Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized, Controlled, Observer-Blinded Trial

Ghisi, Daniela; Fanelli, Andrea; Vianello, F.; Gardini, Marco A.; Mensi, G.; Colla, Luca La; Danelli, G.

doi:10.1213/ane.0000000000001267

Cited by 42 publications

(63 citation statements)

References 15 publications

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“…There was no clinically significant difference in median maximal pain scores in the immediate postoperative period, but the liposomal bupivacaine group had decreased maximum pain scores, decreased opioid use, and a lower incidence of PONV for the first 24 hours 39. Ghisi and coworkers40 compared ultrasound-guided TAP block with systemic opioid analgesia and found no advantage in terms of VAS score, opioid consumption, postoperative mobilization, or adverse events. Finally, Guardabassi and colleagues41 found no advantage in terms of opioid consumption during the first 24 hours, and no difference in pain scores, when TAP blocks were added to a systemic analgesia regimen including opioid PCA.…”

Section: Resultsmentioning

confidence: 97%

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Lirk

Thiry

Bonnet

et al. 2019

Reg Anesth Pain Med

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Background and objectivesLaparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy.Strategy and selection criteriaRandomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed.ResultsOf the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain.ConclusionsThe baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

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Section: Resultsmentioning

confidence: 97%

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Lirk

Thiry

Bonnet

et al. 2019

Reg Anesth Pain Med

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“…Also Ghisi et al [40] found that, TAP block did not reduce morphine consumption during the first postoperative 24 h after elective total laparoscopic hysterectomy.…”

Section: Discussionmentioning

confidence: 96%

The Effect of a Preoperative Single Dose of Magnesium Sulfate versus Preoperative Ultrasound Guided Bilateral Transversus Abdominis Plane Block on Hemodynamics and Postoperative Analgesic Requirements in Patients Undergoing Colorectal Surgery

Amin¹,

Mohamed²

2017

J Anesth Clin Res

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Background: The transversus abdominis plane (TAP) block is a peripheral nerve block, utilized to anesthetize the sensory nerves by local anesthetic injection in the neurovascular plane. Magnesium sulfate can prevent the induction of central sensitization from peripheral nociceptive stimuli at the spinal action site by blocking N-methyl-Daspartate (NMDA) receptors. The aim of our study is to compare the effect of preoperative single-dose of Magnesium sulfate versus preoperative ultrasound guided bilateral transversus abdominis plane block on hemodynamics, and postoperative analgesia in patients undergoing colorectal surgical operations.

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“…Recent randomized controlled studies (2011 ~ current) on the analgesic effect of single-shot TAP block after laparoscopic lower abdominal surgery are shown (Table 3) 7-10, [12][13][14][15][16][17][18][19] . Although a meta-analysis including these investigations suggested that TAP block reduces perioperative opioid consumption 20 , NRS was decreased in only 4 of those 12 studies.…”

Section: Discussionmentioning

confidence: 99%

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

Taninishi

Matsusaki

Morimatsu

2020

Sci Rep

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Analgesic effect of transversus abdominis plane block (TAP block) in lower major abdominal laparoscopic surgery with about 5 cm of maximum surgical scar has been controversial. We hypothesized that TAP block has benefits, so the analgesic effect of TAP block after robot-assisted laparoscopic prostatectomy (RALP) was evaluated. One hundred patients were enrolled in this prospective, double-blinded, randomized study. Standardized general anesthesia with wound infiltration on camera port and fentanyl dose limit of 3 µg/kg was provided. Ultrasound-guided, singleshot subcostal TAP block with either 0.375% ropivacaine (Ropivacaine group, 48 patients) or normal saline (Control group, 52 patients) was performed by anesthesiologist in charge (34 anesthesiologists) after surgical procedure. Pain score using numerical rating scale (NRS) and postoperative intravenous fentanyl were evaluated for the first 24 postoperative hours. Median values (interquartile range) of NRS scores when the patients were transferred to post-anesthesia care unit (PACU) were 5 (2-7) in Ropivacaine group and 6 (4-8) in Control group at rest (P = 0.03), 5 (2-8) in Ropivacaine group and 7 (5-8) in Control group during movement (P < 0.01). These significant differences disappeared at the time of discharging PACU. Fentanyl doses for the first 24 postoperative hours were 210 µg (120-360) in Ropivacaine group and 200 µg (120-370) in Control group (P = 0.79). These results indicated that subcostal tAp block by anesthesiologists of varied level of training reduced postoperative pain immediate after RALP. TAP block had fundamental analgesic effect, but this benefit was too small to reduce postoperative 24-hour fentanyl consumption.In the past few decades, lower abdominal major surgical procedures such as colectomy, hysterectomy and prostatectomy have changed from laparotomy to laparoscopic methods. Although epidural anesthesia has been used as gold standard in laparotomy, smaller surgical scar in laparoscopic procedures and early recovery after surgery motivated us to consider peripheral nerve blocks instead of epidural anesthesia 1,2 .Transversus abdominis plane block (TAP block), first reported in 2001 3 , has recently been spreading as an alternative to epidural anesthesia. Analgesic effect of TAP block has been established in laparoscopic cholecystectomy 4-6 . Although enhanced recovery after surgery (ERAS) protocol in elective colorectal surgery recommended abdominal wall blocks because of postoperative less opioid use and early recovery2,decrease in pain score by TAP block in lower major abdominal laparoscopic procedures remains controversial 7-10 . One of reasons for this controversy is these major procedures require a larger port scar in order to extract resected organs. Furthermore, there are several technical biases affecting TAP block efficacy such as approach options, timing of TAP block (preoperative or postoperative), local anesthetic concentration and dose, and supplementary analgesics. It is necessary to minimize these biases when evaluating ...

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Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Laparoscopic Hysterectomy: A Randomized, Controlled, Observer-Blinded Trial

Abstract: TAP block did not reduce morphine consumption during the first postoperative 24 hours after elective total laparoscopic hysterectomy.

Cited by 42 publications

References 15 publications

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

The Effect of a Preoperative Single Dose of Magnesium Sulfate versus Preoperative Ultrasound Guided Bilateral Transversus Abdominis Plane Block on Hemodynamics and Postoperative Analgesic Requirements in Patients Undergoing Colorectal Surgery

Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial

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