Subcostal Transversus Abdominis Plane Block Under Ultrasound Guidance

Hebbard, Peter

doi:10.1213/ane.0b013e318161a88f

Cited by 264 publications

(220 citation statements)

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“…Since Rafi's classic description, 1 a growing number of studies appeared in the literature showing different new techniques to perform the TAP block (e.g., oblique subcostal approach). 68 As suggested in some cadaveric studies, 2-4 the spread of local anesthetic is influenced by the approach used. Moreover, a 2013 systematic review and meta-analysis 69 showed that the posterior TAP block technique determined a greater reduction in opioid consumption and in rest and dynamic pain scores compared with the lateral approaches.…”

Section: Discussionmentioning

confidence: 98%

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

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

131

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Purpose The transversus abdominal plane (TAP) block has been described as an effective pain control technique after abdominal surgery. We performed a systematic review and meta-analysis of randomized-controlled trials (RCTs) to account for the increasing number of TAP block studies appearing in the literature. The primary outcome we examined was the effect of TAP block on the postoperative pain score at six, 12, and 24 hr. The secondary outcome was 24-hr morphine consumption. Source We searched the United States National Library of Medicine database, the Excerpta Medica database, and the Cochrane Central Register of Controlled Clinical Studies and identified RCTs focusing on the analgesic efficacy of TAP block compared with a control group [i.e., placebo, epidural analgesia, intrathecal morphine (ITM), and ilioinguinal nerve block after abdominal surgery]. Meta-analyses were performed on postoperative pain scores at rest at six, 12, and 24 hr (visual analogue scale, 0-10) and on 24-hr opioid consumption. Principal findings In the 51 trials identified, compared with placebo, TAP block reduced the VAS for pain at six hours by 1.4 (95% confidence interval [CI], -1.9 to -0.8; P\0.001), at 12 hr by 2.0 (95% CI, -2.7 to -1.4; P\0.001), and at 24 hr by 1.2 (95% CI, -1.6 to -0.8; P \ 0.001). Similarly, compared with placebo, TAP block reduced morphine consumption at 24 hr after surgery (mean difference, -14.7 mg; 95% CI, -18.4 to -11.0; P \0.001). We observed this reduction in pain scores and morphine consumption in the TAP block group after gynecological surgery, appendectomy, inguinal surgery, bariatric surgery, and urological surgery. Nevertheless, separate analysis of the studies comparing ITM with TAP block revealed that ITM seemed to have a greater analgesic efficacy. Conclusions The TAP block can play an important role in the management of pain after abdominal surgery by reducing both pain scores and 24-hr morphine consumption. It may have particular utility when neuraxial techniques or opioids are contraindicated. RésuméObjectif Le bloc dans le plan du muscle transverse de l'abdomen (ou TAP bloc) a été décrit comme une technique efficace de contrô le de la douleur après une chirurgie abdominale. Nous avons réalisé une revue systématique et une méta-analyse des études randomisées contrô lées (ERC) pour faire un état des lieux du nombre croissant d'études

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Section: Discussionmentioning

confidence: 98%

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

Brogi

Kazan

Cyr

et al. 2016

Can J Anesth/J Can Anesth

131

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“…In our study, TAB block prolonged the Time to the first postoperative using of analgesic drugs (112 min vs. 23 min). McDonnell et al, [15] recorded that, TAP block with 0.5% lignocaine in patient undergoing cesarean section produced effective post-operative analgesia and prolonged the Time to the first postoperative using of analgesic drugs for 4-6 h. A single-shot TAP block technique produces effective analgesia and Reduce postoperative analgesic requirements up to 24 hours. The reasons for the prolonged duration of analgesic effect after single-shot TAP block may related to relatively poorly vascularized this area of block so drug clearance may be delayed and may be due to prolonged action of the amide local anesthetic drug (bupivacaine).…”

Section: Discussionmentioning

confidence: 99%

“…[12] The blind technique was difficult and may carries potential risk of possible visceral injury, [13] so TAB block was done with ultrasound guidance To minimize these complication. [14][15] The aim of this study were to assess the effect of TAB block on intraoperative, postoperative opioid requirements and postoperative pain scores in the first 24 hours in patients undergoing total abdominal hysterectomy(TAH).…”

Section: Introductionmentioning

confidence: 99%

Analgesic Efficacy of Ultra-Sound Guided Transversus Abdominis Plane (Tap) Block With Total Abdominal Hysterectomy

Gawad

Emara

Hameed

et al. 2017

Zagazig University Medical Journal

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Background: Pre-incisional bilateral Ultra-sound guided transverses abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents for postoperative analgesia. The aim of this study is, assess the effectiveness of Ultra-sound guided TAP block on requirement of intraoperative fentanyl and post-operative analgesia in patients undergoing total abdominal hysterectomy. Subjects and Methods: Eighty patients ASA physical status I and II, were randomly allocated into two groups (40 patients each), group TAP: received bilateral Ultra-sound guided TAP block with 20ml bupivacaine 0.25% in each side and group GA: received Ultra-sound guided TAP with same volume of normal saline. both groups given standardized GA. Intra-operative fentanyl requirements and postoperative pain using visual analogue score (VAS) at 30 min.1, 2, 3, 6, 12 and 24 h post-operatively were assessed and if VAS ≥3, patients received i.v. pethidine as a rescue analgesic and time to first request of analgesia was recorded. Results: Intra-operative fentanyl requirement reduced in TAP group compared to GA group; it was 100.4±21.6 and150.3±24.3 mcg respectively. Time to the first analgesic request was also reduced in TAP group compared to GA group; it was112.5±5.4 min.vs.23.4 ± 2.3 min respectively. VAS at most post-operative measurement points and pethidine requirement were reduced in TAP group compared to GA group; (41.7 and 92.3 mg respectively).There were no recorded complications attributed to the TAP block procedure. All TAP group patients were highly satisfied with their postoperative analgesic regimen. Conclusion: TAP block provides effective intra and postoperative analgesia, prolongs time to the first analgesic request and reduces total intra and postoperative analgesic consumption with minimal PONV after total abdominal hysterectomy.

