Laparoscopic-assisted Tranversus Abdominis Plane (TAP) Block Versus Ultrasonography-guided Transversus Abdominis Plane Block in Postlaparoscopic Cholecystectomy Pain Relief: Randomized Controlled Trial

Ravichandran, Niranjan T.; Sistla, Sarath Chandra; Kundra, Pankaj; Ali, Sheik Manwar; Dhanapal, Baskaran; Galidevara, Indira

doi:10.1097/sle.0000000000000405

Cited by 32 publications

(30 citation statements)

References 23 publications

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“…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.…”

Section: Transversus Abdominis Plane Blockmentioning

confidence: 97%

“…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.…”

Section: Transversus Abdominis Plane Blockmentioning

confidence: 99%

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Transversus Abdominis Plane Block

et al. 2019

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In this narrative review article, the authors discuss the anatomy, nomenclature, history, approaches (posterior vs. lateral vs. subcostal), techniques, pharmacology, indications, and complications of transversus abdominis plane blocks, as well as possible alternative truncal blocks. Despite the scarcity of evidence and contradictory findings, certain clinical suggestions can nonetheless be made. Overall transversus abdominis plane blocks appear most beneficial in the setting of open appendectomy (posterior or lateral approach). Lateral transversus abdominis plane blocks are not suggested for laparoscopic hysterectomy, laparoscopic appendectomy, or open prostatectomy. However, transversus abdominis plane blocks could serve as an analgesic option for Cesarean delivery (posterior or lateral approach) and open colorectal section (subcostal or lateral approach) if there exist contraindications to intrathecal morphine and thoracic epidural analgesia, respectively. Future investigation is required to compare posterior and subcostal transversus abdominis plane blocks in clinical settings. Furthermore, posterior transversus abdominis plane blocks should be investigated for surgical interventions in which their lateral counterparts have proven not to be beneficial (e.g., laparoscopic hysterectomy/appendectomy, open prostatectomy). More importantly, because posterior transversus abdominis plane blocks can purportedly provide sympathetic blockade and visceral analgesia, they should be compared with thoracic epidural analgesia for open colorectal surgery. Finally, transversus abdominis plane blocks should be compared with newer truncal blocks (e.g., erector spinae plane and quadratus lumborum blocks) with well-designed and adequately powered trials.

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Section: Transversus Abdominis Plane Blockmentioning

confidence: 97%

Section: Transversus Abdominis Plane Blockmentioning

confidence: 99%

Transversus Abdominis Plane Block

et al. 2019

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“…Studies have shown that the laparoscopically assisted TAP blocks result in similar pain scores and postoperative opioid consumption 31 32 but shorter block performance time compared with the ultrasound-guided block. 31 In addition, patients receiving a laparoscopically assisted TAP block had statistically significant reduction in pain scores and opioid consumption compared with controls. 30 33 A similar laparoscopically guided technique has been described for rectus sheath block.…”

Section: Introduction Backgroundmentioning

confidence: 93%

Randomised, double-blinded, placebo-controlled trial to investigate the role of laparoscopic transversus abdominis plane block in gastric bypass surgery: a study protocol

et al. 2020

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IntroductionEvaluating the efficacy of a laparoscopically guided, surgical transversus abdominis plane (TAP) and rectus sheath (RS) block in reducing analgesic consumption while improving functional outcomes in patients undergoing laparoscopic bariatric surgery.Methods150 patients Living with obesity undergoing elective laparoscopic Roux-En-Y gastric bypass for obesity will be recruited to this double-blinded, placebo-controlled randomised controlled trial from a Bariatric Centre of Excellence over a period of 6 months. Patients will be electronically randomised on a 1:1 basis to either an intervention or placebo group. Those on the intervention arm will receive a total of 60 mL 0.25% ropivacaine, divided into four injections: two for TAP and two for RS block under laparoscopic visualisation. The placebo arm will receive normal saline in the same manner. A standardised surgical and anaesthetic protocol will be followed, with care in adherence to the Enhanced Recovery after Bariatric Surgery guidelines.AnalysisDemographic information and relevant medical history will be collected from the 150 patients enrolled in the study. Our primary efficacy endpoint is cumulative postoperative narcotic use. Secondary outcomes are peak expiratory flow, postoperative pain score and the 6 min walk test. Quality of recovery (QoR) will be assessed using a validated questionnaire (QoR-40). Statistical analysis will be conducted to assess differences within and between the two groups. The repeated measures will be analysed by a mixed modelling approach and results reported through publication.Ethics and disseminationEthics approval was obtained (20170749-01H) through our institutional research ethics board (Ottawa Health Science Network Research Ethics Board) and the study results, regardless of the outcome, will be reported in a manuscript submitted for a medical/surgical journal.Trial registration numberPre-results NCT03367728.

