Analgesic effects of ultrasound-guided transverse abdominis plane block using different volumes and concentrations of local analgesics after laparoscopic cholecystectomy

Abstract

ObjectiveTo evaluate the effects of an ultrasound-guided transverse abdominis plane (US-TAP) block used for postoperative pain relief by comparing the efficacy of two different volumes/concentrations of the local anaesthetic bupivacaine in patients undergoing laparoscopic cholecystectomies.MethodsThis randomized study enrolled patients undergoing laparoscopic cholecystectomies. They were randomized to two groups: group A received a 20 ml US-TAP block (50 mg bupivacaine +10 ml saline solution) and group B received a 30 ml US-TAP block (50 mg bupivacaine + 20 ml saline solution). The intraoperative consumption of remifentanil, the requirement for postoperative rescue analgesics, patient satisfaction scores, postoperative complications, and postoperative pain as measured by a visual analogue scale at 20 min, 12 h, and 24 h were recorded.ResultsA total of 60 patients enrolled in the study. There were no differences between the two groups with respect to demographic characteristics, duration of anaesthesia and patient satisfaction scores. The intraoperative consumption of remifentanil, postoperative VAS scores (20 min, 12 h and 24 h) and the requirement for postoperative analgesics were all significantly lower in group B who received a larger volume but a lower concentration of local anaesthetic solution compared with group A.ConclusionA US-TAP block can form part of a balanced postoperative analgesic regimen following laparoscopic cholecystectomy.

Postoperative analgesic efficacy of ketamine added to bupivacaine in ultrasound guided transversus abdominis plane block for laparoscopic cholecystectomy

“…Considering our literature review, it can be stated that researchers generally apply unilateral TAP block for adult patients using 15-30 ml local anesthetic agents in varying concentrations [10][11][12][13]. Bupivacaine, ropivacaine, and levobupivacaine are usually preferred local anesthetic agents for TAP block [1,14].…”

Comparison between Post-Operative Analgesic Efficacy of Low-Concentration High-Volume and High-Concentration Low-Volume Combinations of Ropivacaine for Transverse Abdominis Plane Block in Pediatric Open Inguinal Hernia Repair

“…Similar results were reported with TAP block for an adult patient who underwent laparoscopic cholecystectomy. TAP block with a large volume and low concentration of bupivacaine was associated with smaller intra-operative requirement of remifentanil, less post-operative pain (at 20 min, 12 h, and 24 h after the procedure), and reduced requirement for post-operative analgesics [14]. However, in interscalene brachial plexus block for arthroscopic shoulder surgery in adults, a high concentration and lower volume of ropivacaine provided a faster onset of analgesia, although post-operative analgesic effects did not improve [15].…”

Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy?

“…While the probe was in the oblique subcostal position, the peripheral block needle (Braun, Ultra360, 100 mm, Germany) was advanced from the medial to the inferolateral area of the probe along the fascia of the transversus abdominis muscle and the internal oblique muscle, and the block area was confirmed through the infiltration of 1-2 ml of a physiological serum solution to create a hypoechoic and biconvex appearance, as mentioned in [ 11 ]. Patients in the unilateral block group received 20 ml of 0.25% bupivacaine on the right side of the abdomen as given in Sahin et al [ 12 ], whereas the patients in the bilateral block group received a total of 40 (20 + 20) ml of 0.25% bupivacaine at both sides of the abdomen. Performing unilateral TAP block would both save time and could reduce consumption of local anesthetic.…”