The Analgesic Effectiveness of Ipsilateral Transversus Abdominis Plane Block in Adult Patients Undergoing Appendectomy: A Prospective Randomized Controlled Trial

Ghimire, A; Bhattarai, B.; Prasad, J.N.; Shah, Sangeeta

doi:10.3126/kumj.v13i4.16838

Cited by 6 publications

(11 citation statements)

References 6 publications

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“…To date, three randomized trials have investigated the benefits of transversus abdominis plane blocks for open appendectomy [195][196][197] and three studies have done the same for laparoscopic appendectomy. [198][199][200] Overall the findings have been fairly consistent.…”

Section: Appendectomymentioning

confidence: 99%

“…[198][199][200] Overall the findings have been fairly consistent. For open appendectomy, both lateral and posterior transversus abdominis plane blocks have been shown to result in decreased postoperative pain scores at rest and on movement as well as significant reductions in consumption of intravenous morphine (22 mg) and tramadol (78 mg) at 24 h and intravenous morphine (12.3 mg) at 48 h [195][196][197] despite the use of acetaminophen and diclofenac. 195,196 In contrast, for laparoscopic appendectomy, two trials have concluded that lateral transversus abdominis plane blocks provide no benefit in the setting of multimodal analgesia.…”

Section: Appendectomymentioning

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: Appendectomymentioning

confidence: 99%

Section: Appendectomymentioning

confidence: 99%

Transversus Abdominis Plane Block

et al. 2019

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“…There was no study investigating TAP blocks in adults for open appendicectomy. Ghimire and colleagues’ three-arm study examined the effect of morphine added to bupivacaine (either as an adjuvant in the TAP block or as intravenous morphine) 70 . Even though there was a significantly longer mean duration of analgesia measured by the time to first analgesic request in the group receiving morphine as an adjuvant, there was no significant reduction in pain intensity or opioid consumption.…”

Section: Regional Analgesia Techniquesmentioning

confidence: 99%

Perioperative pain management for appendicectomy

Freys,

Bigalke,

Mertes

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Despite being a commonly performed surgical procedure, pain management for appendicectomy is often neglected because of insufficient evidence on the most effective treatment options. OBJECTIVE To provide evidence-based recommendations by assessing the available literature for optimal pain management after appendicectomy. DESIGN AND DATA SOURCES This systematic review-based guideline was conducted according to the PROSPECT methodology. Relevant randomised controlled trials, systematic reviews and meta-analyses in the English language from January 1999 to October 2022 were retrieved from MEDLINE, Embase and Cochrane Databases using PRISMA search protocols. ELIGIBILITY CRITERIA We included studies on adults and children. If articles reported combined data from different surgeries, they had to include specific information about appendicectomies. Studies needed to measure pain intensity using a visual analogue scale (VAS) or a numerical rating scale (NRS). Studies that did not report the precise appendicectomy technique were excluded. RESULTS Out of 1388 studies, 94 met the inclusion criteria. Based on evidence and consensus, the PROSPECT members agreed that basic analgesics [paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)] should be administered perioperatively for open and laparoscopic appendicectomies. A laparoscopic approach is preferred because of lower pain scores. Additional recommendations for laparoscopic appendicectomies include a three-port laparoscopic approach and the instillation of intraperitoneal local anaesthetic. For open appendicectomy, a preoperative unilateral transverse abdominis plane (TAP) block is recommended. If not possible, preincisional infiltration with local anaesthetics is an alternative. Opioids should only be used as rescue analgesia. Limited evidence exists for TAP block in laparoscopic appendicectomy, analgesic adjuvants for TAP block, continuous wound infiltration after open appendicectomy and preoperative ketamine and dexamethasone. Recommendations apply to children and adults. CONCLUSION This review identified an optimal analgesic regimen for open and laparoscopic appendicectomy. Further randomised controlled trials should evaluate the use of regional analgesia and wound infiltrations with adequate baseline analgesia, especially during the recommended conventional three-port approach. REGISTRATION The protocol for this study was registered with the PROSPERO database (Registration No. CRD42023387994).

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“…7 It provides effective analgesia for patients undergoing lower and upper abdominal surgeries such as cesarean delivery, open appendectomy, and liver resection. [8][9][10] However, no reports have described the postoperative analgesic effect of the TAP block on patients with hepatic echinococcosis (HE). Enhanced recovery after surgery (ERAS) is a comprehensive perioperative approach that aims to accelerate recovery after surgery.…”

Section: Introductionmentioning

confidence: 99%

Effect of the transversus abdominis plane block on postoperative pain and recovery in patients with hepatic echinococcosis

Deng

et al. 2018

J Int Med Res

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ObjectivesHepatic echinococcosis (HE) is a severe parasitic disease that occurs worldwide, and radical surgery is the recommended therapy. This study was performed to investigate the efficacy of using a transversus abdominis plane (TAP) block during surgery on postoperative pain and recovery of patients with HE under the guidelines of an enhanced recovery after surgery (ERAS) protocol.MethodsFifty-eight patients from the Tibetan plateau who underwent surgery for treatment of HE by the same surgeons under the guidance of ERAS were included in the present study. A TAP block was conducted before closing the abdominal cavity.ResultsThe consumption of sufentanil was significantly lower in patients of the TAP than control group. Patients had a significantly shorter time to first flatus in the TAP than control group. Other parameters showed no significant differences between the two groups.ConclusionsUse of the TAP block could reduce the consumption of analgesic medication and promote recovery of patients from the Tibetan plateau under the guidance of an ERAS protocol.

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The Analgesic Effectiveness of Ipsilateral Transversus Abdominis Plane Block in Adult Patients Undergoing Appendectomy: A Prospective Randomized Controlled Trial

Abstract: Background

Cited by 6 publications

References 6 publications

Transversus Abdominis Plane Block

Transversus Abdominis Plane Block

Perioperative pain management for appendicectomy

Effect of the transversus abdominis plane block on postoperative pain and recovery in patients with hepatic echinococcosis

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