Combined subcostal and posterior transversus abdominis plane block for postoperative pain relief after abdominoplasty

Abstract

Background: Abdominoplasty is a common aesthetic surgery. Adequate pain management during the postoperative period is of great importance. Previous studies have failed to achieve safe and reliable effective analgesic techniques beyond the recovery room. This research aims to investigate the outcome of the abdominoplasty operation for the patients' received transversus abdominis plan block in comparison with the non-blocked patients.Methods: 58 patients, undergoing elective abdominoplasty, received general anesthesia. Patients were randomly assigned to two equal groups of 29 patients each. Combined subcostal and posterior transversus abdominis plane block group and non-blocked group. For both groups, the standard postoperative analgesic regimen consisted of IV Paracetamol 1 g every 6 hours. Values of visual analog scale values were recorded postoperatively, once the patient had a visual analog scale ≥ 4, IV opioids administered and visual analog scale recorded every 30 min till pain improved. The primary outcome was opioids consumption in the first 72 hours postoperatively, the secondary outcome was the value of visual analog scale at rest and movement (or with knee flexion) in the first 72 hours postoperatively, time to first ambulation, time to first incentive spirometer 900 ml/min were recorded and also the incidence of postoperatively mechanical ventilatory support (CPAP) requirements.Results: Morphine consumption in the first 72 hours was 6.97±1.97 in the non-blocked group and 4.38±2.04 in the blocked group (p < 0.05). Pethidine consumption in the first 72 hours was 208.62±85.64 in the non-blocked group and 20.69±25.06 in the blocked group (p < 0.05). VAS was lower in the blocked group during the first 72 hours were (p < 0.05). Time to first ambulation was 12.41±5.04 hours in the non-blocked group and 4.62±1.08 hours in the blocked group (p < 0.05), time to first incentive spirometer 900 ml/min was 11.45±5.05 hours in the non-blocked group and 4.27±1.09 hours in the blocked group (p < 0.05).Conclusion: Combined subcostal and posterior transversus abdominis plane block is a promising regional anesthetic technique for postoperative pain relief in abdominoplasty surgery, it offers a longer postoperative analgesic effect duration and fewer analgesic requirements with less postoperative complications.