Preemptive analgesic efficacy of ultrasound-guided transversus abdominis plane block in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision

Abstract

BackgroundThe transversus abdominis plane block is recently described peripheral block to providing analgesia to the anterior abdominal wall. The goal of this study is to evaluate the analgesic efficacy of the ultrasound-guided transversus abdominis plane block (US-TAP block) in patients undergoing gynecologic surgery via a transverse lower abdominal skin incision.MethodsThirty-two patients undergoing gynecologic surgery were randomized to undergo standard care such as PCA, or to receive additional US-TAP block with standard care. After general anesthesia induction, a bilateral US-TAP block was performed using 0.375% ropivacaine 20 ml on each side. Postoperative demand of rescue analgesics in PACU and ward were recorded. Each patient was assessed postoperatively by a blinded investigator in the postanesthesia care unit (PACU) and at 2, 6, 10, 24, 48 hr postoperatively to investigate pain, drowsiness, nausea and itch.ResultsThe US-TAP block reduced pain intensity compared to standard care in the PACU (5.2 ± 3.1 vs 8.4 ± 1.3) and at 2, 24 postoperative hours (3.0 ± 2.4 vs 5.2 ± 2.4, 0.9 ± 1.5 vs 2.2 ± 1.9). Fentanyl requirements in PACU was reduced (20.3 ± 20.9 vs 62.5 ± 35.4 µg, P < 0.05). In ward, pethidine requirements was reduced (21.9 ± 28.7 vs 56.3 ± 34.8 mg, P < 0.05).ConclusionsThe US-TAP block with standard care provide more effective analgesia after gynecologic surgery via a transverse lower abdominal skin incision.

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

“…Pain scores at six and 12 hr were investigated in 23 and 18 [16][17][18][19][20][21][22][23]25,26,29,31,32,[34][35][36][38][39][40][41] studies, respectively. The overall analyses showed that, in the TAP block group, the six-hour VAS pain score was reduced by 1.4 (95% CI, -1.9 to -0.8; P \ 0.001) (Fig.…”

“…Transversus abdominal plane block in gynecological surgery Eleven studies 17,21,26,32,50,51,54,[58][59][60][61] evaluated the efficacy of TAP block in gynecological surgery. Compared with the control group, TAP block reduced the six-hour pain score 17,21,26,32,50,51,54 by 1.2 (95% CI, -1.8 to -0.6; P \ 0.001), the 12-hr pain score 17,21,51 by 1.1 (95% CI, -2.0 to -0.3; P = 0.007), and the 24-hr pain score by 1.1 (95% CI, -2.1 to -0.2; P\0.001). The TAP block also reduced 24-hr morphine consumption 17,21,26,50,54,60,61 by 5.9 mg (95% CI, -8.6 to -3.1; P \ 0.001) ( Fig.…”

Efficacy of transverse abdominis plane block in reduction of postoperation pain in laparoscopic cholecystectomy

“…3,9,10 Opiates, which are the most commonly used and efficient postoperative analgesic agents, accompany adverse effects such as nausea, vomiting, pruritus, and respiratory depression. 11 The adverse effects of opioids are dose dependent, so using a multimodal approach to pain control would enhance analgesia while decreasing the side effects.…”

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

“…Compared to systemic opioids, patients receiving TAP blocks after major abdominal surgery had less pain up to 24 hours postoperatively than non-TAP block groups, but in that study no statistical differences were found with respect to nausea (Siddiqui 2011). The benefits of TAP blocks are so far measured in relation to reduced postoperative opioid requirements, lower pain scores or a reduction in opioid-related side effects (Shin 2011). As an example, a metaanalysis of 7 studies demonstrated an average reduction in 24-hour morphine consumption of 22 mg compared with systemic opioids, and TAP blocks were associated with reduced early postoperative pain VAS in 4 of the 7 studies (Petersen 2010).…”