The effects of adding upper and lower subcostal transversus abdominis plane blocks to a lateral transversus abdominis plane block after laparoscopic cholecystectomy

Takimoto, Kayo; Sakai, Norihiro; Ono, Mayu

doi:10.1097/eja.0000000000000305

Cited by 9 publications

(9 citation statements)

References 5 publications

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“…Several approaches using transversus abdominis plane (TAP) block for the management of peripheral postoperative pain after CLC [ 7 – 9 ] have been evaluated; however, the results have been somewhat contradictory. [ 10 , 11 ] Considering that the main source of pain after CLC is the umbilical trocar site, [ 12 ] bilateral rectus sheath block (RSB) may be applicable. [ 13 , 14 ] Bilateral RSB can provide postoperative analgesia for procedures involving a midline incision [ 15 – 17 ] with a slower absorption kinetics profile for local anesthetic than other compartment blocks.…”

Section: Introductionmentioning

confidence: 99%

Pain related to robotic cholecystectomy with lower abdominal ports

Choi¹,

Lee²,

Kim³

et al. 2016

Medicine

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Background:Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients.Methods:We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study).Results:Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups.Conclusions:After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB.

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Section: Introductionmentioning

confidence: 99%

Pain related to robotic cholecystectomy with lower abdominal ports

Choi¹,

Lee²,

Kim³

et al. 2016

Medicine

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“…The effect of TAP block depends on the pattern of local anesthetic spread. 16 , 17 The results of the study conducted by Lee et al 16 showed that maximum dermatomal block distribution was observed at 30 min and usually regressed by 24 hours. In the present study, TAP block was performed after emergence from anesthesia, which allowed observation of the difference in VAS scores before and after the block.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy

Arı

Karip

et al. 2017

SMJ

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Objectives:To investigate the analgesic effect of a subcostal-posterior transversus abdominis plane (TAP) block combination following laparoscopic sleeve gastrectomy.Methods:This study was conducted at Fatih Sultan Mehmet Educational and Research Hospital, Istanbul, Turkey, between March 2014 and June 2015. A total of 40 patients with a body mass index of 40-60 kg/m2 scheduled for laparoscopic sleeve gastrectomy were randomly allocated into 2 groups. Patients in Group I (n=20) received a bilateral subcostal TAP block, and patients in Group II (n=20) received a bilateral subcostal and posterior TAP block. Pain intensity was assessed at rest and during coughing using the visual analog scale (VAS) prior to and at various time points after TAP block (0 min, 30 min, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours). Morphine consumption over 24 hours and time to first morphine requirement were recorded.Results:There was no difference in VAS scores between groups. Morphine consumption was 6.78±5.95 mg in Group I, and 7.28±5.95 mg in Group II (p=0.795). Time to first morphine requirement was 267.22±303.84 min for Group I, and 207.80±209.81 min for Group II (p=0.154).ConclusionsSubcostal-posterior TAP block provided equivalent analgesia to subcostal TAP block alone following laparoscopic sleeve gastrectomy.

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“…Classification of TAP blocks based on a unified nomenclature system is shown in Table 1 . Many approaches have been suggested to provide analgesia over the upper abdomen, such as oblique subcostal, subcostal, or upper subcostal approaches [ 11 , 13 , 15 , 17 , 39 , 40 , 43 ]. However, they are quite similar in the area where local anesthetics deposit except for the oblique subcostal approach, which covers both the upper and lower abdomen using the hydrodissection technique.…”

Section: New Nomenclaturementioning

confidence: 99%

Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques

Tsai

Yoshida

Chuang

et al. 2017

BioMed Research International

299

196

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Purpose of Review Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. This review highlights the nomenclature system and recent advances in TAP block techniques and proposes directions for future research. Recent Findings Ultrasound guidance is now considered the gold standard in TAP blocks. It is easy to acquire ultrasound images; it can be used in many surgeries involving the anterolateral abdominal wall. However, the efficacy of ultrasound-guided TAP blocks is not consistent, which might be due to the use of different approaches. The choice of technique influences the involved area and block duration. To investigate the actual analgesic effects of TAP blocks, we unified the nomenclature system and clarified the definition of each technique. Although a single-shot TAP block is limited in duration, it is still the candidate of the analgesic standard for abdominal wall surgery because the use of the catheter technique and liposomal bupivacaine may overcome this limitation. Summary Ultrasound-guided TAP blocks are commonly used. With the unified nomenclature and the development of catheter technique and/or liposomal local anesthetics, TAP blocks can be applied more appropriately to achieve better pain control.

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The effects of adding upper and lower subcostal transversus abdominis plane blocks to a lateral transversus abdominis plane block after laparoscopic cholecystectomy

Cited by 9 publications

References 5 publications

Pain related to robotic cholecystectomy with lower abdominal ports

Pain related to robotic cholecystectomy with lower abdominal ports

Ultrasound-guided subcostal-posterior transversus abdominis plane block for pain control following laparoscopic sleeve gastrectomy

Transversus Abdominis Plane Block: An Updated Review of Anatomy and Techniques

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