Efficacy of transversus abdominis plane block in patients undergoing emergency laparotomies

Parasa, Mrunalini; Raju, NVijaya Rama; Nath, VemuriNagendra; Saheb, ShaikMastan

doi:10.4103/0259-1162.143153

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…48,49 A small RCT in emergency laparotomy found that transversus abdominus plane blocks lowered pain scores and postoperative need for rescue analgesia compared with placebo. 50 Findings are consistent with earlier MAs, which demonstrated benefits from truncal nerve blocks in open and laparoscopic elective abdominal operations. 51,52 Summary and recommendations Epidural analgesia and truncal regional blocks are potentially beneficial for emergency major abdominal operations and should be considered in the appropriate clinical setting.…”

Section: Evidencesupporting

confidence: 85%

Technical Evidence Review for Emergency Major Abdominal Operation Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Grant

Hornor

et al. 2020

Journal of the American College of Surgeons

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Enhanced recovery pathways (ERPs), initially developed more than 2 decades ago for colorectal operations, have been shown to improve patient outcomes for many elective procedures. 1-4 They apply standardized, evidencebased, and multidisciplinary approaches to reduce surgical stress and modify physiologic responses. 5-9 As these pathways evolve, it is evident that the key principles, including multimodal analgesia, early mobilization, patient and family engagement, and best practices for preventable harms, can benefit surgical patients broadly, including those undergoing emergency operations. Emergency general surgery (EGS) represents a growing public health burden in the US, with more than 3 million patients admitted annually for these conditions and nearly 30% requiring operation. 10 EGS patients are complex; 35% are older than 70 years and 50% have at least 1 medical comorbidity and are at higher risk for morbidity (15%) and mortality (1.2%). 10,11 Rates are even higher for complex emergency procedures, including 46.9% morbidity for bowel resections and 23.8% mortality for laparotomies. 11 Quality improvement work in EGS is challenging, limited by the urgent nature and heterogeneity in disease and patient characteristics. However, given that the success of ERPs lies in reducing perioperative stress through transdisciplinary teamwork and standardization, the benefits of ERPs might be even more pronounced in this high-risk population. The Safety Program for Improving Surgical Care and Recovery (ISCR) is a national ERP initiative implemented in 2017 through a collaboration among AHRQ (funder), American College of Surgeons, and Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. The ISCR program has been implemented across colorectal, orthopaedic, and gynecologic surgery services. Building on the lessons learned from earlier cohorts, the final cohort of the program will expand into EGS and include appendectomy; cholecystectomy; and emergency, nontrauma, and nonvascular major abdominal operations. The objective of this study was to evaluate the evidence for ERPs for emergency major abdominal operations and to provide a framework for developing and implementing ERPs in this patient population. METHODS Seven common EGS procedures, including appendectomy, cholecystectomy, perforated peptic ulcer repair, colectomy, CME questions for this article available at http://jacscme.facs.org

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Section: Evidencesupporting

confidence: 85%

Technical Evidence Review for Emergency Major Abdominal Operation Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Grant

Hornor

et al. 2020

Journal of the American College of Surgeons

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“…They stated that open TAP blocks are safe and reduce postoperative opioid requirements and sedation after liver resection and other surgeries as hemi-colectomies, liver transplant, and emergency laparotomy, respectively. [212223]…”