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“…[8][9][10][11][12] Furthermore, several reports show that laparoscopic-assisted TAP block may be considered equally effective as the standard US-guided TAP block and can be considered the choice in centers where ultrasound is not always available in operating rooms. [11][12][13] More recently, intraoperative laparoscopic-assisted trocar-site bupivacaine infiltration 10,12,14,15 has shown promising results, in terms of post-operative pain relief, in different kinds of miniinvasive surgery. Thus, the aim of this evaluation is to investigate the possible role of laparoscopic-assisted trocar-site ropivacaine infiltration during laparoscopic adrenalectomy (via the lateral transperitoneal approach) in terms of post-operative pain control.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic-Guided Ropivacaine Trocar-Site Infiltration Can Improve Post-Operative Pain Control after Laparoscopic Adrenalectomy

et al. 2021

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Background There is no consensus on pain control in patients undergoing laparoscopy; nowadays, conventional therapy may be improved by transversus abdominis plane block. The aim of this evaluation is to investigate the role of laparoscopic-assisted trocar-site ropivacaine infiltration during adrenalectomy in pain control Methods This is a retrospective evaluation of a prospectively maintained database including patients undergoing adrenalectomy. Patients were divided into 2 groups: Group A patients received laparoscopic-assisted trocar-site infiltration of 7.5 mg/mL ropivacaine and Group B patients did not receive any infiltration. All patients received a 24-hour infusion of 20 mg morphine; pain was checked at 6, 24, and 48 hours after surgery by Visual Analogue Scale (VAS) score. A rescue analgesia by was given if VAS score was > 4 or on patient request. Results No differences in operative time, complications, and post-operative stay and no complications related to trocar-site infiltration were found. 6-hour and 48-hour VAS scores were not found to be significantly different between groups, even if a slight decrease in VAS score in Group A was reported. Group A showed significant reduction in VAS score at 24 hours (2.44 +/− .41 vs 3.01 +/− .78, P < .005) and in the number of patients requiring further analgesic drugs administration (40.6% vs 57.8%, P < .005) Conclusions Laparoscopic-guided trocar-site ropivacaine infiltration can be considered safe and effective in the management of post-operative pain and in the reduction of analgesic need in patients undergoing laparoscopic adrenalectomy. The retrospective nature of the study and the lack of a consistent series of patients require further evaluations.

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Laparoscopic-assisted Tranversus Abdominis Plane (TAP) Block Versus Ultrasonography-guided Transversus Abdominis Plane Block in Postlaparoscopic Cholecystectomy Pain Relief: Randomized Controlled Trial

Abstract: Laparoscopy-assisted TAP block is faster and equally efficacious when compared with USG-guided block and has a definite role in centers where ultrasound is not available in operating rooms.

Cited by 32 publications

References 23 publications

Transversus Abdominis Plane Block

Transversus Abdominis Plane Block

Randomised, double-blinded, placebo-controlled trial to investigate the role of laparoscopic transversus abdominis plane block in gastric bypass surgery: a study protocol

Laparoscopic-Guided Ropivacaine Trocar-Site Infiltration Can Improve Post-Operative Pain Control after Laparoscopic Adrenalectomy

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