Transversus abdominis Plane Block for Improved Early Postoperative Pain Management after Periacetabular Osteotomy: A Randomized Clinical Trial

Abstract

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18–43, SD ± 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg ± 2.8 vs. 10.8 mg ± 5.6, p < 0.0001), 24 (18.4 ± 16.2 vs. 30.8 ± 16.4, p = 0.01) and 48 h (29.1 mg ± 30.7 vs. 54.7 ± 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

Transversus Abdominis Plane Block Reduces Intraoperative Opioid Consumption in Patients Undergoing Periacetabular Osteotomy

“…A TAPb reliably anaesthetizes the PAO surgical field, including the incision site, iliac crest, and groin [ 6 ]. Improved postoperative pain management and lower opioid consumption have been previously shown [ 4 , 22 ]. This fact, and the findings of this study, support our perception that surgeries of the hip and of the lower abdominal region are among the best indications for TAPb [ 21 ].…”

“…ilioinguinalis, iliohypogastricus, and spinal nerves in the plane between the internal oblique and transversus abdominis muscles (IOAM and TAM, respectively) using local anesthetics (LA), providing anesthesia of the anterolateral abdominal wall [ 1 ]. TAPb is a long-established locoregional procedure for anesthesia in abdominal and retroperitoneal surgery, and more recently, it has been used in orthopedic surgery [ 2 , 3 , 4 , 5 , 6 ].…”

Transabdominal Plane Block for Postoperative Pain Management: A Case Series

“…7 TAP block provides an analgesic effect on the abdominal wall, so it is recommended for post-abdominal pain management. 9 TAP block is a simple procedure with moderate difficulty and less risk when compared to epidural analgesia techniques. TAP block can be done unilaterally in cases of surgery on one side of the abdomen, such as appendectomy, herniorrhaphy in cases of lateral inguinal hernia, cholecystectomy.…”

The Scientific Evolution of Periacetabular Osteotomy: A Global Review

“…In the era of digitalization, augmented reality will assist in performing bony cuts and act as an aid for some of the blind ischial and retro-acetabular cuts [ 44 ]. Innovations in perioperative management will enhance recovery after the procedure and allow for early recovery programs with optimized protocols of pain management [ 45 , 46 ]. Altogether, it seems that the future of this procedure is yet to come.…”