were observed in operation time, intraoperative blood loss, unplugging the analgesic pump due to adverse reactions, first exhaust time, and postoperative adverse events between the two groups. Conclusions Ultrasound-guided TAPB combined with PCIA was an effective and safe perioperative analgesic technique for patients undergoing LC compared to PCIA only.

Effect of General Anesthesia Combined with Anterior Serratus Muscle Plane Block on Pain Relief and Cognitive Function in Undergoing Thoracoscopic Lobectomy

“…The premise is that the anesthesiologist needs to set the corresponding background amount and injection speed in terms of the basic condition of patients. At present, the commonly used analgesia program after thoracic surgery is PCIA, which is mainly based on the infusion of opioids [15,16] . However, this conventional method is still relatively effective for patient's pain relief at rest, but it is not useful for pain relief resulted from exercise, and often causes adverse reactions [17,18] .…”

“…Postoperative analgesia treatment: Three groups of patients were pulled out and connected with the analgesia pump when they recovered consciousness and met the indications for extubation after the operation, and then returned to the postoperative care unit of thoracic surgery. In the PCIA and SPB groups, 2~3 µg/kg sufentanil+12 mg butorphanol+0.9 % sodium chloride injection 150 ml was used, the background dose was 2 ml/h, Patient Controlled Analgesia (PCA) 2 ml was given, and the blocking time was 15…”

Analgesic benefits of pre-operative versus postoperative transversus abdominis plane block for laparoscopic cholecystectomy: a frequentist network meta-analysis of randomized controlled trials

“…MAINTENANCE: Vecuronium 0.02 mg/kg iv, air and oxygen and SEVO 1.5–2.0 dial concentration MAC of 1. paracetamol 1 g IV at extubation and 8th hourly, Tramadol 1 mg/kg was given IV whenever VAS was ≥4 Postoperative Pain Ra YS (2010) [ 29 ] Korea 20–65 I-II 0.25% levobupivacaine 30 mL – Preoperative PREMEDICATION: none, INDUCTION: glycopyrolate 0.2 mg and MDZ 0.05 mg/kg and introducing 2% PRP and REM 50 μg/ml, ROC 0.6 mg/kg MAINTENANCE: oxygen and nitrous oxide, PRP at 2 μg/ ml PACU: NRS > 6 ketorolac 30 mg IV, If the pain was not relieved, FNT 20 μg; in WARD: ketorolac 30 mg was injected into all the patients 3 times during postoperative 24 hours for 8 hour Postoperative Pain Dai LM (2022) [ 30 ] China > 18 I-II 20 mL 0.5% ropivacaine Postoperative INDUCTION: MDZ (0.05 mg/kg), SUF (0.03 μg/kg), ETM (0.3 mg/kg), and cisatracurium (0.15 mg/kg), MAINTENANCE: PRP (6 mg/ kg/h) and REM (0.3 μg/kg/min) 100 mL of normal saline mixed with SUF (100 μg) and dezocine (20 mg); basal inf. 2 mL/h, bolus dose was 0.5 mL, and a lockout interval of 15 min Morphine Consumption Al-Refaey K (2016) [ 31 ] Egypt 18–40 I-II 20 ml volume 0.25 bupivacaine Preoperative INDUCTION: PRP 1–1.5 mg/kg, FNT 1 μ/kg, and atracurium 0.5 mg/kg, MAINTENANCE: SEVO, 0.4 oxygen/air mixture morphine (0.02 mg/kg) if VAS score ≥ 4 Recruitment Rate.…”

“…In total, 22 of the included studies compared pre-operative TAP block with a control [ 22 , 23 , 25 , 27 – 29 , 31 , 33 , 35 – 43 , 45 , 46 , 49 , 52 , 54 ], 11 evaluated the effect of postoperative TAP block compared with a control block [ 24 , 26 , 30 , 32 , 34 , 44 , 47 , 48 , 50 , 51 , 53 ], and only one directly compared pre-operative TAP block with postoperative TAP block [ 11 ]. A total of 2317 patients were enrolled in the included trials: 456 patients were randomised to the postoperative TAP block group, 773 to the pre-operative TAP block group, and the remaining to the control group.…”

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer

“…Ultrasound-guided bilateral transversus abdominal plane block (TAPB) provides analgesic effects by injecting a local anesthetic into the plane between the internal oblique and transversal abdominal muscles under the guidance of ultrasound, thus blocking sensory nerves that pass through this plane. With the advantages of fast onset and a good analgesic effect, TAPB has been widely used for auxiliary anesthesia and postoperative analgesia in patients undergoing abdominal surgery[ 5 , 6 ]. At present, there are few relevant literature reports comparing the application effects of epidural anesthesia and TAPB in laparoscopic radical gastrectomy.…”