Comparison of the analgesic effect between continuous wound infiltration and single-injection transversus abdominis plane block after gynecologic laparotomy

Abstract

CWI reduced pain on coughing after the day of surgery compared with single-injection TAP block when performed as part of multimodal analgesia in patients undergoing gynecologic laparotomy.

Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials

“…Similarly, the differences among the patients (e.g., age, comorbidities) and interventions (e.g., type of block, timing, postoperative analgesia) may have played an important role in increasing heterogeneity. Both single-injection and continuous TAP blocks provide postoperative analgesia; however, 67 the two techniques may have had a different impact on the postoperative VAS score. Transversus abdominal plane block is an operator-dependent procedure that can be performed following different approaches.…”

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

“…As regards the first macro-area (laparotomy), all the analyzed studies agree in demonstrating the superiority of CWI compared to single-shot nerve blocks or placebo in ensuring better pain relief, lower opioid consumption, lower opioid-related side effects; enhancing, at the same time, the postoperative recovery. [21][22][23][24][25][26][27] Unfortunately, the same conclusions cannot be drawn when CWI is compared to epidural analgesia (EA). In this field there is a high heterogeneity and, while some RCTs have shown a better or similar analgesic effect of CWI when compared to EA, [28][29][30][31][32][33][34][35] others have claimed exactly the opposite; [36][37][38] often in the face of a higher incidence of side effects (ie, treatment failure, vasopressor requirement, prolonged recovery time) and higher costs.…”

Efficacy of Modified Thoracoabdominal Nerves Block Through Perichondrial Approach in Open Gynecological Surgery: A Prospective Observational Study and a Cadaveric Evaluation

“…NRS: Numerical rating scale NRS scores at rest were 5 (range: 2-6.5), 0.5 (range: 0-2), and 1 (range: 0-2) at 2, 24, and 48 h postoperatively, respectively. NRS scores on movement were 3 (3-5.5) and 3.5 (3)(4)(5) at 24 and 48 h postoperatively, respectively. NRS scores on movement at 2 h postoperatively were not available; the patients hardly moved within 2 h postoperatively.…”

“…The median numbers (interquartile range) of anesthetized dermatomes at 2 and 24 h postoperatively were 6 (5-7) and 6.5 (5)(6)(7) in the anterior cutaneous branch area and 5 (4-7) and 7 (5)(6)(7) in the lateral cutaneous branch area, respectively. There was an 85% chance of simultaneously acquiring analgesia in areas innervated by Th8-Th11, including complete block in areas innervated by the anterior cutaneous branches of Th9-10.…”

“…However, there are concerns that the effect time of a single shot is short and that the local anesthetic dose per site is inevitably reduced by multiple punctures. The effectiveness of continuous wound in ltration (CWI) through multiple-ori ce catheters has also been reported, [4,5] but the expected even distribution of local anesthetic solution through each pore may not be guaranteed. [6] Thoracoabdominal nerves block through perichondrial approach (TAPA) was described in 2019 by Tulgar as a peripheral nerve block that provides effective analgesia between Th5 and Th12.…”