Section: Discussionmentioning

confidence: 99%

Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection

Eldin¹,

Mahmoud²,

Hassan³

et al. 2014

LRA

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BackgroundCoagulation changes can complicate liver resection, particularly in patients with cirrhosis. The aim of this prospective hospital-based comparative study was to compare the postoperative analgesic efficacy of intravenous fentanyl patient-controlled analgesia (IVPCA) with and without transversus abdominis plane (TAP) block.MethodsFifty patients with Child’s A cirrhosis undergoing liver resection were randomly divided into two groups for postoperative analgesia, ie, an IVPCA group receiving a 10 μg/mL fentanyl bolus of 15 μg with a 10-minute lockout and a maximum hourly dose of 90 μg, and an IVPCA + TAP group that additionally received TAP block (15 mL of 0.375% bupivacaine) on both sides via a posterior approach with ultrasound guidance before skin incision. Postoperatively, bolus injections of bupivacaine 0.375% were given every 8 hours through a TAP catheter inserted by the surgeon in the open space during closure of the inverted L-shaped right subcostal with midline extension (subcostal approach) guided by the visual analog scale score (<3, 5 mL; 3 to <6, 10 mL; 6–10, 15–20 mL) according to weight (maximum 2 mg/kg). The top-up dosage of local anesthetic could be omitted if the patient was not in pain. Coagulation was monitored using standard coagulation tests.ResultsAge, weight, and sex were comparable between the groups (P>0.05). The visual analog scale score was significantly lower at 12, 18, 24, 48, and 72 hours (P<0.01) in IVPCA + TAP group. The Ramsay sedation score was lower only after 72 hours in the IVPCA + TAP group when compared with the IVPCA group (1.57±0.74 versus 2.2±0.41, respectively, P<0.01). Heart rate, systolic blood pressure, and fentanyl consumption were lower in the IVPCA + TAP group at 24, 48, and 72 hours (P<0.05). Intensive care unit stays were significantly shorter with TAP (2.61±0.74 days versus 4.35±0.79 days, P<0.01). Prothrombin time and International Normalized Ratio indicated temporary hypocoagulability in both groups.ConclusionCombining TAP with IVPCA improved postoperative pain management and reduced fentanyl consumption, with a shorter stay in intensive care. TAP block can be included as part of a balanced multimodal postoperative pain regimen.

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“…It is still controversial about whether QL block can be safely performed in the case of coagulopathy or in the anti-coagulated patient [ 33 ]. Some practitioners suggest that plane blocks may be safe with changes in coagulation function [ 34 ]. As warned by the latest evidence-based guidelines for regional anesthesia use in patients receiving antithrombotic or thrombolytic therapy released by the American Society of Regional Anesthesia and Pain Medicine, deep regional anesthesia performed in the anti-coagulant patient may result in significant morbidity that has already been reported in multiple case reports [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery

et al. 2022

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Background Quadratus lumborum block is a truncal block with several technique variations. It has been reported as providing effective analgesia for postoperative pain. The aim of this study is to determine the efficacy of the QL block in providing postoperative analgesia for hip surgery when compared with placebo or no block or other analgesic techniques. Methods Randomized trials evaluating quadratus lumborum block benefits in elective hip surgery were sought. The primary outcome was the 24 h opioid requirement after surgery. Two independent reviewers selected the studies and extracted the data. Results Thirteen randomized-controlled trials were included in this study. The included studies had significant heterogeneity regarding comparator groups; therefore, a limited quantitative analysis was undertaken for the comparison of QL block versus no block or placebo only. QL block reduced the opioid use by 15.78 (95% CI, 2.31 to 29.26) mg IME in the first postoperative 24 h compared with no block or placebo with no difference in static pain scores, pain grade was reduced by 2.95 (95% CI, 2.40 to 3.60) in the QL block group compared with placebo or no block in the first postoperative 24 h during movement. Conclusions Our meta-analysis indicates that QL block may be effective for analgesia in patients after hip surgery compared with placebo or no block. There is currently limited evidence comparing QL block with other analgesic techniques for hip surgery.

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Efficacy of transversus abdominis plane block in patients undergoing emergency laparotomies

Cited by 18 publications

References 27 publications

Technical Evidence Review for Emergency Major Abdominal Operation Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Technical Evidence Review for Emergency Major Abdominal Operation Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

Intravenous patient-controlled fentanyl with and without transversus abdominis plane block in cirrhotic patients post liver resection

Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery

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