Unilateral Ultrasound-Guided Transversus Abdominis Plane Block After Nephrectomy; Postoperative Pain and Use of Opioids

Abstract

BackgroundPain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression.ObjectivesThe current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound.Patients and MethodsRetrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression.ResultsMean surgical time was 162 minutes in group A and 92 minutes in group B (P < 0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P = 0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P = 0.58); while the means of sufentanil use were 9.8 μg and 6.0 μg in groups A and B, respectively (P = 0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P = 0.001) and sufentanil use (+6.2 μg [95% CI, 2.3 - 10.2], P = 0.003). There was no difference in morphine use on multivariate analysis (P = 0.99).ConclusionsTAP-block in conjunction with laparoscopic nephrectomy did not reduce pain or opioid consumption. On the contrary, it seemed to prolong surgical time.

Combined subcostal and posterior transversus abdominis plane block for postoperative pain relief after abdominoplasty

“…On the other side, Azawietal (2016) found that local anesthetic wound in ltration was superior to the TAP block concerning postoperative analgesia after laparoscopic nephrectomy [20]. J. Kessler, also found that TAP block did not improve postoperative quality of recovery (QoR-40) for patients undergoing total laparoscopic hysterectomy [21].…”

Post-operative bilateral continuous ultrasound-guided transversus abdominis plane block versus continuous local anaesthetic wound infusion in patients undergoing abdominoplasty

“…The analgesic effect of TAP block has been compared with placebo or local anaesthetic wound infiltration in various surgeries such as cesarean deliveries, open gynecologic procedures, nephrectomy, and inguinal hernia repair. [ 12 13 14 15 16 ] Analgesia achieved through local anaesthetic infiltration of the subcutaneous or subfascial planes of the wound has different mechanisms of action including simple local anaesthesia, anti-inflammatory effect, and systemic absorption of the local anaesthetic. [ 17 18 ]…”

To Compare the Postoperative Analgesic Efficacy of Levobupivacaine and Ropivacaine Using Transversus Abdominis Plane Block in Patients Undergoing Inguinal Hernia Surgeries

“…The results of our study are consistent with the findings of other studies. 18,[23][24][25][26][27] The haemodynamic parameters remained stable perioperatively with both drugs used in TAP block. The results are in accordance with other studies.…”