Evaluation of postoperative analgesic efficacy of transversus abdominis plane block after abdominal surgery: A comparative study

Abstract

Background:The transversus abdominis plane (TAP) block is an effective method of providing postoperative analgesia in patients undergoing midline abdominal wall incisions, by blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 48 postoperative hours after abdominal surgery, in a randomized, controlled single-blind clinical trial.Materials and Methods:Sixty patients (mean age 36.2 ± 9.6 years) of either sex of ASA grade 1 and 2 who underwent major gynecological or surgical operation were randomized either to receive standard care, including patient-controlled tramadol analgesia (n = 30), or to undergo TAP block (n = 30) in addition to standard care. After completion of surgery, 20 ml of 0.375% levobupivacaine was deposited into the transversus abdominis neurofascial plane via the bilateral lumbar triangles of Petit. Each patient was assessed in the postanesthesia care unit and at 2, 4, 6, 12, 24, and 48 h postoperatively.Results:The TAP block reduced Visual Analog Scale pain scores at most (2, 4, 6, 12, 24 h), but not at all time (36, 48 h) points assessed. Patients undergoing TAP block had reduced tramadol requirement in 24 h (210.05 ± 20.5 vs. 320.05 ± 10.6; P < 0.01) and 48 h (508.25 ± 20.6 vs. 550.25 ± 20.6; P < 0.01), and a longer time to the first PCA tramadol request (in minutes), compared to the control group (178.5 ± 45.6 vs. 23.5 ± 3.8; P < 0.001).Conclusion:The TAP block provided highly effective postoperative analgesia in the first 24 postoperative hours after major abdominal surgery, and no complications due to the TAP block were detected.

Comparison of Transversus Abdominis Plane Block and IV Patient-Controlled Analgesia after Lower Abdominal Surgery

“…Effective postoperative pain treatment reduces surgical stress and plays a direct role in morbidity (6). Furthermore, prevention of respiratory depression due to early patient mobilization and pain affects postoperative respiratory functions positively.…”

“…Sharma et al(6) compared the analgesic effects of tramadol PCA and TAP block performed in addition to PCA, and they revealed that VAS values were lower in patients undergoing TAP block than in patients not undergoing TAP block.…”

Epidural analgesia in laparoscopic radical prostatectomy

“…To clarify these data, comparative studies between the epidural technique and new anesthetic techniques would be necessary, which is what we are currently undertaking. For example, several studies supporting TAP block as an analgesic technique in colorectal surgery have been published (30,31). Our study has some limitations.…”

“…Other complications include urinary retention (28) or direct spinal cord injuries. For this reason, several studies advocate for other analgesic techniques (30,31).…”

Bloqueo laparoscópico subcostal del plano transverso abdominal (TAP) como analgesia multimodal postquirúrgica en pacientes con patología biliar

“…Al ser un anestésico local de vida media, su inicio de acción una es de 30 minutos luego de ser colocada, presenta una vida media de 5 a 10 horas, razones por la cuales posee mayor tiempo de latencia y duración terapéutica mayor 17. La concentración mínima para obtener un efecto de bloqueo nervioso periférico es de 0,25%, sin embargo se recomienda una concentración de 0.5% para obtener mayor biodisponibilidad y efecto terapéutico 18 . Al colocarse la bupivacaína en el plano transverso del abdomen provee de anestesia a la piel, tejido celular subcutáneo músculo y peritoneo parietal, anatómicamente este se caracteriza por ser una zona pobremente vascularizada lo cual permite que la absorción del anestésico local sea más lenta, prolongando su efecto farmacológico y bloqueo nervioso sensitivo más prolongado en los nervios intercostales torácicos y primer lumbar 19 .…”