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“…Daugumoje aprašomų literatūros atvejų teigiama, jog pasiekiamas L1-L5 dermatomų blokados aukštis, todėl šis anestezijos metodas tinkamas naudoti vidurinio pilvo aukšto chirurginėms operacijoms [21,22]. Kiti tyrėjai nustatė, kad blokada patikimai nepakyla virš bambos, todėl labiau tinka tik apatinės pilvo chirurgijos operacijoms [23,24]. McDonnell ir Laffey teigia, jog blokados aukščio vertinimas netrukus po blokados atlikimo yra netikslingas, kadangi pilnas blokados aukštis buvo pasiektas po keleto valandų po TAP blokados atlikimo [21].…”

Section: Tyrimo Objektas Ir Metodikaunclassified

Ttransversus abdominis plane (TAP) blokada

Ragaišis¹,

Jucevičiūtė²,

Tamošuitis³

et al. 2014

Sveikatos Mokslai

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Raktažodžiai: TAP blokada, pooperacinis nuskausminimas, anestezijos metodai, regioninė anestezija. SantraukaTAP blokada tampa vis svarbesne multimodalinio nuskausminimo dalimi. TAP blokados panaudojimas užtikrina efektyvią analgeziją ir sumažina morfino poreikį pooperaciniam skausmui malšinti po retropubinės prostatektomijos operacijų, kolorektalinės chirurgijos operacijų, cezario pjūvio, histerektomijos, laparoskopinių apendektomijų bei kirkšni-nių išvaržų plastikos operacijų. Tai nebrangus, paprastas ir efektyvus būdas su retomis komplikacijomis ir beveik neturintis kontraindikacijų. Ultragarso pagalba galima ženkliai padidinti blokados atlikimo patikimumą ir išvengti retų specifinių komplikacijų. TAP blokada pasitvirtino kaip konkurencinga alternatyva auksiniam standartui, epidūrinei analgezijai. ĮvadasGera pooperacinio skausmo kontrolė yra vienas svarbiausių momentų pooperacinėje paciento priežiūroje [1]. Tačiau 30 -80 proc. pacientų po operacijos skundžiasi vidutiniu arba stipriu pooperaciniu skausmu [2]. Pooperacinis skausmas bei pooperacinis virškinimo trakto funkcijos sutrikimas yra pagrindiniai faktoriai, kurie sukelia diskomfortą pacientui pooperaciniu laikotarpiu bei lemia ilgesnį hospitalizacijos laiką [3]. Opiatai tebėra pagrindiniai sistemiškai vartojami pooperacinio nuskausminimo vaistai. Taikant multimodalinį skausmo malšinimo gydymą, analgetinis jų efektyvumas gali būti sustiprintas, o šalutiniai reiškiniai sumažinti. Nustatyta, kad skiriant nesteroidinius vaistus nuo uždegimo kartu su opiatais sustiprėja analgezinis poveikis, geras nuskausminimas pasiekiamas skiriant mažesnes abiejų preparatų dozes nei reikėtų monoanalgezijos atveju bei sutinkami retesni šalutiniai poveikiai [4]. Opioidiniai analgetikai išlieka pagrindinis tiek perioperacinio, tiek pooperacinio skausmo malšinimo ramstis, tačiau sukelia nemažai reikšmingų šalutinių reiškinių: paciento slopinimą, pykinimą, vėmimą, šlapimo susilaikymą, kvė-pavimo funkcijos slopinimą bei žarnų peristaltikos slopinimą, paailgina pooperacinį žarnyno nepraeinamumą [5,6]. Kai kurie autoriai jau daugelį metų pateikia duomenų apie pooperacinio nuskausminimo neefektyvumą [7][8][9]. Neefektyvios pooperacinio nuskausminimo priežastys: skirtingi administracijos ir med. personalo požiūriai į skausmo gydymą ("skausmas -tai natūralu"), žinių apie skausmo gydymą trūkumas, organizaciniai trūkumai (ūminio skausmo tarnybų nebuvimas).Epiduralinė anestezija laikoma auksiniu standartu pooperaciniam skausmo malšininui po kolorektalinės chirurgijos operacijų, [10] tačiau jos atlikimo technika yra pakankamai sudėtinga, reikalaujanti priežiūros pooperaciniu laikotarpiu bei turi gana didelį komplikacijų dažnį [11]. Jeigu epiduralinė anestezija kontraindikuotina arba nepavyksta jos atlikti, pilnavertei pooperacinei analgezijai pasiekti skiriamos didelės opioidų dozės, kas sukelia nepageidaujamų šalutinių reakcijų. Noras rasti alternatyvų anestezijos būdą, kurį galima taikyti beveik visiems pacientams, siekiant kuo mažiau invazyvumo bei visiškai sumažinantį grėsmingų komplik...

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Subcostal Transversus Abdominis Plane Block Under Ultrasound Guidance

Cited by 264 publications

References 1 publication

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

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

Analgesic Efficacy of Ultra-Sound Guided Transversus Abdominis Plane (Tap) Block With Total Abdominal Hysterectomy

Ttransversus abdominis plane (TAP) blokada

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